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2101106-A-0069-0000-0
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Parcel ID:210/106.A-0069-0000.0 Community:North Andover
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Summary
Residence
Detached Structure
Condo _ ..
Commercial ---
Comparable Sales
23 FOREST STREET
Location: 23 FOREST STREET
Owner Name: MARTIN REALTY TRUST
E C&S S MARTIN,TR
Owner Address: 23 FOREST STREET
City:NORTH ANDOVER State: MA ZIP: 01845
Neighborhood:6-6 Land Area: 1.74 acres
Use Code: 101 -SNGL-FAM-RES Total Finished Area: 1472 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 421,800 398,500
Building Value: 185,000 185,100
Land Value: 236,800 213,400
Market Land Value:236,800
Chapter Land Value:
LATEST SALE
Sale Price: 1 Sale Date:09/30/1999
Arms Length Sale Code: F-NO-CONVNIENT Grantor:EDWARD MARTIN
Cert Doc: Book: 05568 Page:0290
http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=990826 4/24/2007
Residential Property Record Card
PARCEL_ID:210/106.A-0069-0000.0 MAP:106.A BLOCK:0069 LOT:0000.0 PARCEL ADDRESS:23 FOREST STREET
PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 05568 Road Type: T Inspect Date: 09/18/2003
Tax Class: T Sale Date: 09/30/1999 Page: 0290 Rd Condition: P Meas Date:
Owner: Tot Fin Area: 1472 Sale Type: P Cert/Doc: Traffic: M Entrance:
MARTIN REALTY TRUST Tot Land Area: 1.74 Sale Valid: F Water: Collect Id: RRC
E C & S S MARTIN,TR Grantor: EDWARD MARTIN Sewer: Inspect Reas:
Address:
23 FOREST STREET Exempt-13/1_0/6 0/0 Resid-B/L% 100/100 Comm-B/LOMO Indust-B/L% 0/0 Open Sp-B/L% 0/0
NORTH ANDOVER MA 01845
RESIDENCE INFORMATION LAND INFORMATION
Style: RN Tot Rooms: 7 Main Fn Area: 1472 Attic: NBHD CODE: 6 NBHD CLASS: 6 ZONE: R1
Story Height: 1 Bedrooms: 4 Up Fn Area: Bsmt Area: 1472 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class
Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 230,868
Ext Wall: AV Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0.74 5,920
Masonry Trim: Ext Bath Fix: Tot Fin Area: 1472 DETACHED STRUCTURE INFORMATION
Foundation: CN Bath Qual: T RCNLD: 180206 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: SE C 80 1988 A A ///89 200
Heat Type: HW Ext Kitch: Year Built: 1958 Sound Value: GR S 80 1988 A A ///89 4,600
Fuel Type: O Grade: AG Cost Bldg: 180,200
Fireplace: Bsmt Gar Cap: Condition: A Aft Str Vail: VALUATION INFORMATION
Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12: Current Total: 421,800 Bldg: 185,000 Land: 236,800 MktLnd: 236,800
Aft Gar SF: %Good P/F/E/R: /100/100/77 Prior Total: 398,500 Bldg: 185,100 Land: 213,400 MktLnd: 213,400
Porch Type Porch Area Porch Grade Factor
E 194
W 105
SKETCH PHOTO
E E W E
8 96 Sq.Ry S22 Ft. 185 Sq. A9 S Ft.
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212/4FSc A. 1248 q.R. 528 Sq.Ft.
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23 FOREST STREET
13arcel ID:210/106.A-0069-0000.0 as of 4/24/07 Page 1 of 1
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
1 �I�'I�A� Off' C(� 11�'GI.,�.�i��
As. of:
Way 11, 2007
q-his is to cert that the individuaf subsurface clisposafsystem received a
S4T15T,4CT0 T1XST'FCT10X of the:
TuffSeptic ,System Xepair
�By:
2'odd(Bateson
At:
23 (Forest ,Street
.forth fl ndover. 914,4 01845
The Issuance of this certificate shaCC not be construed as a guarantee that the system wiCC
function satisfactori)5.
