Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 2 Forest Street
_ Lot 2 Forest Street North Andover , MA 01845 '(D r E HASTINGS, IAN ik i; f - -...... -. ... �.n ., '�.'.z ....•�ti-}"s�-_� ...-.rte -_ -w. ..:.s' - .:»'�G�---- ..i.� 1 i Date.. . .... ...... ... ..... A i i µpR71y TOWN OF NORTH ANDOVER pf ��ao ,e1ti0 3j '+ ° O PERMIT FOR GAS INSTALLATION �O++no'��•,.ty i �,SSACMUSES This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . ... . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . : . GASINSPECTOR WHITE:Applicant CANARY:Building Dept." PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI MASSACH R TTtNC (Print or Type) NO s NORTH ANDOVER Mass. Date `� C o`Z 3 4uilding Location Permit # *ZZ�' •� 1�©R�1^ �ivOc�y�r� Owners Name H, e• 13 LFAa!( .� a,vh> • - New Renovation U] Replacement Plans Submitted D Cf- FIXTUR!S z N Y W N z cc rn t» v a t- a cc N tr .o N = F W W m W a v m ~ x (a z a ucti a ¢ a o a a z w Z tt] 01 W W O 0. tG W q N N O V x W W 4 a 0 c > to OC W ul 0 a z d z a oc a a w r W o t- x P z W W d 7 LL t- w 1 to z d W < a .-. H y- to o z W o (rt x G1 Q to > C W , = 4 tz a d o o W a W t- £ a z o to to ..t u x > a a t- o SUR—BSIMT. BASEMENT IST FLOOR 2ND FLOOR 3R4 FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TK FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name f1p yo Po LQ 1 Ltj m ,•,n f',ti e-- Ercorp. Address ( k U2'1 rAC- (2-0 Partner. It 6/ZL14 N(I ✓✓A Firm/Co. Business Telephone: 508) Sol/ — a & 5,57 Name of Licensed Plumber or Gas Fitter STE><Fry PUoPo L-0 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property . Owner 17 Agent M 1 hcteby certify chat au or the devils and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that al! plumbing work and installations performed under'Permit iueed for this sppGcalion wiil_be in compliance with ali pertinent provisions of the Massachusetts State Cas Code and Chapter 142 of the Genual Laws. By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plumber or Gasfitter Journeyman 1 p S 7 y APPROVED (OFFICE USE ONLY) License Number BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME& TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GAS INSPECTOR Lot 2 FOREST STREET JS-2004-0770 Proiect Detail Report Printed On:Tue Jun 22,2004 Project Name: GIS#: 6400 Project No: JS-2004-0770 Owner of Record NIAHALATI, SIAVASH Map: 1053 Date Submitted: Feb-11-2004 36 BEAVER BROOK ROAD Block: 0002 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Septic System Work Location: Lot 2 FOREST STREET Zoning: Proposed Use: District: land Use: 132 Proposed Use Detail Subdivision Description Septic Plan Review Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0036 6/15/04-Well Application received back with Pump Test information. (Pump information not filled in.).File. 5/27/04-Well Construction Permit issued to McKinney Well Co. 4/14/04-Plan Approved. Note that Soil Testing was done in May of 2000,September of 2000 and October 2001 per the records in the file. 3/31/04-Plan Rev. I received from NEES. Passed on to Susan Sawyer for Review. 3/12/04-Septic Plan-Denied. 2/11/04-Received application for Septic Plan. Forwarded to Consultant for review.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Plan Review BHP-2004-0337 Apr-15-2004 SIGNED OFF JS-2004-0770 Rev.2 Plan Review BHP-2004-0285 Feb-18-2004 DENIED JS-2004-0770 1st Plan Review Well Construction BHP-2004-0396 May-27-2004 SIGNED OFF JS-2004-0770 Well Drilling / F 4,1nicipal Solutions,Inc. Page 1 of I Town of North Andover ,,oRT„ Office of the Health Department Community Development and Services Division 400 OSGOOD STREET w z^ � x ,r•° North Andover,Massachusetts 01845 �'�'°"•�° <' SS�cMustt Susan Y. Sawyer,RENS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax CE9 ' I FICA�IE Off' COJ�I��GIA�C2 As of: ,dune 30, 2005 This is to cert that the individuafsukurface disposal system Constructed(X) or repaired - By Ben Osgood At .Got 2 aka 1535 Forest Street WorthAndover, 9Y3 01845 Yfas been installed in accordance with the provisions of Title V of the State Sanitary Code and with the,North Andover Board of 9fealth regulations. The Issuance of this certifi'cate shall not 6e construed as a guarantee that the system will function satisfactorily. Susan T Sawyer, REWSIR, Tu61icYlealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC June 10, 2005 Susan Sawyer . RECEIVED North Andover Board of Health 400 Osgood Street JUN 10 2005 North Andover, MA 01845 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Re: Lot 2 Forest Street,North Andover, MA Septic System As-Built Plan Submittal Dear Ms. Sawyer, 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. d611d 2. Copy of Designer's/Installer's Certification Fe Please contact this office with any questions or conce Sincerely, Thomas Hector Project Engineer cc: Homeowner 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System �Qvj constructed; ( )repaired; by &nf' Ml' es-000a, I P �. located at Lo> °2 C �� f rD,_eg ' S+eec sX� t/ Adowr was installed in conformance with the North Andover B and �f Health approved plan, System Design Permit.# ,plan dated—_!2 y o� , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000,Title S 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: /a•7�D /j C v Engineer Representative Final inspection date: /a"dS Engineer Representative Installer: LLic.