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HomeMy WebLinkAboutMiscellaneous - 270 SOUTH BRADFORD STREET 4/30/2018 (2)tA FA ON pu"a- J-ot- -k'A -:v7 o &. 6wh ,t & Street &0--toMap/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date:- /I r� Approved by: Designer: O.j�., &j)4,q Raw, a Plan Date: Conditions: Water Supply: own Well Permit: Well Test§��Chemical Blar�ria I Bacter'ia-I,L Plumbing Sign -Off: Comments: Well Driller: Date Approved Date Approved Date Approved Wiring Sign -off: Form "U" Approval* Approval to Issuer YES"�,,) NO Date Issued Conditions: Final Approval: All Permits Paid? Cj_�D NO Well Construction Approval? IV14 YES NO Septic System Construction Approval? 6�:Y�� NO Certification? - �Y�E NO Other? YES NO Any Variance Needed? YES FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? 1,4V Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES Q16 Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: DWC Permit Paid? DWC Permit# Begin Inspection: Excavation Inspection: Needed: YES NO YES NO Installer: '56,eW (0 Z5 60n Passed:—///2 2- �p� By: / _ Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: 12, Z, -),,21 By:_ 6� � / Final Grading Approval: Date: �2 Z-,, �� By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: YES NO s 11019 01 ��29, 212. 20.00,54" 102,16' 20 7.17' cn U C� 00 tT — �4 0 N 5 u z z W 1�1 IZI F- E 0 ya CD > 0 LU LLJ Q_ �j TA rz CD C C4 z DO C4 00 0 �i U) C4 F 0 0 02 LL z Z C/D C-11 ZD Z Lij 0 > C4 6i L) LL LL 0 C u 0 Z z [TI z R < LLJ C�, M co 00 CL ob 00 oo LL LLI -i < Z Z _r C) U) b C\l (o o 20 7.17' cn U C� 00 tT — �4 0 N 5 u z z W (06 "P 4� C) 1�1 IZI E ya CD > 0 00 Q_ �j TA rz CD C C4 z DO C4 00 0 �i Z C4 F LL z (06 "P 4� C) 1�1 IZI E ya CD > 0 00 Q_ 00 TA (06 "P 4� C) 1�1 IZI E ya CD > 0 Q_ rz CD C C4 z DO C4 00 0 �i Z C4 F LL z Z C/D �Z. (06 "P 4� C) j , ON 0 A. 4) 0 5 0.2 2' -ORO �_�'j "' -2 0 w �4 13-2 'o 50\3-VkA \N \0 19018'5711 W iL� 113.95 cr 1�1 IZI E ya CD > 0 Q_ rz CD C C4 z DO C4 00 0 �i Z j , ON 0 A. 4) 0 5 0.2 2' -ORO �_�'j "' -2 0 w �4 13-2 'o 50\3-VkA \N \0 19018'5711 W iL� 113.95 cr C) E ya CD > 0 Q_ j , ON 0 A. 4) 0 5 0.2 2' -ORO �_�'j "' -2 0 w �4 13-2 'o 50\3-VkA \N \0 19018'5711 W iL� 113.95 cr ya Cl. ,CD rz CD C C4 z DO C4 C m u z 0 �i Z C4 F C4 z Z C/D �Z. ZD Z C4 �D Z C u CID 2 4 9 Z 0 0 N �.) b 0 p U z Z b Z 0 0 C) z (D ui N TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 7/12/01 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Ben Osgood, Jr. at 270 So. Bradford Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will fimction satisfactorily. Board of Health Inspector COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 270 South Bradford Street— North Andover— Owner's Name: James Nyhan_ Owner's Address: 270 South Bradford Street- - North Andover, MA 01845_ Date of Inspection: 6/6/2003 Name of Inspector: —Neil J. Bateson— Company Name: —Batesbn Enterprises ]Inc.— Mailing Address: —111 Argilla Road — — Andover, Ma. 01810 Telephone Number: _( 978 ) 475-4786_ Towiv ,A. D BOA- RD b Q 9nm L-- — - - CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Inspector's Signature: Date: 6/6/2003 -T U The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 270 South Bradford Street_ — North Andover— Owner: ­Nyban Date of Inspection: 6/6/2003 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 3 10 CMR T5—.�-03 or in 3 10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (YN,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 270 South Bradford Street- - North Andover— Owner: _Nyban Date of lns�ecti;n: 6/6/2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require finther evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(l)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: — The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 270 South Bradford Street - North Andover Owner:.Yyhan - Date of Inspection: 6/6/2003 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No -No- Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool -No- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool -No- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool - No Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2day flow -No�- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No Any portion of the SAS, cesspool or privy is below high ground water elevation. -No-- Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone I of a public well. -No- Any portion of a cesspool or privy is within 50 feet of a private water supply well. -No- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No�__ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — — the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - lVV`PA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 270 South Bradford Street — North Andover— Owner: _Nyhan— Date of Inspection: 6/6/2003 Check if the following have.been done. You must indicate "yes" or "no" as to each of the following: Yes No —Yes— — Pumping information was provided by the owner, occupant, or Board of Health — —No— Were any of the system components pumped out in the previous two weeks ? —Yes— — Has the system received normal flows in the previous two week period ? — —No— Have large volumes of water been introduced to the system recently or as part of this