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Miscellaneous - 220 BOXFORD STREET 4/30/2018
/ Q20 BOXFORD STREET it 1 21 O/104.-D-0057-0000.0 'I I I I� I IllI f f _ i Commonwealth of Massachusetts City/Town of 010 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT 41.y s+'y'v 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 tQ determine the form they use.The System Pumping Record must be submitted to the local Board of Health orother approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of h�ght rear of o Left rear of building. Right rear of building. Address City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town SrZ.' ode �ca> I Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons II, 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location a contents were disposed: LS,D Lo II ste Water Signatur of a er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of tU,Z System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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.The System Pumping Record must be submitted to the local Board of Health or other approving authority. I A. Facility Information 1. System Location: Left/Right front of hous y g house;16D Righ ar of hou , Left/right side of house, Left/ Right side of building, L /Ri t f nt of building, Left/ Ig rear o building, Under deck Address City/Town State Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zip Code (lo d-K ' '36 5 - t3Sg Telephone Number B. Pumping Record 1. Date of Pumping Date (y 02 2. uantity Pumped: S� Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: ✓vl 6. System Pumped By: Neil Bateson F5821 Name .Vehicle License Number Bateson Enterprises Inc Company 7. Location whe ents were disposed: G.L Lowell Waste Water Sign a Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 �—� Cy 51 d c' a c:?4 � 2 v► � Q � -v+/1 �- lP� i I North Andover Community Blood Drive Wednesday Junel , 2005 2 • 00 p. m . — 7 : 00 p. m . North Andover Senior Center 120 Main Street, North Andover VALID ID REQUIRED ! Enter to win Red Sox tickets as "Blood Donor of the Game" To schedule an appointment to donate blood, please call 1-800-GIVE LIFE (1-800-448-3543 ) or visit www.givelife.org + American Red Cross North Andover Board of Assessors Public Access Page 1 of 1 ✓ 4 r Parcel ID: 210/104.D-0057-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to.Enlarge No Picture I Available k Location: 220 BOXFORD STREET Owner Name: KEIVER,PETER O PAMELA C KEIVER Owner Address: 220 BOXFORD STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 1.28 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1176 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 320,800 306,600 Building Value: 150,900 144,600 Land Value. 169,900 162,000 Market Land Value: 169,900 Chapter Land Value: LATEST SALE Sale Price: 190,000 Sale Date: 07/27/1995 Arms Length Sale Code: Y-YES-VALID Grantor: MARINO,FRANK A Cert Doc: Book: 04303 Page: 0341 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=466966 11/21/2'' Residential Property Record Card F PARCEL_ID:210/104.D-0057-0000.0 MAP:104.D BLOCK:0057 LOT:0000.0 PARCEL ADDRESS:220 BOXFORD STREET PARCEL INFORMATION Use-Code: 101 Sale Price: 190,000 Book: 04303 Road Type: T Inspect Date: 12/02/21102 Tax Class: T Sale Date: 07/27/1995 Page: 0341 Rd Condition: P Meas Date: 12/02/2002 Owner: Tot Fin Area: 1176 Sale Type: P Cert/Doc: Traffic: M Entrance: X KEIVER, PETER O Tot Land Area: 1.28 Sale Valid: Y Water: Collect Id: RRC PAMELA C KEIVER Grantor: MARINO, FRANK A Sewer: Inspect Reas: C Address: 220 BOXFORD STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RR Tot Rooms: 6 Main Fn Area: 1176 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Story Height: 1 Bedrooms: 3 Up Fn Area: Bsmt Area: 1176 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 888 1 P 101 S 43560 1 168,577 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0.28 1,316 Masonry Trim: Ext Bath Fix: Tot Fin Area: 1176 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 125619 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class Kitch Qual: T Eff Yr Built: 1965 Mkt Adj: 1.2 SE C 80 1988 A A ///91 200 Heat Type: HW Ext Kitch: Year Built: 1962 Sound Value: Fuel Type: O Grade: A Cost Bldg: 150,700 VALUATION INFORMATION Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1: Current Total: 320,800 Bldg: 150,900 Land: 169,900 MktLnd: 169,900 Central AC: N Bsmt Gar SF: 288 Pct Complete: Att Str Va12: Prior Total: 306,600 Bldg: 144,600 Land: 162,000 MktLnd: 162,000 Att Gar SF: %Good P/F/E/R: /100/100/77 Porch Type Porch Area Porch Grade Factor P 96 W 192 SKETCH PHOTO 37 12 w 192 Sq.R 12 12 BIFM I 1 76 Sq.R. 288 Sq. 24 24 24 No Picture ,24 49 12 i 4 96 R. 4Avalable Parcel ID:210/104.D-0057-0000.0 as of 11/21/05 Page 1 of 1 1 Irc, I 11► - �' E t _ TYPE OF SEWARGE DISPOSAL / Public Sewer F1Tanning/Massage/Body Art ❑ Swimming Pools H' y Well Tobacco Sales ❑ Food Packaging/Sales 11 1Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund c Signature of Agent/Own i*� Signature of Contractor Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS �D�TE REJECTED DATE APPROVED CONSERVATIOq; N COMMENTS_ �: ( G (, hm JOD DATE REJECTED DATE APPROVED HEALTH -`� ❑ ! .j J/A-) "\ O COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes no Fire Department signature/date 188'54' INSPECTION PORT(TYP.) TP2 36 )XFORD STREET /p MAP 104D, PARCEL 57 55,840± SF P �� < / / PT1 't DISTRIBUTION BOXTRIPLE MAPL E. / G TP5 BENCHMARK:SPIKE BASE OF ELEV N 00.00(ASSUMED DATUM) ROCK OUTCROP(TYP.) �4Ppr�k , ! \TP1 2SCH.40 PVC j FORCE MAIN 1500 GALLON 5 1000 GALLON SEPTIC TANK PUMP CHAMBER O O 66' DECK Z �• EXISTING DWELLING SILL ELEV. 102.27 ' f tAORTH q.