#: Date: 6 Z olr' s OF R� Engineer: �° ti Date: o o QSC,O -+ �L P. y ��� 165,go,4j b0.45891 fl itJs /STE��� � ANAL E�� TOWN OF NORTH ANDOVER Gt pORTb 4 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 'SSACHUstt Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: Lot 2 Forest Street MAP: 105.13 LOT: 0002 INSTALLER: Ben Osgood DESIGNER: New England Engineering Service PLAN DATE: BOH APPROVAL DATE ON PLAN: DATE OF BED BOTTOM INSPECTION: 10/18/04 DATE OF FINAL CONSTRUCTION INSPECTION: 11/15/04 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 TYPE OF SAS = Infiltrator trenches DIMENSIONS AND DETAILS OF SAS:2 trenches — 9 chambers each SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer p 9 g ❑ h Topograpy appreciably not reciabl altered Comments: Page 1 of 1 TOWN OF NORTH ANDOVERp0R*H , Office of COMMUNITY DEVELOPMENT AND SERVICES `,, •. �O HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged D 1,500 gallon tank has been installed (H-10 monolithic) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) Inlet tee installed, under access port (see comment) ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present 0 Hydraulic cement around inlet & outlet Comments: 11/15/04 - Need to verify watertightness and stone base. Tank not set level (inlet & outlet differ by <1"). Inlet tee at center, but partially under front edge of tank. Must verify outlet tee baffle. D-BOX ❑ Installed on stable stone base ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: Need to verify d-box on stone base. Speed levelers to be provided — no distribution test. Needs hydraulic cement around all pipes. SOIL ABSORPTION SYSTEM D Bottom of SAS excavated down to C soil layer, as provided on plan D Size of SAS excavated as per plan Title 5 sand installed, if specified on plan Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Rear of trench 0.5' higher than front. Must be reset level. Page 2 of 2 TOWN OF NORTH ANDOVER °t N°pT:�M Office of COMMUNITY DEVELOPMENT AND SERVICES "?•? °gip HEALTH DEPARTMENT «i 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 ��SSACHU Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SYSTEM ELEVATIONS Benchmark: 99.70 Rod at Benchmark: 6.26 Height of Instrument: 105.96 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 95.50 100.54 Septic Tank IN 100.25 100.29 Septic Tank OUT 100.00 100.22* Distribution Box IN 99.83 99.83 D-Box OUT Manifold 9965 99.65 Lateral 1 Top 99.83 100.55 Lateral 1 INVERT 9937 99.56 Lateral 1 To (End) 9983 100.03'* Lateral 2 Top 99.83 100.47 Lateral 2 Invert 99.37 99.62 Lateral 2 To end 99.83 1100.08 *Outlet is 0.07' below inlet—tank must be re-set, or outlet dropped. ** Rear of trench is 0.5' lower than front of trench—should be level. Page 3 of 3 Page 1 of 1 Dellechiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Friday, December 03, 2004 9:47 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: inspection Lot 2 Good morning, Lot 2, Forest Street, is set for inspection on Tuesday, Dec 7 at 7:30. thanks, Lisa Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin2.com 12/3/2004 Page l,of 1 I Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, November 18, 2004 4:24 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: Forest Street Lot 2 Folks, Attached please find the construction inspection form for the parcel on Forest Street(the section of Forest Street nearly in Boxford) known as Lot 2. Some problems were identified as shown on the attached report. We are attempting to arrange with Ben Osgood, the licensed installer, for a re-inspection. Dan 'Aill iver, consulting'� 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.mil1riverconsulting.com dano@millriverconsulting.com 11/18/2004 Page 1 of 2 v Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Friday, November 12, 2004 2:32 PM To: mgrant@townofnorthandover.com Cc: Pamela Dellechiaie; Susan Sawyer Subject: RE: Forest Street All set for Monday 11115 at 8:00 a.m. Dan Afill Ruler. -consulting 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 dano@millriverconsulting.com From: Michele Grant [mailto:mgrant@townofnorthandover.com] Sent: Friday, November 12, 2004 10:21 AM To: info@millriverconsulting.com Subject: RE: Forest Street Hi Dan, Pam is off today, did she mention Lot 2, Forest st. needs a final inspection? Thanks Michele -----Original Message----- From: Dan Ottenheimer [mailto:info@millriverconsulting.com] Sent: Friday, November 12, 2004 9:38 AM To: Susan Sawyer; Pamela Dellechiaie; mgrant@townofnorthandover.com Subject: Forest Street Sue, Pam & Michelle, I went to both lots A & C yesterday and found quite the situation. A bit too complex to try put into an e-mail at this hour but suffice it to say that neither site was given the permission to backfill and that further work needs to be done by the contractor before a final inspection can occur by US. As to the neighbors concerns about grading - it does generally appear that the systems are going in as per the design plans. This might not assuage her concern, but in theory a properly designed, built and maintained onsite 11/15/2004 Page 2 of 2 .E� t ' system should not pose a risk to a neighbors property from things like drainage. We'll know more after the final inspection. Dan .Afill River consulting 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 dano@mi-11r.iverconsulting.com millriverconsulting.com 11/15/2004 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Friday, November 26, 2004 1:51 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: inspections Folks, ,r We will bei pecting Forest Street Lot 2 sgood), Forest Street Lots A&C (Henderson)and 70 Oakes Drive (Whyman)onday-mStti'inng— Dan 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 dano@millriverconsulting.com 11/29/2004 Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Thursday, November 18, 2004 4:24 PM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: Forest Street Lot 2 Folks, Attached please find the construction inspection form for the parcel on Forest Street(the section of Forest Street nearly in Boxford) known as Lot 2. Some problems were identified as shown on the attached report. We are attempting to arrange with Ben Osgood, the licensed installer, for a re-inspection. Dan i ',Alill River., ,' consulting 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 dano@millriverconsulti;ig.com 11/18/2004 Page 1 of 2 Dellechiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Friday, December 03, 2004 1:13 PM To: pdellechiaie@townofnorthandover.com Subject: RE: inspection Lot 2 Thanks and no problem at all. I think I've got it all straightened out, but that's yet to be determined. My"I'm new here" excuse is getting a little old! Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com -----Original Message----- From: Pam Dellechiaie [mai Ito:pdellechiaie@townofnorthandover.com] Sent:.Friday, December 03, 2004 10:07 AM To: 'Lisa LeVasseur' Subject: RE: inspection Lot 2 Importance: High Lisa, Sorry for the confusion on the phone the other day. I have been harried lately with all the computer problems, etc. Thanks for keeping it straight. Pamela p.s. —I like your name—that is my middle daughter's name as well. O -----Original Message----- From: Lisa LeVasseur [mailto:lisal@millriverconsulting.com] Sent: Friday, December 03, 2004 9:47 AM To: Susan Sawyer; amcbrearty@millriverconsuIting.com; 'Pamela Dellechiaie' Subject: inspection Lot 2 Good morning, Lot 2, Forest Street, is set for inspection on Tuesday, Dec 7 at 7:30. thanks, Lisa Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 12/3/2004 t Town.of North Andover Health Department Date: 1&111/",-;/ Location: / (Indicate A dress, ' esidential,or Name of Business) Check#: 4/.,. 7?�/ Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ tic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) �- /I r 2 r� Health Agent Initials �. White-Applicant Yellow-Health Pink-Treasurer APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 7 a 4 CURRENT INSTALLER'S LICENSE# LOCATION: o-? �� 2�s i S►re e LICENSED INSTALLER: �� ; vr, C 0 SIGNATURE: 24 TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION,PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $IY,9CFee Attached? Yes � No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: �� INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property (f at �vT �? gcs; s7 —( relative to the application of dated \o l -7 ( (D -1 for plans by N6,Fo&L.,i,un Fv&- and dated r-e P, with revisions dated 3 �6 Zap I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to 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 two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 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 BOH,after which installer calls for inspection time. Instailer.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. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. 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. Undersigned Licensed Septic Installer Date: D Z d N�•*r i(; J`d OF NORTH ANt?t% A/ cf;.rt5 *ti0 80A'�D OF NEALTN� t 11I�I f 5 <� BOARD OF HEALTH ss�`""SE NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMS Permit # 4 ^d , Date ' � � A permit is requested to: drill a well install a pump LOCATION: r Lot # 3� . Rwa Address _v Tel Q r Ic v- M NRLi Well Contrctr Add. P{rt�,� ' , ,�, �_Tel lock l rlG►* L Pump Contrctr. �nn�, ��1�'.t f�l�I,LC dd. . , Tel9n—I WELLS (To be completed at time of pump test. ) Type of well Use Z2 Diameter of well Size of casing � t0 Depth of bed rock �" t Depth casing into bedrock l Seal been tested? Yes O No (_) Date of test Depth of well " Water-bearing rock Depth to water Delivers_ GPM for (how long?) Drawdown feet after pumping hours at 5 _ GPM Date of completion y� Sign ture of well contract ** * �F ** *** * *********************************** PUMPS (To be filled in before installation. ) Name & size of pump — Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (�) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health COMMONWEALTH OF MASSACHUSETTS NUMBER BHP-2004-0396 North Andover FEE Board Of Health $125.00 McKinney Artesian Well & Pump Supply Co., Inc. ------------------------------------------------------------------------------------------------------------- NAME Lot 2 FOREST STREET ------------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires ----------------May 27,2006-----------------unless so o uspended or revoked. ------- ----- ---------- - ---- ---------------------------- Board Of May 27,2004Health - - ----- ----- ------------- ---------------------- ------ ------------- --------- ---- ------- y Massack .ts Department of Environmental Manage it 12 8 3 32 Office of Water Resources TYPE OR PRINTANLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL)r LATITUDE • LONGITUDE Address at Well Location: �--ot t" .'Property Owner: L' �`/' Subdivision Name: tet' Mailing Address: 3 6, DP14 d City/Town: D� 061T a"6 City/Town: 6 Orr1plItA ` �VA' Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if nQ street address available j0 039 Board of Health permit obtained: Yes Not Required ❑ Permit Number ate' Date Issued 5`a2t5? 2. WORK PERFORMED 3 PROPOSED USE 4. DRILLINGMETHOD New Well ❑ Abandon Domestic El Irrigation ❑ Cable ❑ Auger ❑ Deepen [--1ReconditionMonitoring ❑ Municipal f Air Hammer ❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other XMud Rotary ❑ Other 5. WELL LOG it Unconsolidated Consolidated 6.SITE SKETCH (use Permanent landmarks with distances) Permeability T y m c > a From (ft) To (ft) High Low `� m Other Rock Type Pf1VXhAv 49 D � f S 7.WELL CONSTRUCTION 8 CASING Total Depth Drilled From (ft) To (ft) Casing Type and Material Size 0 . (in) Well Seal Type Date Drilling C mplete p` � 9.SCREEN From (ft) To (ft) Slot Size f Screen Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT'-MATERIAL 11. ADDITIONAL WELL INFORMATION Developed? ❑ Yes No From (ft) To (ft) Material Description Purpose Fracture Enhancement? ❑ Yes. . No 1 G Method Disinfected? Yes ❑ No 12.WELL TEST DATA(PRODUCTION WELLS) 13.STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs& min) (Ft. BGS) (hrs&min) (R. BGS) Date Measured Ground Surface (FT) 14. PERMANENT PUMP(IF AVAILABLE) 15.NAME/ADDRESS OF PUMP INSTALLATION COMPANY Pump Description Horsepower Pump Intake Depth (ft) Nominal Pump Capacity (gpm) 16. COMMENTS I Wt of WLAO 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules // and regulations, and this PZZZ'6i��5-7!o lete and correct to the best of my knowledge. Driller: lst Supervising Driller Signature: egistration #: 0 v Firm: LL. Gd Date: Rig Permit#: NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion. i BOARD OF HEALTH COPY � s TOWN OF NORTH ANDOVER of NORTH q Office of COMMUNITY DEVELOPMENT AND SERVICES �tY4`° e..;o . e.,. O HEALTH DEPARTMENT ` ^ *M1O 27 CHARLES STREET �9g7gATeo^*^,� NORTH ANDOVER,MASSACHUSETTS 01.845 �SSACNUsti� 978.688.9540—Phone Susan Sawyer,REHS/RS 978.688.9542—FAX Public Health Director heal thdept@townofnorthandover.corn www.townofnorthandover.co.m FAX Ta , From: L5" Fax: Pages: Phone: Date: ' Re: UO CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle Please contact the Health Department at the above numbers for further assistance. V. L HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Jun 02 2004 11:54am Last Transaction Date Time Type Identification Duration Pages Result Jun 2 11:52am Fax Sent 819782836296 0:49 3 OK performance of a pressure and operating test of the system before final approval; the test must demonstrate that the system will deliver adequate pressure and volume consistent with the well and the well requirements . The Board of Health must . be given reasonable notice of when the installation is ready for inspection. 