inspection ? —Yes— — Were as built plans of the system obtained and examined? (If they were not available note as N/A) —Yes— — Was the facility or dwelling inspected for signs of sewage back up ? —Yes— — Was the site inspected for signs of break out ? —Yes— — Were all system components, excluding the SAS, located on site ? —Yes Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condiiio� —of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? —Yes— — Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no —Yes— — Existing information. For example, a plan at the Board of Health. No Determined in the field (if any of the failure criteria related to Part C is at issue approximation of disia�ce is—unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 270 South Bradford Street- - North Andover - Owner: _j�iyhan- Date of Inspection: 6/6/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): — 4 — Number of bedrooms (actual): - 4 DESIGN flow based on 3 10 CMR 15.203 (for example: I 10 gpd x # of �ed�ooms): 440 Number of current residents: Does residence have a garbage grinder (yes or no): -Yes- Is laundry on a separate sewage system (yes or no): -No- [if yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or no): -No- Water meter readings: -Yes- Sump pump (yes or no): _NPm- Last date of occupancy: -Current_ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 3 10 CMR 15.203): gp d - Basis of design flow (seats/persons/sqft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: -Never pumped, owner_ Was system pumped as part of the inspection (yes or no): -Yes_ If yes, volume pumped: - 1500_gallons -- How was quantity pumped determined? -Measured tank - Reason for pumping: -Never pumped, inspect tank & tees - TYPE OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be �b—tained from system owner) — Tight tank — Attach a copy of the DEP approval — Other (describe): Approximate age of all components, date installed (if known) and source of information: -2 years old, 5/18/2001, As built plan - Were sewage odors detected when arriving at the site (yes or no)- -No- Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 270 South Bradford Street- - North Andover— Owner: _Yyhan— Date of Inspection: 6/6/2003 BUILDING SEWER (locate on site plan) X Depth below grade: —5'_ Materials of construction: —cast iron —X-40 PVC — other (explain): Distance from private water supply well or suction line: Comments (on condition ofjoints, venting, evidence of leakage, etc.): — —4" PVC thru wall to septic tank. 3" PVC in house, no leaks visible._ SEPTIC TANK: —X —locate on site plan) Depth below grade: —4 — Material of construction: —concrete —metal _fiberglass ___polyethylene __other(explain If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of certificate) Dimensions: 10' x 51 x 4'— Sludge depth: — 4" — Distance from top of sludge to bottom of outlet tee or baffle: 2311 Scum thickness: —5"— Distance from top of scum to top of outlet tee or baffle: —8"— Distance from bottom of scum to bottom of outlet tee or baffle: 1611 How were dimensions determined: — Measured scum & sludge depths to tee length_ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): —Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. _ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: —concrete —metal _fiberglass ___polyethylene —other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: – 270 South Bradford Street- - North Andover– Owner: _y4yhan– Date of Inspection: 6/6/2003 TIGHT or HOLDING TANK: _ (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: _ Material of construction: —concrete metal fiberglass olyethylene other(explain): Dimensions: Capacity: _____gallons Design Flow: ____gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: _X_ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: –0– Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): _ – D -box level & distribution equal. No evidence of leakage. Evidence of carryover, pumped d -box to clean. PUW CHAMBER: (locate on site plan) Pump in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 270 South Bradford Street_ —North Andover— Owner: _Nyhan_ Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): X— (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, number: leaching galleries, number: X— leaching trenches, number, length: —2 trenches 66' long ­ leaching fields, number, dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _ —Soil ok. Vegetation ok. No sign of ponding to surface. — CESSPOOLS: _ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 270 South Bradford Street- -North Andover— Owner: _Nyban_ Date of Inspection: 6/6/2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Driveway • to Septic Tank = 26'9" • to D -Box = 34'2" B to Septic Tank = 20' B to D -Box = 12'10" House W ter Meter D - Septic Tank Box <S) P� Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 270 South Bradford Street_ – North Andover– Owner: _Yyhan – Date of Inspection: 6/6/2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water –4– feet Please indicate (check) all methods used to determine the high ground water elevation: — X— Obtained from system design plans on record - If checked, date of design plan reviewed: 10/10/2000 Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: _ _ You must describe how you established the high ground water elevation: Design plan info_ NORTH ANDOVER DPW -j 0 r, N Lm M N -1 cc cc cr 0 Ln 07 C13 W co ..... %o W LA 0 Ln Ln N. P� N. r� w Lh LM Ln LA C2. a. ON. u . . I . . I . I . I GO 6mowinwowow ca Eixii!'i Ch 0 42 0 42 C2 0 0 42 M; C; C; C� C� C; C; C; uj 0 C2 LU (A Ln LU ca AT 4 P.