• O -(V-10 16,, '•O O Z. O cxwrz.w�wrc•y1• 40 to 9SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division r(FRTI(FICA2'E O F CO_1VI(P.GIAjr\r As of: ,duly 28, 2006 This is to cert that the individuasubsurface disposafsystem was: Fully Repaired 6y:. ,john Soucy At: 220 Oo.Vord Street North Andover, W,4 01845 'The issuance of this certificate shad not 6e construed as a guarantee that the system wiff function satisfactorily. IS*Ian 2'. Sawyer, XOTS/QS a6fic.Meath Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER N°STM�ti Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT . . w 400 OSGOOD STREET ...s.s_... . a ONORTH ANDOVER,MASSACHUSETTS 01845 �� 978.688.9540—Phone Susan Y.Sawyer,REHSIRS 978.688.8476-FAX Public Health Director E-MAIL:healthdeptaa,townofnorthandover.com WEBSITE:hq://www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed; ()�)repaired; by RECEIVED (Print Name) JUN - 5 2006 located at Z Zo F ox2,2-D ST.2GLTGWNOF NORTH ANDOVER (Installation Address) HEALTH DEPARTMENT was installed in conformance with the North Andover Board of Health approved plan,originally dated and last Revised on ,with a design flow of gallons per day. The materials used were in conformance with those Ospecified 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: 6// z-142(0 Engineer Repr tative(Signature) And-Print Name Final inspection date: -5 -7z o G A2, G Engin er Representative(Signature) And Print Name Installer: ;W6 (Signature) Date: 41� And-PrintfNarne Engineer: (Signature) Date: —7 8 cpq dQ J�- And-Print 14ame I � Page 1 of 1 ' O O v DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Tuesday, May 09, 2006 2:24 PM To: Grant, Michele; Lisa Kozel LeVasseur; Marianne Peters; DelleChiaie, Pamela; Sawyer, Susan Subject: 220 Boxford Street Construction inspection attached. Sorry the write-up got delayed on our end. Dan a Daniel Ottenheimer,President Mill River Consulting,Inc. On-Site Wastewater Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinQ.com dano@millriverconsulting.com 5/9/2006 I 0 O t TOWN OF NORTH ANDOVER f NORTI Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT *� F � 1600 OSGOOD STREET BUILDING 20, STE. 2-64 *�'•��, NORTH ANDOVER, MASSACHUSETTS 01845 9SSACHUSet Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX j ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 220 Boxford Street MAP:104D LOT: 57 INSTALLER: John Soucy DESIGNER: New England Engineering Services PLAN DATE: 11/29/05 BOH APPROVAL DATE ON PLAN: 12/6/05 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 4��� DATE OF FINAL CONSTRUCTION INSPECTION: 4/28/06 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS � ®Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ®Topography not appreciably altered Comments: Could not access basement but laundry located right near main building sewer 4/28/06. SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port ® 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 ® Hydraulic cement around inlet & outlet Comments: Manhole over inlet. Wastewater System Documentation—Feb 2006 Page 1 of 4 O •TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ry 1600 OSGOOD STREET BUILDING 20, STE. 2-64 NORTH ANDOVER, MASSACHUSETTS 01845 �1SSwCMUS t� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® 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 Comments: D-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: Wastewater System Documentation—Feb 2006 Page 2 of 4 OTOWN OF NORTH ANDOVER O pCRTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT _ p 1600 OSGOOD STREET BUILDING 20, STE. 2-64 NORTH ANDOVER,MASSACHUSETTS 01845 ��SU t� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SOIL ABSORPTION SYSTEM Bottom of SAS excavated down to soil layer, as provided on plan ® 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 ® Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ® Gravel-less 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: Force main from pumpamber to distribution box has a section which is lower than the weep hold and may have water in the pipe at all times. Installer indicated he will maintain 4' of cover to prevent freezing. 4/28/06. CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 3 of 4 4 TOWN OF NORTH ANDOVER O t pORTh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT t 1600 OSGOOD STREET BUILDING 20, STE. 2-64 0�, ._,�,:. NORTH ANDOVER, MASSACHUSETTS 01845 �',Ss eta' ACNUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT 96.90 97.27 Septic Tank IN 96.40 96.95 Septic Tank OUT 96.15 96.57 Pump Chamber IN 96.05 96.55 Pump Chamber OUT 95.80 96.64 Distribution Box IN 98.23 98.24 Distribution Box OUT 98.06 98.09 Lateral 1 IN 97.96 97.95 Lateral 1 TOP 98.29 98.32 Lateral IN 9796 97.93 Lateral 2 TOP 98.29 98.32 Lateral 3IN 97.96 97.95 Lateral 3 TOP 98.29 98.32 Wastewater System Documentation—Feb 2006 Page 4 of 4 °� NORTry ` :�,.•��� .'�, Commonwealth of Massachusetts Map-Block-Lot p Board of Health 104.D-0057- --------- ` . r•`_' P I North Andover Peet Na BHP-2006-0066 s$4F.I. - ----- -------------- FEE ---------- $250.00 Disposal Works Construction Permit Permission is hereby granted John Soucy -- - - ---- - -- --------------------------- to(Construct)an Individual Sewage Disposal System. --------------------- at No 220 BOXFORD STREE asshown on the application for Disposal Works Construction Permit No. BHP-2006-006 Dated March -- --2006- ' k t-- Issued On:Mar-15-2006 -------------------------------------------- - --- - ------- Board of Health / A Town of North And ver Health Department Date: D� Location• oC vv (Indicate Address,if Residential,or Name of Business) Check#: 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 $ L1S�eptic-Design Approval $ O/Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER(Indicate) "Health Agent Initials 1452 White-Applicant Yellow-Health Pink-Treasurer °N�h Ati Application dor Septic Disposal System--� 4. - �' `A Construction'hermit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 0.00- ull Repair p. 0--Component Important: Appllcatiorf is hereby made for a permit to: When filling out Construct a new on-site sewage disposal system` forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key G� to move your ❑ Repair or replace an existing system component --- cursor-do not use the return key. A. Facility Information 41�_� / 9 4k o r� . a rab Address orvLot —_ -- — — rewn Cityfrown -------` 2.