1
i9victefe E. «'rant
,Pu6Cir,7fea.Cth inspector
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.6889540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT APR 2 3 2007
Community Development Division TOy,r tv O,
UCVER
f:EAST
, 'T
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(Jfconstructed;( )repaired;
(Print Name)
Located at: z:;-2-'7 f5o P T
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
�-7-'p (o and last revised on '�P 1 -Z-10-7 ,with a design flow of
-44o gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local
regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on
the As-built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: /'"77
Engineer Representative(Signature)
And-Print Name ,J
Final Construction Inspection Date: _I -e7-7.
Engineer Repr entative(Signature)
V2 i L�,i Vt4 t'r a-9
And-Pri::t Natne
Installer• ' nature) Dater I I
0'1. as{ J And-Print Name
Engin
er: (Signature) Date: OV-312 ov
iUEi4�C;4•�fdC?fC
CL� No.39840 cfvff G) V44olvil 40W6Y�C.14-1,e-
And-Print Name
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1 sgood Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandaver.com
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AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
(/ TIES TO LOT
(, LINES &DWELLING, WELLS
a. FROM-SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES &PERC
TESTS
r
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
/// DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK&D-BOX L--L- cLti bre C-f'
ORIGINAL STAMP& SIGNATURE
IMPERVIOUS AREAS -DRIVEWAYS, ETC.
i/ NORTH ARROW
�- LOCATION& ELEVATIONS OF BENCHMARK USED
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PUBLIC HEALTH DEPARTMENT
Community Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 23 Forest Street MAP: 106A LOT: 69
INSTALLER: Bateson Enterprises Inc.
DESIGNER: Merrimack Engineering Services
PLAN DATE: December 2, 2006
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANK INSPECTION: q11 01 v-)
DATE OF BED BOTTOM INSPECTION: Qho�o�
DATE OF FINAL CONSTRUCTION INSPECTION: April 13, 2007
DATE OF FINAL GRADE INSPECTION: 5111 I o-�
SITE CONDITIONS
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
Comments:New water line from street installed (noted on 4/13/2007)
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
® 1,500 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
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
SEPTIC TANK (Continued)
® 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:
PUMP CHAMBER (Check Here if not applicable ®)
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ Combo Tank installed. Size:
❑ 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 by
Visual testing
❑ Hydraulic cement around inlet & outlet
Comments:
DISTRIBUTION-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:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
SOIL ABSORPTION SYSTEM (General)
Bottom of SAS excavated down to 6 in into C soil
layer, as provided on plan
® Size of SAS excavated as per plan
® Title 5 sand installed, if specified on plan
❑ 40 Mil HDPE barrier installed
❑ Retaining wall (boulder/concrete/timber/ block)
❑ Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand and Model of Chamber Infiltrator Quick 4
® Number of chambers per row 7
® Number of rows (trenches) 6
❑ Laterals installed and ends connected to header (and
vented if impervious material above)
® Elevations of laterals and chambers installed as on
approved plan
Comments:
CONTROL PANEL (Check Here if not applicable ®)
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel:
❑ Rated for exterior if placed outside
❑ Alarm signal located inside
Comments:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
SYSTEM ELEVATIONS
INVERT INFIELD PLAN INVERT ELEV.