- N T- Lm jr N N w C4 0- M W Ln T- I W 4 .7 LLJ N m Ln 5i co V. L6 11C i FRIq 06 C3 N N M 4 w M M r� C4 w 04 = N r- N N co CC LU CY N T- r, C12 C* -W C2 cm ch IM CID IN Pft CO JT q- M 014 W fl- N r- W AC2 T- C%l r, CY CV3 cn "Co I C14 CY IN r, T- C14 CY C0 C2 0 C2 CD 0 0 a* = 0 = 10 C2 0 C2 C2 .fc I - C2 I Lu IN N N N N IN N N LA M .7 %M a 0 cc co C.) r. T- C4 C2 C2 C4 CY T. C2 ra I tn CC N -1 �C CY C%l Ql- C14 CfJ C2 CM 0 C2 ;!g gl", VP U. 0 -J I cr) cf) CID m C9 cl CV) tv) -ni ir Z=.- c= I Lu I I I I I I I I I I -j N N N -j m Q ca 1292 LU I Z.- a 0 IN C4 N m -T Ln c r, w C2.. o D, !,,I i 'i ca ... .... cc LU cc F - ca v a In UJ 'm C _j - = = u cc 39 w c a —01 w w w IQ 'R Q z w ci uj w w LAJ I.- gm I cc 0 w c w CL. w w —j LLJ 6U cm C.3 LLJ w [a 002 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTE"FJSES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service I 11 Argilla Road Andover, Mass. 0 18 10 Title 5 Inspection Report Property Address: 270 South Bradford Street, North Andover Owner: Nyhan Date of Inspection: 6/6/2003 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any ftu-ther operation of your current septic system. NA611 Ba beson Bateson Enterprises, Inc. 7",77, DISPOSAL S);qTj,:jNj TOWN' OFNORTH ANDOVER SMVAGr IN \,STALLA-rioN CERTIFICATION The undersitmed here:_,v cer-,Ifv that the Sewage Disposal System recaired.- by B rk, 0 5 6-0 j-70 located at was installed in 6onfcrmance with the North A_nC'over Board of He-aith a`proved plan. Svste,mDesii-,nPe.,-:r.l't.--�'/)_M dated. With an arr-roved desi-n flow of gallonsperday The mater:a1s, usea; were in conformarct w-Ith those specified oh the appi­o�7ed- plan; the sysiem was irwafled in' a-ccordarcevith the provisions of 31 10 CNIR 15.000, Title 5 and local -m-ilaElons, and the final Qr-adipa agrees su6stantlally,Nrith the approved Ail workis accuraieiv reoresemed ��r the As -built 'Health. M -Lich has been subm'tted to the Board c. Bed inspection d atd-. Engineer RI--m:stn-.aijVe a ion date F'naJ inspect - Engineer Represen1_11:-.-:e Ver: Date: Ensta. Date� Cesism, Enrineer: R C_ a 416 1DTIC CIV V op� S'E CTIO 3,hor;aOn of 13ed er depill are beneath i - , etc - P rf 00p C Vatjon �Oujjda&n id ca`.Jll�_ fr Bottom tioll to a, ,;�jce s f e�( cefrom des Of e) Cava 1h s sp a , istOA ches, 51 ecifid d' With tren, ca, otion e "I -ca. 4atioll SP 3. 'Edge of Comments' � 7— �Wllld_ ecified Retai!130�ulgr Wa VR ?Adth 35 SP 13. Wall tieight . facility I. roofed 01 leaching waterp I '2. wall nj;jli�m spec,fi ons of P130 3. meets 4. 'N . Comments* S—ewer , . X, C. BUitau1% a-imeter minimum I. pipe 40 pipe 2 Schedule . oints . gatertigh' 3 cemented 119" per foot minimum 3. Inlet to ta[4L 001 or fjrM base . 4. . . um * , 0, line Slope rk compa stral 5. erlY set 01 and rnmull Ct pipe PrOP grade in ygnme,11 tinuous gr 'Alftge 6. laid on con .11 Chan 1 - p1pe 90 1 Ch Cle3nouts precede !. . nge 9. lesAan'y ettO Water line 9. Manho Offs 0, minimum comments-- Septle I - Level Fa I juilivaorn n outlet 1500 g esent 0 2. 1 Sjjje Pr ,,h tee 3. Manho e to 3nd 4. Ma�holes Over invert 5. " marlho der 6. 3 -20 IT' Un , invert Urn g under Inlet imulu tee rnir�. 6�ilet tee minim et * e c ent 9. ®r, ace I above t to outlet from stone under tank T f 3/," CrUShed p1pe set wi& 6 0 ,act base 13. Comp. Xgtertight 14. T33�k is Comments' 7,—� Initials 'so r7: - Yes NO E. Pump Chamber 1. If separate from tank, compact base with 6" of3/4" stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D-boxievel 2. Minimum 0.17(2") drop from inlet to outlet 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double -washed - 1/4" - 1 1/2" - pea stone Bucket test done? 2. Minimum 2", of pea stone above distribution lines 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 11 slope 6. Minimum of 9" of fill graded over system 7. Toe of slope stops minimum 5' from edge of property-, if not, then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan - Minimum 2'; maximum - 4'. 4. Vent present if <50 feet or specified .5. Distance between trenches minimum 4' and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field I . Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. SeparationbaWee pipe6'maximurn �p 4. Pipes connected at en 5. Separation between adjace , fields 10' minimum 6. Pipes set on stable base �* 7. Maximum 4' separation from edg field to first line rl 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 41 ide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade I . Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond 00 9 �10/ N<e r7 Ji ju C -A - - 4 r) f c I ff W i (�z <Zs < i>> U. 0 00 Cx C -A - - 4 r) f c I ff W i Sao RECEIVED PAykWM1*1* SETOWNW NORTH ANDOVER T PPTI�9A$ INSTALLATION No. #PWIM, Ate This certifies that .... f has 'permission for gas installation ...... in the buildings of ...... at North Andover*,' Mas Fee. A e5v .... Lic No,�/ . rA-t� GASINSPECTOR WHITE: Applicant 5- CACRY: Building Dept. PINK: Treasurer GOLD: File i T -T I I "S C H, U S E T -T S U f-41 F P'! .1", A P PL I C AT I N 17 C!: F" 0 1) 0 G A S F I I -N' cy X Sut-di--*g Loci tlon2�6�-5�a- 0w:-,c's Narre AVf Type of Oc c v;�,& -'y && e� //Z, %-- �� N evy Renovztion Rep4acern� 0 Plans SurbrJtled: Yes[3 No [D Propane Gas T-r.c. Chreck c4 -w-: certiricale Address 131 Water Street G--&'Wration npT-�Vprc mzc-c- olq?l 0 ParinersNp 5us';r---ssTe:ep.1tone 508-774-1930 0 Fivrn/Co. Nzme of Ucenst�d Plumt>---r C>r Gas Fit er A- - INSURANCE COVEFLAIGE: I havc a curl C nt_jt�-�� "Y insJrz nce PC4icY Of Ls subeanlia! e-q0v.-!cn', vehich rneets V.e requi.tments of MIGL Ch. 142. Yes D NO 0 1'. you have checkc-,ySs, p;erse lr�dicate the tyPe coverage by clNecking the ap;xopr'--te t>ox. A 4abliey iasu,-arice policy CLJ"-'� Other type of indemnily 0 sond n - OWNER'S INSURANCE WAWER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of, the Mass. Genera! Lzws. and that MY sig.-Iz'ure On this permit app;ica!ion waives this (equirement. Check one., $d9n.a'xre o! D.Ttr of Csv�*!'s 4ent OwnerO Agent 0 I he-ebyoetify Vz! 0 of the detAl(s and info.mation I h1vt sVb�nilttd (or enie!edl in &bave zppijzation &:c tnie ar�d &=,rale to the best of my ar�d thal� V P;VMbjnl;; And "ta?lZti0n-S PerlcKrr*:l unde- %ne '0 th(s 111ricatio, I I in iance with all pertinen�provisi�s of vie V2ssad-.&:set!s State Gas Code " 01.apter 142ortZ I Llsowts E)� fv'�' * I �� T I ucense: vt*.- v Gas F-j5F- sfalet Vaster Lkense Winbe, Orty/Town r APP OFFI�;E USF 01%' -Yl ID SEP 2 6 1990 BUILDING DEFARTAAENT cc C or a 0 Z 0 = r- C 0 C rx X 0 0 0 0 0 ou g K 0 a Z X 0 > 2 %L 0 Z > 0 -K 0 C W 0 0 4A %J x *-- > 9) 0. 1?- 0 E Ell� T iST FLOOR 21qD FLOOR 3AD FLOOR ATt'. FLOOR S'Th FLOOR GTH FLOOR 7TKFLOOK V—,H FLOOR --1 1 1 1 Propane Gas T-r.c. Chreck c4 -w-: certiricale Address 131 Water Street G--&'Wration npT-�Vprc mzc-c- olq?l 0 ParinersNp 5us';r---ssTe:ep.1tone 508-774-1930 0 Fivrn/Co. Nzme of Ucenst�d Plumt>---r C>r Gas Fit er A- - INSURANCE COVEFLAIGE: I havc a curl C nt_jt�-�� "Y insJrz nce PC4icY Of Ls subeanlia! e-q0v.-!cn', vehich rneets V.e requi.tments of MIGL Ch. 142. Yes D NO 0 1'. you have checkc-,ySs, p;erse lr�dicate the tyPe coverage by clNecking the ap;xopr'--te t>ox. A 4abliey iasu,-arice policy CLJ"-'� Other type of indemnily 0 sond n - OWNER'S INSURANCE WAWER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of, the Mass. Genera! Lzws. and that MY sig.-Iz'ure On this permit app;ica!ion waives this (equirement. Check one., $d9n.a'xre o! D.Ttr of Csv�*!'s 4ent OwnerO Agent 0 I he-ebyoetify Vz! 0 of the detAl(s and info.mation I h1vt sVb�nilttd (or enie!edl in &bave zppijzation &:c tnie ar�d &=,rale to the best of my ar�d thal� V P;VMbjnl;; And "ta?lZti0n-S PerlcKrr*:l unde- %ne '0 th(s 111ricatio, I I in iance with all pertinen�provisi�s of vie V2ssad-.&:set!s State Gas Code " 01.apter 142ortZ I Llsowts E)� fv'�' * I �� T I ucense: vt*.- v Gas F-j5F- sfalet Vaster Lkense Winbe, Orty/Town r APP OFFI�;E USF 01%' -Yl ID SEP 2 6 1990 BUILDING DEFARTAAENT I I M d9 Ul IL gn I I m 0 LO Town of North Andover �T OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WMLIAM J. SCOIT A 1H U Director NOTICE OF DECISION (978) 688-9531 Fax (978) 688-9542 Any appeal shall be filled within (20) days after the date of filling this Notice in the Office of the Town ClerL Date: September 8, 2000 Date of Hearing: August 1, 2000 Petition of- John Zahoruiko Premises affected: ' 262 South Bradford Street C— C) -< rri C:) C-') M Referring to the above petition for a definitive subdivision in accordance with the provisions cC:* m m Chapter 41,. Section 81U of the Massachusetts General Laws M M C-) C� Mp .,,rr, C:)m so as to allow: the definitive subdivision for a two(2) lot subdivision with one new ho M > existing home known as 262 South Bradford Street C:) After a public hearing given on the above date, the Planning Board voted To: APPROVE the: Definitive Subdivision CC: Director of Public Works Building Inspector Conservation Department Health Department Assessors Police Chief Fire Chief Applicant Engineer Towns Outside Consultant File based upon the following conditions(attached): 1 Signe4 Alison M.,Lescarbem John Simons, Vice Chairman Alberto Angles, Clerk Richard S. Rowen Richard Nardella Witham Cunningham BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 689-9530 HEALTH 688-9540 PLANNING 688-9535 4 262 South Bradford Street Definitive Subdivision Conditional Approval The Planning Board herein APPROVES the Definitive Subdivision for a two (2) lot subdivision with one new home and one existing home known as 262 South Bradford Street. John Zahoruiko, 262 South Bradford Street, North Andover, MA 0 1845, submitted this application on June 23, 2000. The area affected is on South Bradford Street and is located in the R-1 Zoning District. The Planning Board makes the following findings as required by the Rules and Regulations Governing the Subdivision of Land: A. The Definitive Plan, dated 1/3/00, last revised on 3/16/00, 3/17/00 and 6/16/00, includes all of the information indicated in Section 3 of the Rules and Regulations concerning the procedure for the submission of plans with the exception of waivers granted below in Condition #11. B. The Definitive