- *TYPE OF SEPTIC SYSTEM' Pump ❑ Gravity (ch— ***If pump svlm*- / ation*** ❑ Conventional l ❑ Infiltrator or Bi / ration to install this type of system. ❑ Pressure Distril ice Agreement) ❑ Pressure Dosed 2. Owner Informs Name V Address(if different from ai City/Town- ------ Zip Code - Telephone Number 3. Installer Information— Name Name Comps _$n � Address 0 ��—=-F — -- -- ---- � - ``Qv'1 LA -------- _._ _ City own State Zip Code Telephone Number(Cell Phone#if possible please) a. Designer Information Name0S � Name o�f/Corny Address 60 -Pe e Vi� O 0% Cit /Town -- ------ --------- -- ----------------___ - y /� ��-_--- �� State � Zip Code Teleph a Numb (Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 pE µ�H, Feq,y Application for Septic Disposal System ' "'g©6, TODAY'S DATE Construction Permit - TOWN OF _ h ... * NORTH ANDOVER, MA 01845 "iso ao uII Repair `$125.00 Component PAGE 2 OF 2 A. Facility Information continued.... s. Type of Building:' Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm al Code, as well as the Local Subsurface Disposal Regulations for the Town of North A ver, and not to lace the system in operation until a Certificate of Compliance has been i u d by this Boa f Health. Na,ge Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes-Z No 2. Project Manager Obligation Form Attached? Yes No_ 3. Pump System? If so,Attach copy of Electrical Penn it Yes_ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approved plan) S. Floor Plans?(new construction only): Yes_ No Application for Disposal System Construction Permit-Page 2 of 2 INSTALLER-PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at g-')(p &04"o relative to the application of < dated—?—Y-046, for plans by , (F— and k At dated with revisions dated / 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 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 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 perso hall absolve me of this obligation. U ersi ed Licensed Septic I taller 4/k^— Dater C>�, Application for Septic Disposal System _`��<9�1-0 of "fib TODAY'S DATE---- AConstructiori Permit — TOWN OF NORTH ANDOVER MA 01845 '2 °'°°-Full Repair su•;• .'ti;,y °- Component j +crus Important: Applicatiorf is hereby made for a permit to: S- When filling out Construct a new on-site sewage disposal system` forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key C to move your ❑ Repair or replace an existing system component �— cursor-do not use the return key. A. Facility Information rab Addressor o� -- -- ------ — -- p� City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name V Address(if different from above) City/Town-- ----- ---------- State -- Zip Code ---------- Telephone Number 3. Installer Information Name Name'ol Comparfy- ' Address --lcc3 City own State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name ©� Address �� Name of Comp y City/Town ��� State Zip Cod C_7Cr Teleph a Numb (Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 HI oq Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE , MA 01845ull Repair ... $f25.00 -Component NORTH ANDOVER PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building:` Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm al Code, as well as the Local Subsurface Disposal Regulations for the Town of North A ver, andnot to lace the system in operation until a Certificate of Compliance has been i u d by this Boa f Health. �� %_--?-C)( — Naffe Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attacbed? Yeses No 2. Project Manager Obligation Form Attacbed? Yes—Z No 3. Pump System? If so,Attacb copy of Electrical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approved plan) r S. Floor Plans?(new construction only): Yes_ No - r Application for Disposal System Construction Permit•Page 2 of 2 __ ., _ - . _ � ait`sa,,•7 .,. r4 s - i - . . : - - . .. .. - ..,: - --. .- -. - - 7d.. " I 11 - 4 i' .z I v - «�10 . .11 I- ��` cf - , . ` * - . _ x� r� ' Y . '[ +' �� r I:.1. r � arta§ �_ 1 �,� s hnt . , + `7 - - - '' :,+; y do � > �sr. q x d tN, , k t, ISE CO �IMO1111 . I 1.�f WEALT' I OF°4MAS A �I E' TS I._1111y , � r � r ,:. .. I I. I I . . . . . I IDEPAR . . 4 �, � i"'' , p r � . TME N : ., I- I __ I -T OF E . �� , ��, lTVIR . ENTALx� PRTCTIOl� � I I e � RI . ��i�_ `�� , �,",""".-! - . i I : ,: . .. I . 11 , . i, . " I 1. . 11 11�,�I. .1 - - .1, IB_ E' I K� 11NOVNt4�.,THAT Nfi�y . . j .I ,.--:., --�.. I _� 1. . 1 ..-. 11J . � 11 +' f r }�' t t c rs 111� y at t t r Vis,t �J ssk ',,.T �, I _r ���� § i John fry - 1. . Soucy . 1*1. , r:. he`x }" `�w N k t is Has71 s1.atisfied the De artme_11-nt s ualincations�as re aired anc _is hereb n 14 `1 s � k� Y { 1. = auth;14orized t use the.tare -; 'f i fly Z'�'< 'i +'; CR%TIFI;ED TI:'FLE 5 SY%STEIVIE" 1'�SECOR 5 r, .f $ # v -' ":: t s s Esc- w :s :* x ^. ... .o i. ::+ - as rodded:ln 3:L0. . MR ,, } w C r 15 340 and Section l:�of1�a der 21 A a the 1 .)�A - 'xv. ' a #� d - :_ Mein- r:.: - .t -...- t...r ._ry,4 r-._.. y [. •. +r..- 1, r. r ,. ,. W. }. \v. .1- ,k:Y:'i ...E�eneral.Laws. _.,zI <, 1 sued b:Y . Thea De rtrn too r .. ,,..,:,J . .. ,.r: . a en y _;, , 1. -k ?, , � yon nta q. �., y,m r. 1 . o ectxon :. ,o t n . e 1 Pr 5 P ? =. s z r_ ,_ ,7:^- I5•'^ - a •(r a; ,�r F z"f,.:�' t' s .3 tt; r.y .,3:r..' .b.,-:v l ';5 aj ^E .ate < 'P t:W." Y .5,. ..�. y �. ,.., .H ?d , , -.e. .r f. V? a i... .s - �, .leis ..;k#s %.5.$ x, a S *n,: - ' ;p-rF �5 - 4 [ L it U y dst'.�{ It? f, rt. > . 3 f - .F` .. _Vll r%t k�� X.. k k4 :Y3 I }i t S, a < z ,�: L. 7 '4'K§pv .. °STs e,'�- yY' ° -' i ' 4. X ..fp f , ,.? -a'#`l'+° .+'.1l' Y. € •[' - .�+r ,in k +rr,5 s i,.s ..3.:j. .l• :.i `� r., _ I. t., - `:'x`M1'{° - f 5't,h. �'.�. 355:r'sq,.: t�-, i'.)' ll:�r, f ~,March'24 1995„ r -r: .. :, . .. .: -.i Ac't� v t ,.: , . :;, W r rectot a the a n DY1. E ion t aterPouuon:Control , >„ - - r,-. `:ix r._ e 4„f:^ y;t t'' '-' } s n �,:1. F r ti ,. :; - ,at.. 'y-.;ic is i s:'L i� �' r :.., h t- A s r a t, .... .,.,':.:. ,. t .y-a .p,„... ) ,+,++ .. r `/1 '.1"z' -'.N .� p £.: v7 'i tyy :$ ., ::. ;, ... ;--c,,. a � .4. '- _:. t':: �i"x t *' .. �_,�•{r: r4.; 3 ,f: - :Ej +�' 2� a[ ... �.,, ..,;,.§ ,.. , a ., .,...: '3 :iii r . »< ...