Benchmark 100
Building Sewer OUT 96.76 97.05
Septic Tank IN 96.64 96.57
Septic Tank OUT 96.41 96.32
Pump Chamber IN N/A N/A
Pump Chamber OUT N/A N/A
Distribution Box IN 96.16 96.17
Distribution Box OUT 96.07 96.00
Lateral 1INV 95.99 95.97
Lateral 1 TOP 96.30
Lateral 2INV 96.01 95.97
Lateral 2 TOP 96.30
Lateral 3INV 95.97 95.97
Lateral 3 TOP 96.30
Lateral 4INV 95.97 95.97
Lateral 4 TOP 96.30
Lateral 5INV 95.97 95.97
Lateral 5 TOP 96.30
Lateral 6INV 95.98 95.97
Lateral 6 TOP 96.31 96.30
Bottom of Sand @ 95.30 95.30
Trench Invert BEGIN
Bottom of Sand @ 95.32 95.30
Trench Invert END
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnarthandover.com
NORTy
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PUBLIC HEALTH DEPARTMENT
Community Development Division
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
Tank SAS Sewer
❑ Property line 10 10 --
❑ Cellar wall 10 20 --
❑ Inground pool 10 20 --
❑ Slab foundation 10 10 --
❑ Deck, on footings, etc 5 10 --
❑ Waterline 10 10 10'
❑ Private drinking well 75 1002 SO
❑ Irrigation well 75 100
❑ Surface Water 25 50
❑ Bordering Vegetated Wetland ,
Salt Marsh, Inland/Coastal Banka 75 100
❑ Wetlands bordering surface
water supply or trib. (in Watershed) 150 150
❑ Trib.to surface water supply 325 325
❑ Public well 400 400
❑ Interim Wellhead Prot.Area
❑ Reservoirs 400 400
❑ Drains(wat. supply/trib.) 50 100
❑ Drains(intercept g.w.) 25 50
❑ Drains(Other)Foundation 10(5) 20(10)
❑ Drywells 20 25
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland
bylaws
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Map-Block-Lot
Commonwealth of Massachusetts 106.A-0069-
c Board of Health Permit No
o +' BHP-2007-0056
North Andover
--------------------
- ; FEE
"•, .«k«:.. ,� ' P.I. -----------------------
2500
'�I 1"'•.r•s.t"�y
�sawcNuye� F.I.
Disposal Works Construction Permit
Todd-Bateson ---------------------------------
Permission is hereby granted ----- --------- ------------------------------------------------------
to(Repair)an Individual Sewage Disposal System.
atNo 23 FOREST STREET -- ------- - ------------------------------------------------------------------------------------------
--------------------------------
---------- -- - - -
------ - --------
as shown on the application for Disposal Works Construction Permit No. BHP-2007-005__ Dated---March-2-2,2-007
__March 22,___ _
q -;fq�,�------- -----------
-17
o d t
Issued On:Apr-05-2007
f �OMTH 1 A„„lication for Septic Disposal System _-__--
k o;,Construction Permit - TOWN OF TODAY'S DATE
^� NORTH air
ANDOVER, MA 01845 pr
$12 . ponent
`SACHU`��
Important: Application is hereby made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal system*
forms on the
computer,use SKepair or replace an existing on-site sewage disposal system*
only the tab key
to move your ❑ Repair or replace an existing system component
cursor-do not
use the return A. Facility Information d�
key.
Address or Lot#
Cityrrown �tGz A
2.- *TYPE OF SEPTIC SYSTEM*:
❑ Pump �ravity (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
Address(if different from above)
CitylTown - ----- ----------- Stat Zip Code
- --_—_--
Tel a Numb
3. Installer Information
_ 1 G' A_e L'AQ Sd� — A 4e-Soca/ 1/v� ��✓L ---...._
Name Name of Company
Address ,,�,�
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
4. Designer Information
Name Name of Company
Address
--
CitylTown State Zip Code
---------------
-- ----'l'7 5- 3 5�5 --- _
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page t of 2
Application for Septic Disposal System _;-
3
pConstruction Permit - TOS OF TODAY'S DATE
ORTH ANDOVER MA 01845 $ 250.00—Full Repair
��.���.. :•Kt„ • $125.00 -Component
PAGE 2OF2
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
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andov r,and not to place the system in operation until a Certificate of Compliance has
been iss y this Board of Health.
7m-1.1 3- 7
Name Date
Application pproved By: oard of Health Representative)
Name Date
zA.)