Plan is in conformance with the purpose and intent of the Subdivision Control Law. C. The Definitive Plan complies with all of the review comments submitted by various town departments in order to comply with state law, town by-laws and insure the public health, safety, and welfare of the town. D. The Definitive Plan dated 1/3/00, last revised on 3/16/00, 3/17/00 and 6/16/00, includes all of the information indicated in Section 7 of the Rules and Regulations concerning the procedure for design standards with the exception of waivers granted below in Condition #11. Finally, the Planning Board finds that the Definitive Subdivision complies with Town Bylaw requirements so long as the following conditions are complied with: 1) Environmental Monitor: The applicant shall designate an independent environmental monitor who shall be chosen in consultant with the Planning Department. The Environmental Monitor must be available upon four- (4) hour's notice to inspect the site with the Planning Board designated official. The Environmental Monitor shall make weekly inspections of the project and file monthly reports to the Planning Board throughout the duration of the project. The monthly reports shall detail area of non-compliance, if any and actions taken to resolve these issues. 2) Prior to endorsement of the plans by the Planning Board the applicant shall adhere to the following: a) A Development Schedule must be submitted for signature by the Planning Board, which conforms to both Sections 4.2, and Section 8.7 of the North Andover Zoning Bylaw. The schedule must show building permit eligibility by quarter for all lots. 2 b) A Site Opening Bond in the amount of one thousand ($1,000) dollars to be held by the Town ofNorth Andover. The Site Opening Bond shall be in the form of a check made out to the Town of North Andover that will be placed into an interest bearing escrow account. This amount shall cover any contingencies that night affect the public welfare such as site -opening, clearing, erosion control and performance of any other condition contained herein, prior to the posting of the Roadway Bond as described in Condition 3(d). This Site Opening Bond may at the discretion of the Planning Board be rolled over to cover other bonding considerations, be released in full, or partially retained in accordance with the recommendation of the Planning Staff as directed by a vote of the NAPB. c) A covenant (FORM 1) securing all lots within the subdivision for the construction of ways and municipal services must be submitted to the Planning Board. Said lots may be released from the covenant upon posting of security as requested in Condition 3(d). d) The applicant must submit to the Town Planner a FORM M for all utilities and easements placed on the subdivision. e) All application fees must be paid in M and verified by the Town Planner. The applicant must meet with the Town Planner in order to ensure that the plans conform to the Board!s decision. A fiffl set of final plans reflecting the changes outlined above, must be submitted to the Town Planner for review endorsement by the Planning Board, within ninety (90) days of filing the decision with the Town Clerk. g) The Subdivision Decision for this project must appear on the mylars. h) I All documents shall be prepared at the expense of the applicant, as required by the Planning Board Rules and Regulations Governing the Subdivision of Land. 3) Prior to any lots being released from the statutory covenants: a) Three (3) complete copies of the endorsed and recorded subdivision plans and one (1) certified copy of the following documents: recorded subdivision approval, recorded Covenant (FORM 1), recorded Growth Management Development Schedule, recorded common driveway easement and recorded FORM M must be submitted to the Town Planner as proof of recording. b) All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must be in place. The Town Planning Staff shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. 3 c) The. applicant must submit a lot release FORM J to the Planning Board for signature. d) A Performance Security in an amount to be determined by the Planning Board, upon the recommendation of the Department of Public Works, shall be posted to ensure completion of the work in accordance with the Plans approved as part of this conditional approval. The performance security must be in the form of a check made out to the Town of North Andover. This security will then be placed in an interest bearing escrow account held by the Town. Items covered by the Security may include, but shall not be limited to: i) as -built drawings ii) sewers and utilities iii) roadway construction and maintenance iv) lot and site erosion control v) site screening and street trees vi) drainage facilities vii) site restoration viii)final site cleanup A Performance Security may be established for each phase individually. 