�t �:. - .. Department of Fire Services Permit No. rV,ev, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IN O ATION) Date: City or Town of: To the Inspector of Wires: By this application the undersigns gi es notice of his or he tention o perform the electrical work described below. Location (Street&Number) CJ Owner or Tenant Q( Telephone No. 35 Owner's Address_: Is this permit in conjunction with a building permit? Yes ❑ No e—` (Checic Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 0Gv Amp's 2_2Z,> /.1ew Volts Overhead Undgrd ❑ No.:of Meters l New Service ` Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity ".:�.:,'� F."..n ... �?P�'°�'�^ 3h..- ..a:. 3.�LJt+'K' YA?�F'•'3..r:r : — __ ._ __ h �>, -'__ _. in table maybe waived by the Inspector o Wires. No.of Total Date.................................. Transformers KVA Generators KV t N°RTN 1 ::•t�`' - o TOWN OF NORTH ANDOVER o.o E mergency I g c BatterPERMIT( FOR WIRING FIRE A . of Zones No.of SS...... � IniNo.of s ^ No.ofSelf- ontained This certifies that E - 4- ... .•......., .......... ................................... Detectio ertin Devices has permission to perform Local Municipal ❑ Other P P `..... .... :... Conne tion Security Systems:* wirin in the building of c „� y 8 8 ..;. ..... ........., No.of Devices or Equivalent . ......... ............. ...w � t�a ` f Data Wiring: at ........ F.•. , f..... ..... ... .. ,North Andover,Mass. No.of Devices or Equivalent om nications Wirin Fee ..... ,•���'�.'d�` Tel No.of Devices or E'uiv g ent EL]8L -r CAL INSPECTOR t Check,'At, if d I desired,or as required by the Inspector of Wires. f' aucipalpolicy. )� ^ ,-, -<. .•� ; h MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coves -is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pans and penalties of perjitry,that the information on this application is true and complete. FIRM NAME: 7 LIC.NO.:Z�2%J4- Licensee: �� Qi,/® f_ SignatureLIC.NO.:�= � (If applicable, ent "exem "in the license number line) Bus.Tel.No.4a ;�_95_lLo " Address: 4 0.z& c fi�`S� ,i zc ke:ic��C'✓ /��' C�/,S'7Ci Alt.Tel.No-T/Zs/5'g5"�� *Security System Contractor License required for this ork;if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. NEW ENGLAND ENGINEERING SERVICES ik INC November 29, 2005 Mrs. Susan Sawyer North Andover Board of Health 400 Osgood Street RECF.IVED North Andover, MA 01845 DEC 0 1 2005 Re: 220 Boxford Street,North Andover, MA TOWN OE NORTH ANDOVER Septic System Design Plan -REVISIONS HiwALTH 5EpARTMEN7 Dear Mrs. Sawyer, The following Septic System Design Plans and enclosures for the above referenced property have been revised and are being resubmitted for approval. The following concerns from your letter dated November 28, 2005 have been addressed. 1. The note about the reserve area has been removed. 2. Nitrogen loading calculations are not required since the system is not in a nitrogen sensitive area. However, 310 CMR 15.214(2) limits the design flow to 440 gpd per acre for residential use. Therefore, with the subject property containing 1.28 acres the allowable design value is 564 gpd, which is greater than the actual design value of 550 gpd. 3. A note has been included to state that the system is not in a nitrogen sensitive area (see GENERAL NOTES,Note 6). 4. This system is being upgraded for a future expansion of the dwelling. No expansion plans currently exist and are therefore not included. 5. Construction note 10 has been reworded to read as CMR 310 Sec. 15.354(3)(b)&(c). 6. An elevation for the building sewer has been provided. 7. A conventional pipe and stone system sketch has been provided on a separate sheet to show that it will work on the site although an Infiltrator system is proposed. If you have any comments or questions please do not hesitate to contact this office. Sincerely, I Steven E. Pouliot Project Manager I 60 BEECHWOOD DRIVE-NORTH ANDOVER MA 01845- 978 686-1768- 888 359-7645-FAX 978 685-1099 n I' TOWN OF NORTH ANDOVER of NORTa 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01.845 SACMUS Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX November 28,2005 Mr.Benjamin C. Osgood,Jr.P.E. New England Engineering Services 60 Beechwood Drive North Andover,MA 01845 Re: 220 Boxford Street,North Andover,MA Dear Mr.Osgood, The North Andover Board of Health received your plan titled,"Proposed Subsurface Sewage Disposal System,"for 220 Boxford Street,North Andover,MA.The plan is dated October 24,2005 and was received in this office October 25,2005.Unfortunately,the plan can not be approved at this time until the following items are corrected.If applicable,each item is followed by the specific section in Title 5,310 CMR 15.000,or the North Andover regulations. 1) It appears this plan is for"New Construction,"such as an addition.Note 7 of the General Notes state,"No reserve area is shown on this plan,"although reserve areas can be seen on the site plan and in the gravel-less chamber detail cross section.Please clarify. 2) Please provide Nitrogen Loading calculations.-214 3) Please include a statement as to whether or not the system is in a Nitrogen Sensitive area.-215 4) Please include any proposed expansions. -220(4)(c) 5) Please clarify note 10 on the"Construction Notes." See-354(3)(b)&(c) 7) Although the invert of the sewer pipe at the foundation will remain the same,please provide the invert elevation so the slope may be verified. 8) As per approvals from the Department of Environmental Protection,when gravelless chambers are used for new construction,it must be first proven conventional methods could be used.Please show on the plan the area that would be comprised by conventional leaching trenches with reserve. Although not a reason for denial,you may wish to consider a clean out somewhere near the middle of the 2 in. force main. Please feel free to contact this office with any questions you may have.We look forward to working with you and obtaining a septic system that will be in compliance with all regulations and assure the protection of public health and the environment of North Andover. Sinc , usan Y. Sawyer,REHS .S. ublic Health Director «4 1 w TOWN OF NORTH ANDOVER f NORT{, Office of COMMUNITY DEVELOPMENT AND SERVICES or HEALTH DEPARTMENT 400 OSGOOD STREETn� - NORTH ANDOVER,MASSACHUSETTS Ol 845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthde t c townofnorthandover.com WEBSITE:hqp://www.townofiiorthandover.com SEPTIC PLAN SUBMITTAL FORM FZ12CEIVED Date of Submission: Qckle ' d405 [ OCT 2 5 2005 M DOWN OF NORTH ANDOVER ca / HEALTH DEPARTMENT Site Location: Engineer: / �S New Plans? Yes�_Z$225/Plan Check# (includes 1St submission and one re- review only) Revised Plans? Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No Telephone#: Fax#: E-mail: Homeowner y Name: ?2Uu J1 CI 11 OFFICE USE ONLY When the submis 'on is complete(including check): ➢ Date stamp plans and letter )0. mplete and attach Receipt ➢ Copy File, Forward to Consultant ➢ V Enter on Log Sheet and Database NEW ENGLAND ENGINEERING SERVICES INC October 24, 2005 Mrs. Susan Sawyer North Andover Board of Health 0 C T 2 5 2005 400 Osgood Street North Andover, MA 01845 TOWN LT vc;CI H.°r,:ENT R HEALTH DErART�:tENT Re: 220 Boxford Street,North Andover,MA Septic System Design Dear Mrs. Sawyer, The following Septic System Design Plans and enclosures for the above referenced property are being submitted for approval. 1. (3) Copies of the Septic System Design Plans. 2. (2) Copies of the Form 11 Soil Evaluator Sheets. 3. (2) Copies of the Form 12-Percolation Test Sheets. 4. Septic Design Submittal Form. 5. Check for the Town approval If you have any comments or questions please do not hesitate to contact this office. Sincerely, . - , berly BrQ Office Manager 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 OCT 2 5 2005 r Percolation test results must be submitted with the Soil Suitability Assessment for On-'site Sewage Disposal. DEP has provided this form for use b local Boards of forms,ma be used, but p p Y Y the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer,use only the tab key Owner Name to move your 2210 ?,Z Xrz�j 2 D 5 i( 0- cursor-do not Street Address or Lot# use the return key. / o a T N AFN.D o L)c/L 44 o'45 Zq.S City/Town State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 2? o� /0.' 3 D Z? 65 /1 ;SO Date Time Date Time Observation Hole# !' / F/ 2 Depth of Perc t)l 1 7 31/17 Start Pre-Soak End Pre-Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate(Min./Inch) 1 rr,n II jcH `�`r�`„ /l AJC N Test Passed: ® Test Passed: n(� Test Failed: F-1TestFailed: El�7RMtn� B ee &, S Test Performed By: IZ,RwDc„ gc�2�E� Witnesse y: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 { Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ' M DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information 'PFTN72 K-Fly FZ Owner Name 2 Z(D3�XY`�r2o S i t Eco r Map/Lot Street Address ND2Tk AA.) fl o'jE't- N f X15 Citylrown State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair r o n 2. Published Soil Survey available? Yes ® No ❑ If yes: A Year Published Publication Scale Soil Map Unit 1 Prn/C1A k'r, Soil Name Soil limitations o 0 3. Surficial Geological Report available? Yes ❑ No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes [ No ❑ Within the 100 year flood boundary? Yes ❑ No [0 Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No Z 5. Wetland Area: National Wetland Inventory Map A,'A4 Map Unit Name Wetlands Conservancy Program Map !yJ,- Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 1 of 7 r Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) Dq oS Range: Above Normal ❑ Normal ❑ Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 'TP Z7 )S — Date Time Weather 1. Location Ground Elevation at Surface of Hole q&,aq Location (Identify on Plan ) c_E,,/-T F-jz or /-0,7- 2. .di2. Land Use: Y#(Z D S o (e.g.woodland, / odla�nd,agricultural field,vacant lot,etc.) Surface Stones Slope(%) 6-(Z r S$ o j2_tg1. 1 BGG PL-K^.l Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body '? I-oo Drainage Way ? L o Possible Wet Area 2 t o 0 feet feet feet Property Line /o o Drinking Water Well /20 Other feet feet 4. Parent Material: RPyc-A-i)o-- Tr t-L_ Unsuitable Materials Present: Yes ® No L If Yes: Disturbed Soil❑ Fill Material Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock[] 5. Groundwater Observed: Yes ❑ No U If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: SV" > q 2. Z-9 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal. Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M inches elevation Deep Observation Hole Number: Tp Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones )1-2-Z P,J1 V ► alc.5 `- i — V&Izi s 22-�9 A2 I o,R 3/3 — — — S, L - 29- 3 �cJw I�yfZ �'� v'' )_•S. X3-.5 G 10 R Additional Notes .-yo OL?.S DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal a Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M C. On-Site Review (Cont.) Deep Observation Hole Number: =Z z7 os' Date Time Weather 1. Location Ground Elevation at Surface of Hole qG•S N Location (Identify on Plan ) 1Zt &-H7- �Erge- 2. Land Use: 1-4 W A/ -5cD M L� cJ�t/L!Es (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) &12 AS-5 Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body ?i Doo Drainage Way ?/o o Possible Wet Area > /C>0 feet feet feet Property Line -5-0 Drinking Water Well Z Other -- feet feet 4. Parent Material: A 3y6-i20,y TI LL Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No EA If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 5/ t' a 9 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 7-12- Soil Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones O-i2 AT f I On 1Z Zo ala IVO s" Additional Notes iyow7 t All 6- 0#Z sTAN int N G- w,�i�2 N© lCCFy-414C- DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C C. On-Site Review (Cont.) Deep Observation Hole Number: I- 7/oS Date Time Weather 1. Location Ground Elevation at Surface of Hole 9 2 7 Location (Identify on Plan ) 2. Land Use: /-1-FLVAJ (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) 61-2 P+SS &I (z }l N E Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body > 10 0Drainage Way -?100 Possible Wet Area }i O O feet feet feet Property Line 2.5- Drinking Water Well 2oort Other feet feet 4. ParentMaterial: ,3�- o n� Tt L-L- Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No Pq If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth.to High Groundwater: 5-� c/;:�' inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: -TF 3 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 3 A- a7-q-7 Additional Notes ilk) iv Di4-1r- /L /'J EFS s L DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M C. On-Site Review (Cont.) Deep Observation Hole Number: 117--11 '-s- Date Time Weather 1. Location Ground Elevation at Surface of Hole '77 Location (Identify on Plan ) 2. Land Use: I-Aw nJ (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope ) &-0-ASS env 2Vf-(A.)c� Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body ? 