- -
plicaion Disapproved for the following reasons:
For Office Use Only:
L Fee Attached? Yes No
2. Project Manager Obligation Form Attached? Yes V/11 No
3. Pump S, sy tem? If so,Attach copy f Electrical Permit Yes_ No r/
4. Foundation As-Built?(new construction ronly): Yes_ No
(Same scale as approved plan)
S. Floor Plans?(new construction only): Yes_ No
17 ^o -
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(address of septic system) For plans by t �0C `�Ci
(� (Engineer)
Relative to the application of-7a749-4 \(�,q �R�j�c/
(Installer's name) And dated
ngma ate
Dated —3 — �---
o ay s ate With revisions dated
(Last revised date)
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 manager, 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 Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
my company.
a. Bottom of Bed–Generally, this is the firste(l') inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection–Engineer must first do their inspection for elevations, ties, etc.
As-built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a 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. Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done 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 ofHealth staff or consultant.
d. Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer, I understand that I am solely responsible for the installation of the system as per the
approved plans. No instructions by the homeowner general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date) 3— "7
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arae– rint e–Signed)
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Health Department
January 31, 2007
Vladimir Nemohenck, P.E.
Merrimack Engineering Services, Inc.
66 Park Street
Andover, MA 01810
Re: Wastewater Treatment and Dispersal System Plan for 23 Forest Street
Map 106A,Lot 69
Dear Mr.Nemohenck:
The proposed wastewater system design plans for the above site dated December 2, 2006 and
received on December 14, 2006 has been reviewed. Unfortunately, they cannot be approved until
the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North
Andover regulation that is not met by this design follows each item.
1. Please provide a description of the proper method of abandonment of the existing
wastewater system—354
Please clarify whether you intend to specify an effluent filter or not. The plan details are
unclear. If to be used, the plan must indicate that annual maintenance is required, and
must indicate a brand and model which is approved for use in Massachusetts
3. Please indicate the distribution box is to have all outlets discharge at the same elevation—
232
4. Please indicate the requirement for an inspection port(s) in the soil absorption system and
provide appropriate detail specifications—240
5. Please clarify the specifications and labels for the gravel-less chambers indicated. The
design appears to be based on the Infiltrator-brand Quick4-model chambers, while the
details are labeled for the Infiltrator-brand Standard-model chambers. This should be
clarified.
6. Please provide for a primary(septic)tank detail which depicts the tees located beneath the
access openings - 227
7. There is only one test pit in the leach area, however, since the soils seem very consistent
we do not see a problem with this. This would require an additional soil test or a Local
Upgrade Approval for only having one test pit in the soil absorption system area
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1
Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
8. The design uses a field instead of trenches, and no explanation is provided as to why
trenches are not used- 240
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sincerely,
uY. Sawyer,2vt--
san
Public Health Director
cc: Owner
File
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS 9 LAND SURVEYORS PLANNERS
66 PARK STREET• ANDOVER,MA 01810•(978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL Info@merrimackengineedng.com
February 8, 2007
Susan Sawyer, Public Health Director
1600 Osgood Street
Building 20, Suite 2-36 '
North Andover,Ma. 01845G��
FEB 0 3, 2007 /
RE: 23 Forest Street 6P le"i5=�i o
TOWN OF NORTH ANDOVER
HEALTH DEPARTfiSENT
Dear Ms. Sawyer:
We have received your review letter dated 1-31-07 for the above referenced site. Enclosed is a
copy of a completed Local Upgrade Approval Form as requested in item#7 of your letter.
With regards to the remaining 7 items of your letter,this information was all shown on the
originally submitted plans. These comments are repetitive comments made on previous reviews
and are unnecessary. I have added the LUA request to the plan and as a courtesy, I have
highlighted the 7 items on one of the enclosed prints and numbered them to correspond to your
review letter. Additionally, I have enclosed a copy of the e QUICK 4 STANDARD infiltrator
brochure (item 5).
In all fairness to you,I understand that these are not necessarily your comments but that of your
consultants',Mill River,however if you would take the time to review their comments before
drafting a letter to the designer it avoid unnecessary costs and delays to the home owner.
I would appreciate your prompt attention to this matter and consideration of the LUA request at
this months BOH meeting.