4 . 9 No certificate of occupancy shall be issued until all the provisions of these regulations have been met. The inspections and these regulations cannot be construed as a guarantee by the town of North Andover or its agents that the water system will function satisfactorily. Section 5. WATER QUALITY 5. 1 In cases of new construction, the Board of Health shall require the submission of a water analysis report. The report shall include bacterial and chemical evaluations conducted by a laboratory approved by the Board of Health or the Massachusetts Department of Public Health. Laboratories conducting testing must supply a copy of Massachusetts certification as verification that it holds current certification for all types of analysis done on water samples . The submission of a chemical analysis to the Board of Health is required before issuance of a building permit. The bacterial analysis must be conducted after the water system is completely installed. A report must be submitted before the Board of Health will issue final approval. The following minimal parameters must be included in the water analysis. total coliform alkalinity arsenic calcium chloride * indicates Primary Contaminants color copper hardness iron lead magnesium manganese nitrogen (ammonia) * nitrogen (nitrite) * odor pH * potassium sediment sodium sulfate turbidity total dissolved solids Additional information shall be required if the well is in an area of agricultural use or within 500-1000 feet of utility rights-of- way 5 .2 All primary contaminants shall meet EPA standards . Based on the results of the water analysis reports, the Board of Health may require additional treatment of a water supply. Section 6. PERMANENT OR TEMPORARY WELL ABANDONMENT 6. 1 All permanently abandoned wells shall be tightly sealed by approved methods to prevent pollution of the ground . water. Prior to plugging, the well shall be checked for debris that may interfere with the process. If the integrity of the original well seal is in doubt, the casing shall be removed or perforated. In addition all pumping equipment and associated plumbing shall be disconnected and removed. 6.2 When a well is not abandoned, but is out of use for an extended period of time, it shall be the owner' s responsibility to properly maintain the well and to prevent the development of defects which may facilitate the impairment of water quality in the well or in the water bearing formations penetrated by the well. Until a well is permanently abandoned by plugging procedures, all provisions for protection of the water from contamination and for maintaining sanitary conditions around the well shall be carried out to the same extent as though the well were in routine use. 6.3 To temporarily abandon a well, the top of the well casing shall be sealed with a watertight threaded cap or with a steel plate welded watertight to the top of the casing. If the top of well seal is watertight, the pump may be left in place. . A well that has, after extended use, been temporarily abandoned for three (3) years shall be considered permanently abandoned, and shall be appropriately plugged. Section 7 . PENALTIES 7 . 1 Any person who shall violate any provisions of these regulations for which a penalty is not otherwise provided in any of the General Laws or Sanitary Code shall upon conviction be fined not less than fifty nor more than five hundred dollars . Section 8 . UNCONSTITUTIONALITY CLAUSE 8 . 1 So far as the Board of Health may provide each section of these rules and regulations shall be construed as separate to the Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover,MA 01845 978.688.9540 healthdep0townolkorthandover.com SEPTIC PLAN SUBMITTAL F A Dor�TTHAN����i OF HEALTH DATE OF SUBMISSION:—A.3) oy r MAR 3 ��^+ SITE LOCATION: y o �? V,C- i ; rcCl- t ENGINEER: NEW PLANS: YES $225.00/Plan Check#: (Includes 1s` and one Re-Review Only) REVISED PLANS: YES V $75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES Telephone#: 972,- (=,SGJ 76 8 Fax#: '?7 6 8S- l 624 E-mail:- N CGS G N &- �-Q fiZ-;>L HOMEOWNER NAME: S K(4w N ✓vr4 f l�9 L�1-i i OFFICE USE ONLY When the submission is complete(including check): 1. ,l/Date stamp plans and letter 2. Complete and attach Receipt 3. Copy File;Forward to Consultant 4. Enter on Log heet and Database NEW ENGLAND ENGINEERING SERVICES INC March 31, 2004 771 rTOWF 10OFNQ H NUS' A/ Susan Sawyer BOARD OF HEALTH North Andover Board of Health 27 Charles Street i k North Andover, MA 01845 MAR I Re: Lot 2 Forest Street,North Andover, Septic system design Dear Susan: Enclosed are 5 sets of revised septic system design plans for the above referenced property. The changes made to the plan address the comments of your letter dated February 18, 2004 and include the following 1. The loading rate has been adjusted and the system size increased.. 2. A sketch showing how a pipe in stone system could be designed to fit this site. A retaining wall would be required to accommodate the grading. 