4) Prior to an application for a building pennit for an individual lot, the following information is required by the Planning Department: a) The applicant must submit a certified copy of the recorded FORM J referred to in Condition 3(c) above. b) A plot plan for the lot in question must be submitted, which includes all of the following: i) location of the structure, H) location of the driveways, iii) location of the septic systems if applicable, iv) location of all water and sewer lines, v) location of wetlands and any site improvements required under a NACC order of condition, vi) any grading called for on the lot, .vii) all required zoning setbacks, viii)Location of any drainage, utility and other easements. c) All appropriate erosion control measures for the lot shall be in place. The Planning Board or Staff shall make final determination of appropriate measures. 4 d) Lot numbers, visible from the roadways must be posted on all lots. 5) Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a) Sprinkler systems must be installed in the home on Lot A- 1-2 per NAFD requirements. c) The connnon driveway must be constructed and paved to properly access the lot in question and inspected by the Town Planner. d) All necessary permits and approvals for the lot in question shall be obtained from the North Andover Board of Health, and Conservation Commission. e) Permanent house numbers must be posted on dwellings and be visible from the road. There shall be no driveways placed where stone bound monuments and/or catch basins are to be set. It shall be the developer's responsibility to assure the proper placement of the driveways regardless of whether individual lots are sold. The Planning Board requires any driveway to be moved at the owner's expense if such driveway is at a catch basin or stone bound position. g) The applicant will ensure that the deeds for lots A- I - I and A- 1 -2 in the 262 South Bradford Street Subdivision has language stating "the driveway being utilized for access to lots A- I -I and A- 1 -2 does not conform to the Towrfs standards for purposes of utilization as a street, nor will the driveway be accepted by the Town as a street unless said driveway is upgraded and then conforms to the requirements of a street as defined in the Town of North Andover Rules and Regulations Governing the Subdivision of Land". In addition, the applicant will also place a note on the plan that states, the above which is to be recorded in the Essex North Registry of Deeds. 6) Prior to the final release of security retained for the site by the Town, the following shall be completed by the applicant: a) An as -built plan and profile of the site shall be submitted to the DPW and Planning Department for review and approval. b) The Applicant shall ensure that all Planning, Conservation Cornmission, Board of Health and Division of Public Works requirements are satisfied and that construction was in strict compliance with all approved plans and conditions. 7) There shall be no burying or dumping of construction material on site. 8) The location of any stump dumps on site must be pre -approved by the Planning Board. 5 9) The contractor shall contact Dig Safe at least 72 hours prior to cornmencing any excavation. 10) Any action by a Town Board, Commission, or Department which requires changes in the driveway alignment, placement of any easements or utilities, drainage facilities, grading or no cut lines, may be subject to modification by the Planning Board. 11) The following waivers from the Rules and Regulations Governing the Subdivision of Land, North Andover, Massachusetts, revised February, 1989 have been granted by the Planning Board: a) Request for waiver of Rules and Regulations Section 3C4 to permit a subdivision plan without a statement of environmental impact if GRANTED. b) Request for waiver of Rules and Regulations Section 3D to permit a subdivision plan without a drainage analysis is GRANTED. c) Request for waiver of Rules and Regulations Section 3KQ) to pern-lit a. subdivision plan without existing forested areas depicted is GRANTED. d) Request for waiver of Rul6s and Regulations Section 3K(p) to permit a subdivision plan without profiles of streets is GRANTED. e) Request for waiver of Rules and Regulations Section 3K(q) to permit a subdivision plan without cross-section of streets is GRANTED. Request for waiver of Rules and Regulations Section 7A, 7B, 7C, 7D, 7E, 7F, 7G, 7H, 7L, 7N, 70 and 7P is GRANTED. The rationale for granting the above waivers is that although the submission is technically a definitive subdivision plan, the proposal does not involve the creation of a street, rather it proposes the creation of a driveway. The above granted waivers refer specifically to the construction of a street, and therefore would not apply to this proposal. 12) This Definitive Subdivision Plan approval is based upon the following information which is incorporated into this decision by reference: a) Plans Entitled: Definitive Subdivision Plan of Land Located at 262 South Bradford Street cc. North Andover, MA Prepared For: John & Jean Zahoruiko Prepared by: Scott Giles, R.P.L.S. Scale: I"=40'. Plan Date: 1/3/00, revised 3/16/00, 3/17/00, 6/16/00 Applicant Engineer File 6 Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott, Division Director 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director December 29, 2000 William Zahoruiko & Dana Cole 262 So. Bradford Street No. Andover, MA 0 1845 Re: Sewer Tie-in Dear Resident: - ANIMMW Telephone (9781 Fax (978) 688 - The Health Department has been supplied with a list of all residences, currently