'erY Y trul yours,
�
i�
fJ 1ERRIMACK ENGINEERING SERVICES INC.
illiam Dufresne, Project Manager
limey�'i�2�
Commonwealth of Massachusetts
Cityffown of
Local Upgrade Approval
Form 913
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility information
knipactngwen fillingout 1. Facility Name and Address
forms on ft
Computer,use Edward Martin
only the tab key Name
to move your 23 Forest Street
cursor-do not Sleet Address
use the return
key. North Andover MA 01845
City/Town State Zip Code
cm
2. Owner Name and Address(if different from above):
Name Street Address
Cityrrown State
Zip Code Telephone Number
3. Type of Facility(check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: gpd
5. System Designer: Name ❑ PE ❑ RS
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for:
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
23 Forest St App 2.27.07•rev.7/06 Local Upgrade pg ApprovaP Page 1 of 2
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Forth 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater.
Separation reduction ft
Percolation rate min Anch
Depth to groundwater ft
❑ Relocation of water supply well(explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a pert test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
Only one test pit within SAS
List variances granted requiring DEP approval:
North Andover Health Department
Approving Authority
Susan Sawyer, Health Director ,-,,February 27, 2007
Print or Type Name and Tdie nature Date
23 Forest St App 2.27.07•rev.7106 Local Upgrade Approval- Page 2 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection –Wastewater Management Program
Form 9A - Application for Local Upgrade Approval
Required by 310 CMR 15.403(1)
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address
forms on the ,!
computer,use UL LA 942 1 A C-rl hJ IZ�C�71 0�`,2C=�
only the tab key Name
to move your Z:5z'? F y g'F- Z7-r
cursor.do not Street Address
use the return t I -� / f
key. 1� OM; YA A �/ E-7-71Q— Lj A,
City State Zip Code
tab
2. Owner Name and Address:
E e"A WQ —I-'I A 121-1 �
Name T Street Address
k k2 qL i-j A E�-i;7-
City State
Zip Te ep one umber
3. Type of Facility(check all that apply):
residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) [✓] Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
U 0
t5form9a•rev.5/02 Application for Local Upgrade Approval•Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Wastewater Management Program
Form 9A - Application for Local Upgrade Approval
Required by 310 CMR 15.403(1)
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: gp 01G e'x �
Design flow of proposed upgraded system
gpd
Design flow of facility 4140
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
�luntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection
2. Describe the proposed upgrade to the system:
(.�Eu7 l � Gn/t.i v t�C1r �'�C►.��/Z -7'7 Z- 7r- LrCxc-d
3. Local Upgrade Approval is requested for:
❑ Reduction in setback(s)-describe reductions:
❑ Percolation rate for 30 to 60 min./inch: mm./inch
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
ft.
Percolation rate min./in h
Depth to groundwater
ft.
❑ Relocation of water supply well (explain):
t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 2 of 4
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection —Wastewater Management Program
Form 9A - Application for Local Upgrade Approval
Required by 310 CMR 15.403(1)
her requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
Cti
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system.in full compliance with 310 CMR 15.000 is not feasible:
Ear err N6 �T-C 69 10al ,aoA )'l2kIii`r� c
Z-I
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:A,,A
3. A shared system is not feasible: AJ4.
4. Connection to a public sewer is not feasible:
Qv t, Ai.✓A 1 L.6 e2 1_.-C' C,'
t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Wastewater Management Program
Form 9A - Application for Local Upgrade Approval
Required by 310 CMR 15.403(1)
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
21"C'omplete plans and specifications
E9,-Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"l, the facility owner,certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
�^ � o
Facility Owner's Signature Date
r a4An.P ►- ►ter, ►.�
Print Name
I L+- tau F►�t •fir:/+-t is �� t�u��s !OE t &-et—,7
Name of Preparer �— Date
Preparer's address City/Town
-"kz-�- �� i a 6 -/&
State/ZIP Telephone
NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade
approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of
Resource Protection, Division of Watershed Management, upon issuance by the local approving
authority and before commencement of construction.