3. The name of the firm doing the delineation of the wetland has been added to the plan. The DEP file number under which the wetland line was approved has been added to the plans. If you have any comments or questions please do not hesitate to contact this office. Sincerely, 3 C-0- Benjamin C. Osg od, Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 r % TOWN OF NORTH ANDOVER �°��s,�•';•q"o HVEALTH DEPARTMENT 27 CHART_FC STREET �> NORTH ANDOVER,MASSACHUSETTS 01845 ��s k,..o•Et<5* Susan Y. Sawyer,REHS/RS 9 8.688.9540—Phone Public Health Director 978.688.9542—Fax healthdept@townofnorthandover.com www.townofnortbandover.com F,AX Benjamin C.Osgood,Jr.,EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover,MA 01845 Fax: 978-685-1099 Pages: 978-686-1768 Date: `/ Phone: 'J 16 d 1� Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File TOWN OF NORTH ANDOVER of �,oerk q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER., MASSACHUSETTS 01845 �"SS Ckus Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX April 14,2004 Siavash Mahalati 36 Beaver Brook Road North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for Lot 2 Forest Street,Map 105B,Lot 2 Dear Mr.Mahalati, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated February 9,2004(Revised March 26,2004)and received by this office on March 31,2004. The design has been approved for use in the construction of a new 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. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe 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. /usan Y. Sawyer,RE /RS Public Health Director encl: List of licensed septic system installers cc: New England Engineering Services file TOWN OF NORTH ANDOVER ?°e,,�o°T "o°L HEALTH DEPARTMENT - . iF 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 sqC use Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—Fax healthdept@ townofnorthandover.com www.townofnorthandover.com FAX Benjamin C.Osgood,Jr.,EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover, MA 01845 978-685-1099 Pages: Fax: 978-686-1768 Date: Phone: T Septic Plan Response CC: Pile Re: ❑ Urgent x For Review ❑Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A'copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File 4 TOWN OF NORTH ANDOVER of NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES -HEALTH DEPARTMENT 27 CHARLES STREET ' NORTH ANDOVER,MASSACHUSETTS..01845 Susan Y.Sawyer 978.688.9540—Phone Public Health Director 978.688.9542—FAX February 18,2004 Richard C.Tangard,PE New England Engineering Services 60 Beechwood Drive North Andover,MA 01845 RE: Lot 2 Forest Street,North Andover,MA-Mau 105B,Parcel l Dear Mr.Tangard, The proposed septic system design plans for the above site dated February 9,2003 and received on February 11, 2004 have not been fully reviewed because of some major design issues. The following items are in need of attention prior to a full review: 1. The soil tests show that the C-horizon consists of Sandy Loam soil. This is a Class II soil type. Please revise the Design Data so that an LTAR value of 0.60 is used,not 0.74. This will increase the size of your required leaching area. 2. The use of the Infiltrator system requires the designer to demonstrate that a standard soil absorption system can be placed on the same location with a proper reserve area(See:DEP Infiltrator Modified Certification for General Use,Section IV.Conditions Applicable to the System Owner,Paragraph 2). Accordingly,please provide the minimum design size required for new construction by the North Andover Regulations. For example,in the instance of leaching trenches,the minimum size is 500 square feet of leach area. Please also accommodate other new construction design standards as defined in state and local regulations,such as a reserve area. 3. Given the proximity of the proposed soil absorption system to a wetlands resource area,please provide the name of the person who delineated the wetlands and the date delineation was performed. Additionally,please provide the North Andover Conservation Commission's confirmation of this delineation. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere r Susan Y. Sawyer,REHS/RS Public Health Director cc: Homeowner File Fax K1220xi Log for ,r NORTH ANDOVER 9786889542 Mar 12 2004 5:20pm Last Transaction Date Time Twe Identification Duration Pages Result Mar 12 5:18pm Fax Sent 89786851099 1:39 2 OK Page 1 of 2 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Friday, March 12, 2004 2:00 PM To: pdellechiaie@townofnorthandover.com Cc: 'Susan Sawyer'; Brian LaGrasse Subject: RE: Lot 2 Forest Street-Plan Review rTwo apologies are in order. First for Sue's middle initial. Second for this plan review. e did it, but failed to send it. It is attached. Dan 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.millriv_erconsultin2.com info@millriverconsulting.com -----Original Message----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent: Friday, March 12, 2004 9:36 AM To: Daniel Ottenheimer(E-mail) Cc: Sawyer, Susan; Lagrasse, Brian Subject: Lot 2 Forest Street- Plan Review Hi Dan, Just checking on the status of Lot 2 Forest Street. This is a new plan review that came in on 2/11/04. Ben Osgood was asking about the status on it. Also--just wanted to let you know that Sue's middle initial is"Y" not T. If you could change that on your letter template, that would be great--just so I don't forget to change it each time. Thanks, Pam :) Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 09845 3/12/2004 r TbWN OF NORTH ANDOVER BOARD OF HEALTH `// Location 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 $ r 7462 - Health Agent White - Applicant Yellow - Dept. Pink - Treasurer NEW ENGLAND ENGINEERING SERVICES INC February 112004 Susan Sawyer North Andover Board of Health 27 Charles Street �------ w- T(Ar-i i OF N©RTF!ANCC"T4 / North Andover, MA 01845 BOARD OF HEALTH Re: Lot 2 Forest Street,North Andover, Septic system design F FEB 12004 Dear Susan: Enclosed are the following documents regarding the above referenced property. 1. 5 sets of septic system design plans. 2. Application for approval. 