10 00 Drainage Way 7 10 a Possible Wet Area > (vim feet feet feet Property Line 2 0 Drinking Water Well 2-S-0 Other feet feet 4. Parent Material: 19-�3(-4771 DN Tf LL-- Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: S-ZU 173,37 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: TIS y Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones A 103 S.L. 10-a 4 V w z-j SI S E 5/6 ��u vii REto DC9 -S . Additional Notes -;D = (ev cr- o tit S TRND i NG— w�—E2 A)O 112- DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 5 of 7 Commonwealth of Massachusetts City/Town of ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: 'r q 12-? c, Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) 2. Land Use: LA -- (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) 6-0-0 s 5 Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >10 0 Drainage Way ';r Possible Wet Area ?100 feet feet feet Property Line,� Drinking Water Well 2Z,!5"- Other -' feet feet 4. Parent Material: R G3 L-A-iloN T(-c_L_ Unsuitable Materials Present: Yes ❑ No Pg If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit — Depth Standing Water in Hole _ Estimated Depth to High Groundwater: X5,9 y ;2, ( 6 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of N Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M Deep Observation Hole Number: -rP S Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones -►y 3/3 s 9-3 L. Bw Z-s 6 3 6_O(z, 14)4 Additional Notes ry 0 w 0: 0.) vii- i-J G- w '1/L o 2C rusA L DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 4 M D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A. >54 B. inches inches / � ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes K No❑ b. If yes, at what depth was it observed? Upper boundary: 2 y Lower boundary: E3 inches inches F. Certification I certify that 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. W Wnatur6 of Soil Evaluator Date �erTRMw C OL C'0"- A10 C/ 1 9S- Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam R do z:'Sl a 0 i2 L E't2 A_2(D(Z--),y AA)D� OVE�Z Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 6 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 7M Use this sheet for field diagrams: ` TPI 1�TP2 PT! -cam+TJ Y i 2 � T►P3 T►�S aEED -Fn }-lam�SrC !Te WG�L CLO ✓-ilLr✓c� DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7 Commonwealth of Massachusetts City/Town of OCT 2 5 2005 Percolation Test _VER Form 12 IT ' M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer,use only the tab key Owner Name to move your 2 uj PCO X fj 2 D S—, a e-6 cursor-do not Street Address or Lot# use the return key. /VO 2TH AAj P o )c(2_ "Vr�q O Mcg yS- CityfTown State Zip Code tab �- Contact Person(if different from Owner) Telephone Number B. Test Results 27 -� /0' 3D 2? 6; /1 ;SD Date Time Date Time Observation Hole# P T / F/ 2 Depth of Perc 3 s)/ ) -7 31117 Start Pre-Soak /o. -3,7 . // ,,,!�_'7 End Pre-Soak /v :Sy ! oZ ;Ja Time at 12" Time at 9" /y `� -7 l a' IRS Time at 6" I� t V� /.-A ' 'Vc7 Time (9"-6") 3 ^^`✓ 15-_._-(N Rate(Min./Inch) t 'V-'- f���f-}* $ &I,` , li kvc H Test Passed: ® Test Passed: IS Test Failed: ❑ Test Failed: ❑ Test Performed By: j?,low D, r30�1 ti Witnesse y: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 IL Commonwealth of Massachusetts NERM City/Town of A U'Ve", Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Owner Name 220 3�Xr4o;?-v . i(LE-4 r Map/Lot / Y D Lc7T -7 Street Address it/D27N AA) 0 0,16-4L o"8 I s Citylrown State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair 2. Published Soil Survey available? Yes ® No ❑ If yes: /1.6/ /:i.S, e Ya H-IrA Year Published Publication Scale Soil Map Unit X-C' i- ` S e C Soil Name Soil limitations r, 3. Surficial Geological Report available? Yes ❑ No If yes: o Year Published Publication Scale Map Unit n Geologic Material Landform cn f N 4. Flood Rate Insurance Map: o C_, Above the 500 year flood boundary? Yes [ZI No ❑ Within the 100 year flood boundary? Yes ❑ No [ Within the 500 year flood boundary? Yes El No ® Within a Velocity Zone? Yes F-1No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map /U 1A Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) Oq (D5 Range: Above Normal ❑ Normal ❑ Below Normal MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 'TP '- Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) 2. Land Use: Yfi-R D S c% (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) 6-(z4 /✓A a/2-t+(AJ v�� 1��-►9�/ Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 7 t 000 Drainage Way ? e o J Possible Wet Area ? t o feet feet feet Property Line o 0 Drinking Water Well 1-7-0 Other feet feet 4. Parent Material: RP2c-t--oUnsuitable Materials Present: Yes ® No[ If Yes: Disturbed Soil❑ Fill Material Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No C2 If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 5y" 7 q-3, 79 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Texture %,b Horizon/ Color-Moist (mottles) Y Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones +22 F-11 V f-alc> V&�Zk s 22-.�9 AZ f as?, 3l _s 2q �3 Rj I0jX LOS /6 Additional Notes C�-2vv w o �`�r2c�Ei k y DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 Commonwealth of Massachusetts City/Town of ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: Tj�Z -7 0 Date Time Weather 1. Location Ground Elevation at Surface of Hole qL s q Location (Identify on Plan ) Rt&-H7- 2EHr�- 2. Land Use: G-A w n/ SCD M (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body ';;,I 000 Drainage Way ?