t5forrn9a•rev.5/02 Application for Local Upgrade Approval•Page 4 of 4
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optimal installation flexibility. Ideal for curvet
The evolutionary Quick4TM Standard Chamber is the most advanced, quickest
to install leachfield product available today. Ideal for curved and straight
systems, it's the only leachfield product installers will ever need for
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PUBLIC HEALTH DEPARTMENT
Community Development Division
February 27, 2007
Edward Martin 'y
23 Forest Street
North Andover, MA 01845
RE: Septic System Design, 23 Forest Street,�North Andover, Map 106A, Lot 69
��
Dear Mr. Martin,
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by Merrimack Engineering Services,
dated December 2, 2006, last revised February 8,2007. This approval includes a Local Upgrade
Approval for the request to have only one test pit within the area of the proposed system. This
plan is valid for two years from the date of a septic system that did not meet the acceptable
criteria in the state regulations.
The design has been approved for use in the construction of an onsite septic system for a 4-
bedroom house(maximum 9-room). During this time, a licensed septic system installer must
obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the
installer, designer and the Town of North Andover. In the event an imminent health problem
such as sewage backup into the dwelling is occurring,the North Andover Board of Health may
reduce the time period for which this plan is valid.
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.
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 or imply
compliance with any of the aforementioned requirement.
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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
may have.
Sincerely,
Y. Sawyer,REHS/RS
Public Health Director
Encl: list of licensed septic system installers
Cc: Merrimack Engineering Services
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
NORTF1
OE4t460 $61tiO
A G
��SSACHUS t�J
PUBLIC HEALTH DEPARTMENT
Community Development Division
February 28, 2007
Merrimack Engineering Services
Attn: Bill Dufresne
66 Park Street
Andover, MA 01810
Re: 23 Forest Street North Andover, MA 01845
Dear Bill:
I went over your letter with Mill River. I don't like missing things either. The numbering of the
plan in regards to the items missing was a great idea. I think sometimes we don't detail the item
enough so that the engineer can know where we are coming from. Of course being too wordy can
be a problem,but it will have to be so that we are on the same page. Some of the items you
circled are basically 50%of what we need so I will try to be clearer. Our goal is to provide a plan
that any installer can pick up and install, without any guessing on their part. This will mean
fewer mistakes. You may feel that basically this is impossible,but we can only try. Though you
may find some items nit picky, once some of them are changed on your CAD you will be set. I
am returning your highlighted plan via mail so you can see what I am referring to. Also,please
note we always need one original stamp and signature on a plan.
1. Please provide a description of the proper method of abandonment of the existing
wastewater system- 354 correct- it is #12 on the plan
2. Please clarify whether you intend to specify an effluent filter or not. The plan details are
unclear. If to be used, the plan must indicate that annual maintenance is required, and
must indicate a brand and model which is approved for use in Massachusetts septic tank
details say either a gels baffle or tee filter and the profile says what to do depending on
which is chosen. We do not think it should be up to the installer to make this decision. I
personally think the engineer would want what they prefer as it will definitely affect the
systems function. There is no requirement to have a filter, so it is the engineers' choice.
The clearer the better.
3. Please indicate the distribution box is to have all outlets discharge at the same elevation-
232 you highlighted the six inches for the outlet, but the elevations must be the same. We
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
don't assume the installer is confirming the elevation of the outlets and are asking to note
that on the plan
4' Please indicate the requirement for an inspection ports) in the soil absorption system and
provide appropriate detail specifications - 240 The infiltrator end section is accurate, but
an installer needs to know where in the field to place them. You asked what N. A.
prefers. We have no rule; however, as an inspector I would encourage l port in each
infiltrator row opposite:the d-box end.
5. Please clarify the specifications and labels for the gravel-less chambers indicated. The
design appears to be based on the Infiltrator-brand Quick4-model chambers,while the
details are labeled for the Infiltrator-brand Standard-model chambers. This should be
clarified. OK
6. Please provide for a primary (septic)tank detail which depicts the tees located beneath
the access openings -227 The narrative says" beneath covers" and yet your highlight of
the detail shows them not in the center. The drawing on the CAD should be changed to
look like what it says.