3. Check to cover the review fee. 4. Copies of soil evaluator sheets as provided to this office by Hancock Associates. These plans are being submitted for approval. If you have any comments or questions please do not hesitate to contact this office. Sincerely, 6" C - Benjamin C. Osg d, Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 0EPTIC PLAN SUBMITTALS LOCATION: Map &Parcel NEW PLANS: YES $225.00/Plan Check#: & Z REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES DATE:-7,1`I I-Q`I DATE TO CONSULTANT: DESIGN ENGINEER: Otiw ,5-o G ,"o Telephone#: q 7 5 G 9 b-1 76 oy �7-tvCr 1ta Cc 4iN(S- When the submission is complete (including check),date stamp plans, COPY for Conservation,and place in existing file with green Design Approval form. • it p 1 FO&NI 12 - PERCOLATION TEST Location Address or Lot No. ewr p 7 ' - COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: yc Time:. :::0bservation Hole # Depth of Perc �_t ' Start Pre-soak End Pre-soak Time at 12" Time at 9" 0 Time at 6" 1 Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both reservethe primary area AND �. ararea. Site Passed 2 Site Failed Q ........................................................ Performed B Witnessed By: Comments: DEP APPROVED FORM-12/0719S FORM 12 - PERCOLATION TEST Lot No. Y'seS�- COMMONWEALTH OF MASSACHUSETTS N6r4N-� Av�over' , Massachusetts Percolation Test' Date: Time:, Observation Hole # �f Depth of Perc. 2� 5 Start Pre-soak End Pre-soak Time at 12" Time at 9" 3,3 Time at 6" Time Rate Min./Inch j MPI Nlinhnum of 1 percoiation test must be performed in both the primary area AND reserve area. Site Passed U Site Failed ❑ ................................................................................................................................_..—...._..... _ Performed By: Charles O jJen ��r ;,�. Enq ineu lm Arsov Ae5 Witnessed By: GoLdAvn �?oto Er0 A)J o.4r 90H - a Comments: DFP APPROVED FORM-12/0719S FOR:%i 11 - SOIL EVALUATOR f 0R.%j t E� Paw 2 of 3 Location Address or Lot Ao, I l i On-site Review _ I 71 -11 Deep Hole Number Dater Time: Weather 14 -"— 7(7 Location (identify on site plant Land Use ro o er Slope M ---Z Surface Stones r `f Vegetation Vie-JL /7/ f , Landform Position on landscape (sketch on the backs Distances from: Open Water.Bod i Y feet Drainage way _ feet Possible Wet Area 7/ff feet Property Line" ' feet Drinking Water Well __tf_0_.. #eet Other DEEP OBSERVATION HOLE LOGS Depth from SW Horaon Sol Texture Sod Color Soa Other Surlace(inches) (USDA) (Munsell) Mottling (Structure.Stones.Boulders.Consistency.% y..' Graven t9rl �'��• � � ter�.� �... •fie. 'p< • i1EQUiRED AT EVERY PROPOSED vlbrusAL AREA Parent(Material( Qeoiopic! OeptlRoBadrvdc: - Death to Groundwater_ Standing Water in the Hole: Weeping horn Pit Face ,' `•' ;. Estimated Seasonal High Ground Water 'Z, IMF APPROMM FDRM-t mItS FORM 11 'SOIL ,,.VALUATOR FORM Pa-c 2 o f 3 i Location Address or Lot No. r t a+ r. On-site Review Deep Bole Number K"_ -'' � Date: Time: Weather Location (identify on site plan) Land Use Slope M Surface Stones _7 - - Is Vegetation ev M— -0 L. j Landform j Position on landscape (sketch on the backs . .�... Distances from:. Open Water Body ICS feet Drainage Nay feet Possible Wet Area feet Property Line fest Drinking Water Well '>/r;r feet Other DEEP OBSERVATION HOLE LOGS Depth from Sox Horizon Sol Texture Sol Color Soil pts Surface(inches) Soil (Muns*M Mottling (Structure.Stones.Boulders;Consistency.% Graved 7 — 30 v r bry i Parent Material(geologic) Depth to Groundwater- Standing Water in the Hole: Weeping from pat Face. '0 ry Esturated Seasonal HighGround Water. DET APPitoyM FORM-Sl0719S FONT 11 - SOIL-EVALUATOR FORM Page 2 or 3 t � Ar � Location Ad"dress or Lot iJo. = r`4 ', On-site Review _ Deep Hole Number �' Oate: A �f Time: ' 10 Weather e.i- Location (identify on site plan) F Land Use _W.P o � 5 Slope M Surface Stones TX of e-90- � Vegetation QM14 , P> -J Landform Position on landscape (sketch on the back) . �... Distances from: Open Water Body /0 C7 feet Drainage way `' feet Possible Wet Area /04? feet Property Line ` oar feet Drinking Water WeA.. feet Other 1------ DEEP OBSERVATION HOLE LOGS Depth from Sol Horizon Soil Texture Sod Color Sod pts Surface(inches) IUSDA) (Munson) Mottling (StruM m,Stores,Boulders,Consistency. % Q Graven I �✓ ZIoYeG414 — M +9 3 > it/se t ;rei 01l'!4. s_. Z -G 7, /l IF a ). If C=-L L 5 F e7 r4-7 Parent Material(geologic) gndc ' d Death to Groundwater- Standing water in the Hole: Weeping(torn pit face. l(2 3 f Estimated Seasonal High raround Water. DFP APPRONM)FORM-UM719S FORM II - SOIL EVALUATOR4 PORNI Pa 2o2of3 ! 270/0 Location Address or Lot No. P= 3 a On-site Review Deep Hole Number r+-0,# Date: _ .�IP/'o I Time: 77 Location (identify on site plan) Land Use _ L•' Slope M Surface Stones o Vegetation �' S Landform Position on landscape (sketch on the back) v-.. Distances from: Open Water Body ��O feet Drainage way�� feet Possible Wet Area `.201174 feet Property Line feet i Drinking Water Well 72 00. feet Other DEEP OBSERVATION HALE LOGS Depth from► Soil Horizon Sod Text�ue Sod Color Sod pts Surface(inches) tUSDAl )Munsell Mottling )Structure,Stones.Boulders.Consistency. % Graven L 0-1674 /gas Gv Z�- Parent Material(geoiogie) ';i Death to Groundwater Standing Water inthe Hole: Weeping from Pit face: _1 C)PV4-.a— Estimated Seasons) High twound Water. bEP APPROVM FORM-12MIPS F0IL11 11 SOIL EVALUATOR FORK Page 2 ,ur 3 7761 �a Location Address or Lot i4o. On-site Review _ Deep Hole Number 7-5--f Date: �O 161 1 Time: Z E Weather _. Location (identify on site plan) Land Use Slope M - Surface Stones i Vegetation gA 14 : �` t Landform j Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area �>/o 0 feet Property Line ✓ feet Drinking Water Well yQ�a +lest Other DEEP OBSERVATION HOLE LOG' i Depth from Soil t(orison Soil Texture Soil Color Soil pts Surface(inches) (USDA) (Munsell) Mottling (Structure.Stones,Boulders,Consistency, % t Graven /off 7-0 + Parent Materia((geologic) Oapdr l:k I Cl Dewith to Groundwater• Standing Water in the Hole: /,VA�j c Weeping from Pit face: �/ ✓�,�� if Estirnated Seasonal High taround Water: Z tf DEP APPROt•M poRM.UM71% FORM 11 - SOIL EVALUATOR I, , OhM Page 2 or 3 Lot i4o. On-site Review _ Deep Hole Number - (. Date:.