>o,.) Possible Wet Area ? o 0 feet feet feet Property Line _,5-0 Drinking Water Well ,? Other feet feet 4. Parent Material: A R,y✓+i?,3,y T[I_(_ Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 5/ " qg.o 9 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M Deep Observation Hole Number: TP 2- Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles 8 Stones O -! Ap la-30 ALV II I onZ0 3D-°u5 Additional Notes 1VJ IA1 QF-PI N G c�►2 sr i__>r A) Cr w+q—i"z"2 a CFO,C� L. DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: '72o e a� c'S Time Weather 1. Location Ground Elevation at Surface of Hole 7 Location (Identify on Plan ) 2. Land Use: i-_4WAJ Surface Stones Slope(%) (e.g.woodland,agricultural field,vacant lot,etc.) C_2 fit-sS t'Y►�►2 Landform Position on landscape(attach sheet) Vegetation 3. Distances from: Open Water Body > 1o&:) Drainage Way ? -"10 Possible Wet Area ?t o a feet feet feet Property Line Z.5- Drinking Water Wellfe Other feet 4. Parent Material: Pr 3 c, A-D o N Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[] Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth.to High Groundwater: �� 9-A' /L inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On Sewage Disposal Deep Observation Hole Number: TP 3 ts Sol[ Soil Soil Soil Matrix: Redoximorphic Features So Texture SoilCo% ts by Vo umearse n Structure Consistence Other Horizon/ Color-Moist (mottles) (Moist) Depth Layer (Munsell) (USDA) (In.) Depth Color Percent Gravel Cobbles &Stones A-� 1 a�t�313 S L- i'a- ;�7 V?>w t o 2'SI oo Z.v J`o Additional Notes AI LD LuC� �— DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) -- Deep Observation Hole Number: T't��l 01 6s Date Time Weather 1. Location Ground Elevation at Surface of Hole R ? Location (Identify on Plan ) 2. Land Use: ►-Aw Surface Stones Slope(%) (e.g.woodland,agricultural field,vacant lot,etc.) t-(7-f:}S5 �^ R vet n 1 c, Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body ?_Jo oo Drainage Way '7- —,b Possible Wet Area > �� feet feet feet Property Line 2 0 Drinking Water Well fee 5a"� Other feet 4. Parent Material: #F, KIN Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No 91 If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 52r` I3..37 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: T� y Soil Coarse Fragments Soil Soil Soil Soil Matrix: Redoximorphic Features Texture %by Volume Structure Consistence Other mottles (USDA) (Moist) Horizon/ Color-Moist (mottles) Depth Layer (Munsell) Gravel Cobbles (In.) Depth Color Percent g Stones 9--3/3 S.L 5.2 TZFZ0r.PCID Additional Notes = ov6— oi*� r,-r"o %&)C— DEP NCDEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: �?'T"� Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) 2. Land Use: LA) — Surface Stones Slope(%) (e.g.woodland,agricultural field,vacant lot,etc.) &-a t S 5 Landform Position on landscape(attach sheet) vegetation 3. Distances from: Open Water Body }e oo-.:> Drainage Way ';,_(O Possible Wet Area 71 0� feet feet _ feet Property Line ,5 Drinking Water Well'fe Z.� Other feet Unsuitable Materials Present: Yes E] No P9 4. Parent Material: c-r�-'�lo —Cc��' If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit — Depth Standing Water in Hole _ Estimated Depth to High Groundwater: inches�a elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: --r? S Soil Coarse Fragments Soil Soil Soil Soil Matrix: Redoximorphic Features Texture %by Volume Structure Consistence Other Horizon/ Color-Moist (mottles) (Moist) Depth Layer (Munsell) (USDA) (In.) Depth Color Percent Gravel Cobbles 8,Stones -►� 'A I t�y�313 s Additional Notes 2 sTA�vi� Int G- wOasG2UC AJ� � �N G' v r 2Ci:-us G DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 7 Commonwealth of Massachusetts City/Town of ` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches VJ Depth to soil redoximorphic features (mottles) A. >5y B. .5 i" s r inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes K No❑ b. If yes, at what depth was it observed? Upper boundary: 2 y Lower boundary: £3S� inches inches F. Certification I certify that 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. r /CJI � Z160S S fiatujle of Soil Evaluator Date Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Rr1N Z�S4 8L)ERi-G, AN--) oL)&,Z Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal * Page 6 of 7 Commonwealth of Massachusetts Cityfrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet for field diagrams: `;�I T('Ll Tp2 yT1 I_Z�P TZ T P3 I iK 1 cm DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 7 of 7 LETTER OF TRANSMITTAL North Andover Health Department pE ���oTH 400 Osgood Street 3�' ��`: _ _ '"�'• �o� North Andover, MA 01845 978.688.9540- Phone ^ _ VL 's 978.688.8476 -Fax healthdei)t(&townofnorthandover.com - E-mail �qs''"*•o '��� www.townofnorthandover.com -Website Page / of s�CHUS� TO: DATE: Daniel Ottenheimer COMPANY: FROM:.Pamela DelleChiaie, Health Dept. Assistant Mill River Consulting RE: Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We are sending you: oil Test OPlans or Review L7 Other all in below) These are transmitted as checked below: OFor Review and comment OAs Requested OAs Required OFor Your Use REMARKS: COPY TO: COPY COPY TO: ``SIGNED: i BOARD OF HEALTH NORTH ANDOVER,MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS SEP 1 3 2005 DATE: 9 /02 d� MAP&PARCEL: 02/0 10 � aa0 S o r�l-� o LOCATION OF SOIL TESTS: � rc� OWNER: 2e e-r TEI.,.NO.: ADDRESS:_&o ��17�►�1� .5��. AUD/ AdopeJr ENGINEER t /1 A T TEL.NO: �1`�� ��o 1768 CERTIFIED SOIL EVALUATOR: . DS 969d r. Intended use of land: Residential Subdivision Single Family ome� Commercial Is This: Repair testing ✓ Undeveloped lot testing Upgrade for addition T I 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$425.00 per lot for new construction. This covers the minimum two deep holes.and two percolation tests required for each disposal area. Fee of 360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators.may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than lr-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not W N.A.Conservation Commission Approv : �-alb Date Received: Check Amount: Check Date: 1f(V ro M/"1 {OM1 c� too( by/13/1005 15:39 9788851099 NEW ENG ENG PAGE 01 New England FAX TRANSMITTAL w� g Engineering Services,Inc. 60 Beechwood Drive,Na Andover,MA 01845 wwwxteweinglanden&eering.net Phone:97$.686.1768 F2x: 978.685.1099 Dale, q OS~ Fax Please Deliver To: D><l SEP 13 2005 i NORTH AN U��t_;< j F,f_r;LTH DEPARTMENT I Company Name/ Address: From: /k/Y!