7. There is only one test pit in the leach area;however, since the soils seem very consistent
we do not see a problem with this. This would require an additional soil test or a Local
Upgrade Approval for only having one test pit in the soil absorption system area ok
Sincerely,
Jz
r` Sdsan Y. Sawyer,REHS/�
Public Health Director
Enc: Marked up septic plan
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web http://www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
March 22, 2007
Edward Martin
23 Forest Street
North Andover, MA 01845
RE: Septic System Design, 23 Forest Street,North Andover, Map 106A,Lot 69
Dear Mr. Martin,
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by Merrimack Engineering Services,
dated December 2, 2006, last revised March 12, 2007. This plan has been approved. The
approval includes a Local Upgrade Approval for the request to have only one test pit within the
area of the proposed system. This plan is valid for two years from the date of this approval.
The design has been approved for use in the construction of an onsite septic system for a 4-
bedroom house(maximum 9-room). During this time, a licensed septic system installer must
obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the
installer, designer and the Town of North Andover. In the event an imminent health problem
such as sewage backup into the dwelling is occurring,the North Andover Board of Health may
reduce the time period for which this plan is valid.
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.
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 or imply
compliance with any of the aforementioned requirement.
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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
may have.
Sincerel ,
Susan Y. Sawyer,REHS/RS
Public Health Director
Encl: list of licensed septic system installers
Cc: Merrimack Engineering Services
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
f
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET•ANDOVER,MA 01810•(978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL Info@merrimackengineering.com
March 12, 2007 ,� r
Susan Sawyer, Public Health Director MAR 1 5 2007
1600 Osgood Street
Bldg. 20, Suite 2-36 ,,
North Andover, MA 01845 TOHN OF EALLTN�DEPART,0pTER
RE: 23 Forest Street
Dear Ms. Sawyer,
I am in receipt of your letter dated February 28, 2007 regarding the above referenced site.
I have revised the plan to specifically require an effluent tee filter. I have also added the
elevation of the distribution outlets to the d. box detail as requested. Lastly, I have added
the location of an inspection port to the plan view.
With regard to the number of inspection ports,title 5 requires only one per s.a.s. and
therefore only one is proposed. From a practical stand point the ports are provided to
inspect the sand layer below the chambers,not the chambers themselves and providing
one port for each row of chambers would not provide any added benefit. Why not require
one port for each chamber?
With regard to your comment regarding the d. box elevations all being the same, I fail to
see how a contractor could not understand that the distribution outlets are to be
constructed at the same elevation when the previous plan showed the outlet elevation in
the profile,the d.box to be set level and all 5outlets at equal distances from the bottom of
the box (6-in.). Do you have licensed installers who do not know that the distribution
outlets are at the same elevation?Isn't a test performed at final inspection to assure these
elevations are the same? Flow equalizers were invented specifically for this reason. I
think this point is very clear and known by any licensed installer even before looking at a
plan.
With regard to item#6 of your letter, it seems to me that you think the word beneath and
center are synonymous. The location of the tees as shown on the CAD drawing is very
deliberate. Covers are required to be 20 inches in diameter and the tees are required to be
directly beneath the covers, any where beneath the 20 inch covers,not specifically in the
center. This plan requires the tees to be beneath the outer edge of the covers. Covers are
used for access to the tank for many reasons,not just to access the tees. The covers are
used to pump and maintain the tanks,to visually inspect the interior of the tank, to access
the tank with other equipment. Placement of the tees in the center of the covers impairs
the ability to use the covers for all the intended purposes.
This point has been argued to your department and to the reviewer in the past.
I feel that this design meets the requirements of Title 5 and the N.A. BOH regulations and
will provide any licensed installer all the necessary information to install the system
properly.
On behalf of our client, we respectfully request this design be approved as re-submitted.
Yours truly,
MERRIMACK ENGINEERING SERVICES, INC.
William Dufresne, Project Manager
MERRIMACK ENGINEERING SERVICES,INC. • 66 PARK STREET • ANDOVER,MASSACHUSETTS 01810
Bill Dufresne,Consulting Engineer LETTER OF TRANSMITTAL
Merrimack Engineering Services, Inc.