on septic, which have access to the municipal sewer system. Your property was listed as having access as of June 2000 due to the completion of the new sewer in your area. This office was notified that you were sent information from the Department of Public Works informing you of your status and the tie-in regulation. As previously published at a Public Hearing on March 17, 1994, the Board of Health has adopted regulations concerning the required sewer tie-in. The following timetable concerning your property status was adopted: 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a maximum time limit of six months. The purpose of these regulations is to safeguard North Andover's drinking water, surface, waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment. A copy of the entire regulation can be obtained at our office. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, da3kod'Osgood, C&airnian Francis P. MacMillan, M.D., Member SF/sc Office of the Health Department Community Development and Services Division William J. Scott, Division Director . 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director January 24, 2001 John Zahoruiko 33 1 B Medallion Blvd. Madeira Beach, Fl, 33708 Re: Sewer tie-in letter Dear Mr. Zahoruiko: Telephone (978) 688-9540 Fax (978) 688-9542 I must say I am a bit p=led myself as to why you received this letter. It is a form letter that goes out when we are notified by DPW that a piece of property with an existing house has sewer available and can tie-in. The names and addresses are generally obtained from the Assessor's Office. We've had some confusion in this particular program before and obviously it still exists. I'll look further into the matter and see what's going on. Hope everything is going well for you. Sincerely, Sandy Starr, � �HZ Health Director Cc: W. Zahoruiko T. Zahoruiko File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION688-9530 NURSE 688-9543 PLANNINTG689-9535 lw�l i'� 1, OF I NO 1, 110 - co g I rl I 0 LOT B-1 128 ACRES 30.00, lin'A' N 65-016tO.90W NORTH' ANDOVI PLANNING BOARL z V. NAF 'SMOLAK a4rf / - DATE oDATE ]MAW LOTS S OWN A�l AND B-1 , LH ARE A LOT INE bH NGE POND �o #tAl- Or- I wr-t:IV LOTS A AND,9 SHOWN ON A PLAN # /0,709 RECORDED AT N.E. R. D. ,6 77-19!02##E 44- 19.41 7T N OF STREET So 13 f? A sr. SOUTH j9RADFORD :-1-0-c-uml- .4' Town of North Andover Office of the Health Department Community Development and Services Division William). Scott, Division Director 27 Charles Street CHU Sandra Starr North Andover, Massachusetts 01845 Telephone (978) 688-9540 Health Director Fax ( 978) 688-9542 December 29, 2000 YVZ4-1?- William Zahoruiko & ana ole 4 262 So. Bradford Street No. Andover, MA 0 1845 Re: Sewer Tie-in Dear Resident: The Health Department has been supplied with a Est of all residences, currently on septic, which have access to the municipal sewer system. Your property was listed as having access as of June 2000 due to the completion of the new sewer in your area. This office was notified that you were sent information from theDepartment of Public Works informing you of your status and the tie-in regulation. As previously published at a Public Hearing on March 17, 1994, the Board of Health has adopted regulations concerning the required sewer tie-in. The following timetable concerning your property status was adopted: 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a maximMam time limit of six months. The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment. A copy of the entire regulation can be obtained at our office. BOARD OF AIWALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, Ga3kolrosgood, Cliairniain Prancis P. MacMillan, M.D., Member Jol ei'4-;2'_j SF/sc Town of North Andover, Massachusetts Form No.2 14ORT#f BOARD OF HEALTH DESIGN APPROVAL FOR C14U SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant - Reference Plans and Specs r )z NGINEE 6 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee LZr -14-'j —CHAIRMAN, BOARD OF HEALTH Site System Permit No. //,32 - �4 INSPECTION CHECKLIST FOR SEPTIC SYSTEMS A. Bottom of Bed Yes NO Init 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10'to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.0 1 or 1/8" per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90' change 10. 10' minimum offset to water line Comments: D. Septic Tank 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Inlet tee minimum 12" under invert 8. Outlet tee minimum 14" under invert 9. Outlet line cemented 10. Air space 3" above tees 11. 2" - 3" drop from inlet to outlet 12. Pipe set 13. Compact base with 6" of %" crushed stone under tank 14. Tank is watertight Comments: .A Yes NO E. Pump Chamber 1. If separate from tank, compact base with 6" of3/4" stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm fimctions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0. IT' (2") drop from inlet to outlet 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double -washed - 1/4" - 1 '/2" - pea stone Bucket test done? 2. Minimum T'. of pea stone above distribution lines 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9" of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not, then swale. Comments: R Leach Trenches I . Minimum 2 trenches 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan - Minimum 2% maximum - 4'. 