�� Time:.,—. Weather Goo), P.c h..�.. Location (identify on site plan) - Land UseR«,i�c�ntAl Slope M) _ Surface Stones- COn^r^+c✓� Vegetation 0.w Landform ,- N\ry rr.l 0 Position on landscape (sketch on the back) Distances from: Open Water Body.A loo_ feet Drainage way. feet Possible Wet Area --LCA feet Property Line . . feet Drinking Water Well 2-152— feet Other r DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture. Soii Color Soil Surface(Inches) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) 6- 32 �j r SL toY� 4/t� 1�ass ;uc ( T::'r'1C'Ul -. 32- `tS G 6 2,5Ys/a; e 46" F,i l,51K 46 cob�l,j 10;/ .S l asY 7/z Parent Material(geologic) Csnd Loo Ti I�_ DepthtoBedrock: 110E de�t_f rGd Depth to Groundwater: Standing Water in the Hole: "0"16— Weeping from Pit Face: NON C Estimated Seasonal High Ground Water: s}3h KEY VEP"PROVFD FORM- 12/07/95 LS L 00.rhJ y Sync) L Sand 5 � � 5:L 5i1f• Loar) C GOa SC FORM 11 - SOIL EVALUATOR h , OI��Z Page 2 Of 3 { . Lot iqo: ------------ - On-site Review Deep Hole Number 1' _ Date:. v0 Location (identify on site plan) Time:.,—. Weather -cool• p,c 1 ,-;.. Land Use R�_Si�len�ttal Slope (%) 3:5 Surface Stones— Co^^�`^a✓1 Vegetation O Li Landform , /\nrrl Zc . Position on landscape (sketch-on the back) Distances from: Open Water Body.ALO—Q feet Drainage way. feet Possible Wet Areao --I _ feet Property Line .. 15 filet Drinking Water Wel( l 0 feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Hof )zon Soil Texture4' Soil Color Soil Surface(Inches) (USDA) (Munsell) Mottli Other �g (Structure,Stones,Boulders, Consistency, 4 Graveq .`.t �D0.SSiV2 8 - 31 to-yk 4/ix SL 2,5Y (See �e�ow, cob�ly Parent Material (geologic) ,, o SeTi��_ DepthtoBedrock: )JOS �e'�erw•�nr�i Depth to Groundwater• Standing Water in the Hole: 00 tic- Weeping from Pit Face: Estimated Seasonal High Ground Walter: �e��SA� 'dUG -t0 �c�rra-c. bou�ds�IS J S t� D{= ,Mo,C�j�. - �uf�r" @.�t.�✓c.�• --'a KEY 9 DEP AL 5 L oar�� PPROVED FO"I• 12/07/9S Sand TtnL 5L 5an8y Loam ^� M�dlvrr: 5.L 54 Loam C. Goa�Sc 1 `'�� % ` • y \ ` � ., ��� ��Yi .\. �I _J si FQRM U - LOT RELEASE FORM INSTRUCTIONS: This fora is usedto verify that all -necessary approval/ permits from Boards and -Departments having jurisdiction have been obtained. This does not relieve the applicant and` or landowner from compliance with any applicable requirements. 00.0a.•aaaa,aaaaaa.a-as•aaamaasasaaassraaaaaaaaasaaaa�sasaasaasr.aaaaaaa�aassaasaa■ APPLICANT S1 5,# MnkLfG,J%/ PHONE ASSESSORS MAP NUMBER. LOT NUMBER SUBDIVISION �,C % „Z LOT NUMB.ER 0 STREET STREET NUMBER 5 �S Ina a*ss s.rssasarssrs ras.•aaaaaaaaa.asaaasaasssasa-a�ssaaaa.asaasasasasss■as as as■ OFFICIAL USE ONLY �a�aaaasraa.rasa•sa�aasaaaaa•aa*m:asassao-onaaaaaanaa aaaaaa■aa■aaa.*aas.aaaass■-aa• RECOA'4DATIONS OF TOWN AGENTS Usama aassasasa-aa-■ saaaaaaaaaa.■aaaasaa�a�aa�aaaaasaaraaaaaaaaaaaaaassasason �' DATE APPROVED CONSERVAT'IONAD TOR DATE REJECTED cohaVIENTS FOOD INSPE OrR TEcC ,o %L P kC-V W AJ no -2/1 0 `� i=ce a.{L c - U4 i pct COMMENTS all A1tJ -/- 1] � _ . -i S�a, I PUBLIC WOR�%KS - SEWER I WITTE;R�CONNECTIONS 1 DRNEWAI .R1v�, C7 FIRE COMMENTS RECEIVED BY BUILDING INSPECTOR r DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED` DATE APPROVED DATE REJECTED 5- 27-o¢. =1 COMMONWEALTH OF MASSACHUSETTS North Andover Board Of Health McKinney Artesian Well & Pump Supply Co., Inc. ----------------------------------------------------------------- -- - NAME Lot 2 FOREST STREET --------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ----------------- May -27,-200.6 --------------_unless sooner suspended or revoked. May 27, 2004 ------------------- ----------------- ------------ ---------- ------------------------------------- ---- NUMBER BHP -2004-0396 FEE $125.00 Board Of Health Townlorh And ver Health Department + Date: L Location: (IndicateAddresX if Residential, or Name of Business). Check #: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ F is T e: Food Service - Type.- $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ - ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: El Septic -Soil Testing $ ❑ ySeptic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ P Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ 1 ➢ Tobacco $ ➢ Tras4lSolid Waste Hauler $ ➢ Well Construction $ - .✓• ➢ OTHER. -(Indicate) Health Agent Intl'' rer White - Applicant- - _Yellow - Health Pink,-� t s *° •'•t�`' BOARD OF HEALTH sswcNuse NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # Date��� A permit is requested to: drill a well install a pump LOCATION: _r'�[?� Lot # Owner9acludl �N.COIP,&. , Address " ✓,� Tel Well Contrctr ���► � 'tc Add.�� Tel ` — i<r� Pump Contrctr ] L-( � �' _ I&dd. Tel ' n WELLS (To be completed at time of pump test.) Type of well Use Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (T) Date of test Depth of well Water -bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours at r GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation.) Name & size of pump _ Type Size of tank Pump delivers GPM Pipe used in well: Cast iron-(_) Galvanized (_) Plastic (^) Sleeve used to,protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Board of Health Wiring inspector 06-10-'04 15.31 FROM -Granite St Analytica 603-434-4837 T-923 P01/04 U-492 The results costa' I herein are confidential and are only tf , reviewed by the addressee or his/her designate. If you have received this fac...nile in error please dispose of it accordingly. GRANITE STATE ANALYTICAL, INC. 22 Manchester Road Derry, NH 03038 (603) 432-3044 Fax (603) 434.4837 To:*Off�i/L// yam/ From:�-�-7�j�--�.. Fax: 7 %� (� (o �r i.