-66 Park Street - 907 Ocean Blvd.
-Andover, MA 01810 - Hampton,NH 03842
-(978)475-3555 Ext. 20 - Cell: (978) 502-6206 R-2-Co"EI ED
Fax: (978)475-1448 MAY 10 2007
Email: brdufresne@comcast.net
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
TO:Board of Health DATE:5-2-07
Susan Sawyer RE:23 Forest Street
WE ARE SENDING YOU: ( )PRINTS (x )PLANS ( )SPECIFICATIONS ( )COPY OF LETTER
COPIES DATE NO. DESCRIPTION
1 4-11-07 As—Built Septic Plan(revised)
THESE ARE TRANSMITTED as checked below
(x )FOR APPROVAL ( )FOR YOUR USE ( )AS REQUESTED
( )FOR REVIEW AND COMMENT ( )APPROVED AS SUBMITTED ( )RESUBMITTED WITH REVISIONS
REMARKS
Susan,
I have added an original stamp to the plan,also added a scaled dimension from the s.a.s.to nearest property line.The ties
from hse corner A and B are already shown on the plan.
SIGNT
TOWN OF NORTH:ANDOVER
� NORTH{
Office of COMMUNITY DEVELOPMENT AND SERVICES
.. GA
HEAL'T'H DEPARTMENT
« «�
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH ANDOVER, MASSACHUSETTS 01845
SACHUSE
Susan V.Sawyer,REHS,RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
healthde tc townofnorthandover.com
www.townofiiorthando er.coiREDEIVED
APPLICATION FOR SOIL TESTS
DATE:A I_2-or NOV -� 3 2006
e MAP&PARCEL:
TOV�OFI�C)F2Ti i ANDOVER
LOCATION OF SOIL TESTS:_ 7i� rp '�+ HEALTH DF�aRTMFNT
OWNER:— V lvl.� YL1'> - dl.W,-t'1 ' Contact#:
APPLICANT: !! A"6 Contact#:
ADDRESS: Z�� IAC/ ,� f l �—
ENGINEER: 2106n"nom' ontact#:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision gleily 1Iom Commercial
IsThis: Repair Testing:—t---'
esting: Undeveloped Lot Tes ��Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No vim,
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership(Tax bill,or letter from owner permitting test)
➢ 8.5"x] "plot lan&Location o Testin leas tojigate test pit sites on the lan
➢ Fee of$42L 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 unerades.
➢ Only Certified Soil Evaluators may GENERAL INFORMATION
y perform deep hole inspections.
➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A.Conservation Commission Approval Date:
Signature of Conservation Agent:
Date back to Health Department. (stamp in): Gt(o
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TOWN OF NORTH ANDOVER Of HORTy
Office of COMMUNITY DEVELOPMENT AND SERVICES o� ` '`'° -0
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 *^ =
NORTH ANDOVER, MASSACHUSETTS 01845 �4SSACHOS
978.688.9540—Phone
Susan V.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL: healthdept@townofnorthandover.com
WEBSITE:http://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM RECEIVED
Date of Submission: l �-CG—�� DEC 14 2006
Site Location:
rO 1ja� � •Z-'��F rD EALWN�7 NORTH
Engineer: LAe'YE*4 I4AcAC, fF0 61 NdT,—Zd
New Plans? Yes ✓ $225/Plan Check# 5 7 (includes 1St submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes L,-/ No
Local Upgrade Form Included? -NA Yes No
Telephone#: M'70) +-� +r.. Fax#: (4'7 5,1 ZHO
E-mail:—
Homeowner
Name: kE L169J2 -'�'i 0
OFFICE USE ONLY DEC 14 2006
When the submission is complete(including check): TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
➢ ate stamp plans and letter
omplete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
i
Location: Onner's Name: C Hil(d:r 10
MaplParcet:_ 1 aGe fv `1 Address: :.
Installer: Tel M."� p 7-7t!n Nen rna1-_____Repilr
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Date: Wetlaad: Zone_Soil Sptnbol�Sotl ihmr--C—y,J Soil Q
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