/L RE: I xif:'kx':•:c%:t: k,,.X.,•...s,.y,rrc,,.,..r r::..}..:..^i�:...niY,i'7i5"!'.^:<.s:n:<.%.x:.%.%:'x.s:':>:: ....... ,i R�31 na w.. mail, x.k .,>~.:'..b.fx?:'::x t N: � r'r..r.r...^.^.....^.,,q•o:o>z.x.>:.x .,;a,; Atx!< ..'f•Ml,. .S.e.<.k.>x.x.>.,.<.x1rt< .S.S. ��# i; k.y.)..aS.�i.4 x+x •ki'% k..... xlx. .SkeM:ok:S:x �7rYY ,klC•.•k:k!fiu:c '1^%•xer..x.>:ox•xo .. .k.!.k:k.!4k: iSpr,Sf•Crl i!.' k.kK...k•' :SF::S::S:Y:/:2:!kM<.S!k':f', f.�Q•S: NINE IOU 1f o5rixx:x ,.3�44 !! 4 ,' uapxx'u.�.u:4:'S:s '�<. !u?'Ke^. Y>: Y1k >t•K>^x 'VW %'WS:NF:1kaW)' .b'6,Foix'Kiiriisk3�x,`Sru;k.f:<:kifi?�rNk :<.xX.n}te 4k .' e•�•.:nA:.:' 5! f!i r 7� %•.xN• k k fSx S:.Y i�ik Y o�x Hie .:6MN k'k'Sr i::' >Y.k.., T. ` A4SiMy<%. F x'S• >Z•�i>ti 'fi!•k .k <x�Y' � iSTbxa:�.:<. :.%• ?01*X 1.l S,� 60AA L50/ 1 as 0 SOX y S Urgent Reply Requested Reply Today x Reply at Your Own Convenience No Reply Necessary Total pages,including Cover Shec (If all pages are not received,please notify our firm as soon as possible,) bylld/2bb5 15:jj 'Jt8bdbIU9J NEW ENG ENG PAGE 02 + N Noll. SEP 13 2005 N0 LaF rc.gNDS TOWN Or UORTH ANDOVER ON y I i HEALTH DEP R?'r''IE�iT ,(L�^ w cn-r l wr O 7e 7— A tiC. TJLe C 1_1 I 4'Z 2 0 • I , X � 2p Sr 2Pr t DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, June 26, 200311:23 AM To: Starr, Sandy Cc: Griffin, Heidi; Lagrasse, Brian Subject: 220 Boxford Street-Question on Garbage Disposal for Septic Importance: High Hi Sandy, Received a call just now from a Pam Keiver of 220 Boxford Street. She was told from Home Depot, Peabody Supply, Plumbers, etc.that there is a special kind of garbage disposal that can be used just for septic systems. It has special enzymes that can be used with it. She is trying to decide if they will pursue putting on an addition and getting septic system approved, or wait for sewer hookup, as her property abuts the farm where the Foster Farm School will be going. Can you call her regarding garbage disposal question at 978-681-9925? 1 read her some of the information from our septic flyers on what is involved in doing additions, etc.,with septic, but she still wanted to speak with someone, and would like a call back today. Thanks. Pamela DelleChiaie, Health Dept. Assistant Town of North Andover Community Development& Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover.com Tel. 978-688-9540 Fax 978-688-9542 1 MASS. LICENSE # 55 Town of North Andover M.G.L. CHAP. 21, SEC. 16 Massachusetts Board of Health Date 7-28-90 APPLICATION FOR WELL AND PUMP PERMIT Application is hereby made for a permit to drill (x) or repair ( ) a well. Application is also made to install ( ) major renovation ( ) or major repair ( ) of pump system. Location: Address 220 Boxford Street, North Andover, MOot Number Owner Mary S. Kimball Address 220 Boxford Street , North Andover, MA Well Contractor CharlesM.RollinsCo.,1Wddress 129 Depot Road, Boxford, MA Pump Contractor Address WELL CONTRACTOR (To be filled in at time of pump test) Type of Well Drilled Well Used For Domestic Diameter of Well 6" Size of Casing 6" Depth of Bed Rock 57 ' Depth of Casing into Bed Rock 80 ' Was Seal Tested? Yes ( ) No ( ) Date of Testing Depth of Well 505Well Ended in What Material Rock Depth to Water 24 ' Delivers 5 Gallons/per/Minute Drawdown feet after pumping hours at GPM. Sketch map of well, location with tie down lines on reverse side of this rm. Date of Completion 7-26-90 Well Contractor's Signature PUMP INSTALLER (To be filled in before installation) Size and Name of Pump 3/4 H.P. Gould Type of Pump Used Submersible ".ater Pump Delivers 12 GPM Size of Tank 100 Gallons Pipe material used in Well : Cast Iron ( ) Galvanized ( ) Plastic k)a If plastic, test strength 160# " ell pit ( ) or Pitless adapter fix) .'.ns sleeve used to protect pipe? Yes ( ) No ( ) Type or Name of Well Seal Date 7-31-90 ��� Pump Installer 's Signatu e •r an:i ivsis report submitted to Board of Health mate relrase given to owner of record and Building Inspector Health Inspector Mxx-xRxrxxMXXRx-X Robert Goebel ®Boxford St. APPLICATION FOR SEWAGE DISPOSAL IIETALIATION HEALTH DEPARTMENT - NORTH ANDOVER, MSS. I hereby make application for a permit for a sewage disposal installation at Boxford at. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gal. in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of -i8o lineal Jp Ap� feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/811 to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA T Si nature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE ?s' Signature of Inkdecting Officer Percolation Test i min. Soil: SandY Garbage Grinder No i t r ` BOARD OF HEALTH 1( TOWN OF NORTH ANDOVER, hMSS. �� s 4,51 � C>t$T.VOK - 701 .._..._....��.�......._..... SF iL -71y t�-- - y 9' 1 30 I. NAVE . !�:G�-�- . . . . . . . . . DATE 2. ADDRESS � � !': . LOT N0. TEL 3. N0, OF BEDROOI,,S . . . . . NO.. . 4. GARBAGE GRINDER YES . . NO.. 5. SHOW DII;4ENSIODIS OF HOUSE x ' 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMIZIOAIS OF LOT 300 8. SHOW LOCATION AND SIZE OF SEPTIC TANK SOL -75-0 q. NOTE LOCATION AND DISTANCE OF WELL FRO1:1 SEVVERAGE SYSTEM 10, SHOW LOCATION OF BROOKS, STIM0,3i , DITCHES, OUTCRO , ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE N0,TE: LOCAI, REGULATIONS SHOULD EE READ CAREFULLY. 1 M4 ��s .�l'•tr't-LL. � cv�, a., 5 S U'1�-�-� �ac a.-.-e . .i June 23, 1962 r" Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Boxford Street building site of Robert Gable. The land in general is high. The subsoil in the area was of sand content and a 3-minute percolation test was conducted. It is recommended that a 1,000 gallon concrete septic .tank be installed together with 180 lineal feet of drain pipe. Very truly yours, illiam J. riscoll WJD:hd