�JC%/ Pages: Phone: Date - Re: CCI ❑Urgent ❑ For Review 13 Please Comment © Please Reply 0 Please Recycle e Comments: I FROM -Granite St Analytica 603-434-4837 T-923 P02/04 U-492 ApRh figft mq% m ite nalyti a i Inc. gain Office / Laboratory 22 Manchester Rd. / Rt. 23 Deny, NH 03038 (803) 432-3044 Lab Contact, Donald A. D'Anjou, Ph. D., Laboratory Director DATE PRINTED: 6/10/2004 CLIENT NAME: Slayash Mahalati CLIENT ADDRESS: 36 Beaver Brook Rd. No.Andover, MA, 011845 CERTIFICATE OF ANALYSIS FOR DRINKING WATER SAMPLE toe: 0406-00116.001 DATE A TIME COLLECTED: 6/3/04 11:30 am SAMPLED BY: Client, Customer DATE 6 TIME RECEIVED: 613104 12:35 pm SAMPLE LOCATION: Lot 2 Forest St..No.Andover.MA ANALYSIS PACKAGE: No.Andover RECEIPT TEMPERATURE: ON ICE 12.0 Test Description Results Test Units Test Fails Ana Is Method Analyst Date & Time Analyzed MCL Sediment Absent SE 6/8/04 2:10 pm Coliform Bacteria` Absent 1100mL Colilart HM 6/3104 1:57 pm Present E. coli Bacteria` Absent/100ml- Colilert HM 613104 1:57 pm Present PH- 7.05 SU EPA 150.1 WH 6/3104 4:30 pm 6.5-8.5 Total Dissolved Solids' 160 mg/L EPA 160.1 SUB 618/04 12:00 am 500 m91L Turbidity' 1.8 NTU EPA 180.1 HM 6AM4 10:30 am 5 NTU Arsenic. 40.004 mg/L EPA 200.7 SE 614104 2:26 Pm 0.050 mg/L Calcium" 10.3 m91L EPA 200.7 SE 614104 2:26 pm None Set <0.01 mg1L EPA 200.7 BE 6/4/04 2:26 pm t.30 mg1L Copper` 38.5 mg CaCO3/1- EPA 200.7 BE 6/4104 2:26 pm None Set Hardness* 0.153 mg/L EPA 200.7 BE 614104 2:26 pm 0.300 mg/L Iron' 3.1 mg/L EPA 200.7 SE 614104 2:26 pm None Set Magnesium' 0.028 mg/L EPA 200.7 BE 6/4104 2:26 pm 0.050 mg/L Manganese' <1 mg/L EPA 2007. SE 618104 5:48 pm Potassium' 34 mg/L EPA 200.7 SUB 8/70/04 12:00 am Sodium* <0.006 mgfl EPA 200.9 BE 614/04 7:22 pm 0.015 mg/L Lead* 8 mg1L EPA 300.0 HM 6/3/04 4:12 pm 250 mg/L Chloride' <0.20 mg/L EPA 300.0 HM 813104 4:12 pm 10.0 mg/L NiRrate' 19.9 mg/L EPA 300.0 HM 613104 4:72 pm 250 mg/L Sulfate' 15 CPU SM 212013 HM 614104 10:30 am 15 CPU Color ND T.O.N. SM 21508 WH 613104 4:30 pm 3T-O.N. Odor Total Alkalinity' 83.6 mg CaCO31L SM 23208 SE 6110/04 2:50 pm Nitrite- 0.012 mg/L SM 4500 NO2 B WM 613104 4:30 pm 1.0 mg/L Note: Bacteria sample volume less than minimum required volume of 100 mL. This sample meets EPA Safe Water Drinking Act requirements for the parameters tested except as noted under "Test Fails". If the Test Fails EPA Primary - WATER IS NOT SAFE TO DRINK If the Test Fails EPA Secondary - Water may be aesthetically unacceptable but Does Not'Fail Test. 4+ i a MCL = Maximum Contaminant level 4 w • NELAC Accredited Analysis a c'� cv Donald A. D'Anjou, Ph.D. Q.:. x Laboratory Director This analysis meets NELAC requirements except as noted. This certificate shall not be reproduced, except in full, without the written approval of Granite State Analytical, Inc. 06-10-'04 15.31 FROM -Granite St Analytica 603-434-4837 T-923 P03104 U-492 a, WWI &Wf wvr iy.vv inn Iua46#44v.v avwa••..•• vv..• m--- Toxikon Dote: 10.Ain-04 CLIENT: GRAMTE STATE ANALYTICAL Client Sample ID: 0406-116-1 Lab Order: 0406059 Tog Number: Project: GSA 0406.116 Ceikedon Date. 6/31200411:30:00 AM Matrix: DRINKING WATER Lijb IDt 0406059-OIA - Analyses Result Limit Quail Units DF Date Analyzed ICP METALS, TOTAL WASTEWATER 200.7 Analyst: At t 6HD/2004 t 11:43:00 AM Bodlum 34 t.0 n,grl TOTAL DISSOLVED SOLIDS E160.1 Analyst. YLK Total Dissolved Solid* (Residua. 160 10 mall t 6/6/2004 Fineralesle) Quaiitiers: N0 • Not oatacted at the Reporting limit S - sp'ke Recovery outside accepted recovery llimir3 J - Analyte detected balow 40061000" IiMit$ R - RPD outside accepted recovery limits B - Analyto detected to the aesoolsted Method Blank P_ . Vehaa above gtWantitation ao6¢ . Value cnoeds mmimum Contominant Lent PagO 1 Of i E 0 111 �g. LL 10-'04 15:32 FROM -Granite St Analytica 603-434-4837 T-923 PO4/04 U-492 V.2 t • ♦ V V i Colo r v a r r .� • • . - - _- - - • • . . IL 2 7 p� 4 !id E Ow [` Wt "S o Z_,, 1z SI WEES.56 ZOaoE� . . F VE30 c ,, .qc s �V v 00Ny10 J IL W O CL w W z z a 0 Moots Moot v I m 0 m � w LZ a T N 0 D�: Town of North Andover, Massa•setts BOARD OF HEALTH A_q APPLICATION FOR SITE TESTING/INSPECTION QDRATED 1SSACHUS� / Form No. 1 19 I f . Applicant NAME ADDRESS i TELEPHONE Site Location L Engineer g NAME ADDRESS' J TELEPHONE v 1 Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No, S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Mass's setts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer • '' •'•f..' r,`%' :� NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee , CHAIRMAN, BOARD OF HEALTH Test No, S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. /Q��SI.ED �b'46NG h� \0 � AT— Town of North Andover, Massi BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 we, Applicant NAME f�� / ADDRESS J` TELEPHONE Site Location Engineer - { NAME ADDRESS ' 1 TELEPHONE Test/Inspection Date and Time Fee - • CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Mass BOARD OF HEALTH "AA°R APPLICATION FOR SITE \TEST� �ING/INSPECTION 7 Q�RAicn WPPP�y q�J Form No. 1 19 Applicant NAME ADDRESS - 1 TELEPHONE r � Site Location-�`'�•'I`�1`�'�t Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time '7 i Fee '` / `� CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. HANCOCK Engineering Associates / 235 Newbury Street, Danvers, MA 01923 (978) 777-3050 Fax (978) 774-7816 www.hancockassociates.com To: North Andover Board of Health Community Development 27 Charles Street North Andover, MA 01845 Aftwdo s Brian LaGrasse ir;�ao'� OF NOR�II ANU�:'f�i/ 8OAQD OF HEALTH FB -42004 s Project: 6787 i Date; 2/3/04 Ree Lot 2 Forest Street Extension CC: (formeiy Lot A Forest Street Extension) We are sending you: ❑ Plans ❑ Prints ❑ Disk ❑ Other. REMARKS: Brian, This information was submitted previously, but the engineer for the buyer of this property has told me that some of it could not be found on file for this lot (maybe it is all with Lot 3?). 1 am re -submitting it to you just in case. SIGNED: _dtj W�' if enclosures are not as noted. kindly notfv us at once. COPIESDATE 1 515103 NO. DESCRIPTION Soil Absorption Area Sketch showing test pit locations 1 5/5100 Soil Evaluator Form 1 9/25100 Soil Evaluator Form 1 10/16/01 Soil Evaluator Form REMARKS: Brian, This information was submitted previously, but the engineer for the buyer of this property has told me that some of it could not be found on file for this lot (maybe it is all with Lot 3?). 1 am re -submitting it to you just in case. SIGNED: _dtj W�' if enclosures are not as noted. kindly notfv us at once.