4. Vent present if <50 feet or specified 5. Distance between trenches minimum 4' and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' 8. Depth of trenches below outlet invert minimum of 6". .4 Yes NO 9. Pipes set on stable base. Comments: 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipe 6' maximum 4. Pipes connected at end 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between IT' and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond IA L A FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obta mied. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Odom OWN 0 own WOUNSEARENEWUNN EVEN W 0 `7F APPLICANT PHONE i -07-e63� ASSESSORS MAP NUMBER IOYC LOT NUMBER 3 6 SUBD I -VISION LOT NUMBER STREET NUMBER 7— 70 A �a_ STREET I &1 111 �_ - OFFICLAL USE ONLY ............... RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED E0--NSERVATION ADMR41STRATOR �- D /�- \ -S-5,j -C, J It 1 _7 d DATE APPROVED TO NER DATE REJECTED CONBEWUS DATE APPROVED FOOD INSPEC3,QR - HEALTH DATE REJECTED DATEAPPROVED ,Tfe, DOWECTOR - HEALTH DATE REJECTED COMN&-NTS 2-0 4c PUBLIC WORKS - S8*0OR WATER CONNECTION DRIVEWAYPERM rr//-ZV­,P0 DATE APPROVED HERE DEPARTMENT DATE -REJECTED COMNIENTS - RECEIVED BY BUILDING INSPECTOR DATE INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 7,& 2, .57, fri a relative to the application of Bew%La C_ nr"� .0"o- J -z- 1-1 C1.1 dated i 6.1> for plans by i1se, and dated /c,/z3/pp with L revisions dated /1/017/00 I understand and a4gre"e to the following obligations for management of this project: 11. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed — generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present b) Final Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. 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. 3. As the installer I understa�d that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I ftirther understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation -or suspension of my license in the Town of North.Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a). Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: I L!;- c, 0 CURRENT INSTALLER'S LICENSE# LOCATION: ;2(:,,Z IP r=,k fD LICENSED INSTALLER: 41 C,0 'd 0, SIGNATURE: TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes kNo a , Foundation As -Built? Yes 15 PZA No Floor Plans? Yes:z No Approval Date: Fj�OUT eLL-VATIOJ TLOOP- k P, Nz L O�Z, fzco AA cloi f5Loo a OAen e,,, I coo -,v -7 6 V"OOJIN LA 'e�67DP,00,kN e'lz -a&-tv( 7:� Boo Fj�owq eLeVATIOJ SEC-oN-�D, VLOOR� F kp-s. T NZ L 0 Vloo),.N LA %G--E>Rook& Oz -e &-tq oo Rc:;;O A& CIDIJ ^rT f5Loo a It. TOWN OF NORTH ANDOVER BOA" OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 SANDRA STARR, R.S., C.H.O. Health Director November 13 2000 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, NIA 01845 Re: 262 So. Bradford Street Dear Ben: %%0RTjf emu Telephone (978) 688-9540 FAX (978) 688-9542 This is to notify you that the septic plans dated 11/9/00 are approved for new construction with a maximum of nine (9) rooms. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director SS/smC cc: Tara Leigh Development File NEW ENGLAND ENGINEERING SERVICES INC November 9, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 0 1845 Re: 262 South Bradford Street, North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. I . 3 sets of revised design plans, I with original signatures. 2. Submittal form for revised plans. 3. Check to cover the fee. The following changes have been made to the plan. 1. Benchmark has been added to the plans. 2. The vent and a note specifying that the end of the pipes shall be tied to the vent has been added in the profile view. 3. The foundation drain with an elevation has been shown on the profile view. 4. The benchmark note has been revised.. If you have any questions please do not hesitate to contact this office. Sincerely, Benja C. Osgoo r., EIT President F3, 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 May -27-99 1,?!:4SP Nor--th Andover- Com. Dev. S08 688,9542 P . 01 SEPTIC PLAN SUBMITTAL FORM LOCATION: Zio-Z S. t=z�, (-�-o NEW PLANS:, YES $125.00/111an REVISED I)LANS: S 60.00/Plan—, SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGrNEER: toe DATE TO CONSLrLTANT: *If you want your plans expedited, please submit three plans and, included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Semtary- j T(- �A �)Cv*'=R/ Nov -06-00 11:35A Paul D. Turbide, PE/PLS 978-465-0313 P.02 PORT ENGINEERING, Civil Engineers & Und Surveyors One Harris Street Newburyport, MA 01950 (978) 465-8594 October 31, 2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for SDS new construction at 262 Soutb Bradford Street Dear Sandra, Enclosed find our review of the "Checklist for North Andover Septic System Plane' for the septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. • Elevation of foundation drain is not shown as required by NA 8.02y' • Benchmark is not shown on the plan as required by 3 10 CNM 15.220(4)(q)..-, • Distribution lines are not capped as required by 310 CMR 15.251(9).,,/ If you have any questions or comments please feel free to contact Tne \\Server PNABIMS84\SO BRADFORD 262.DOC NEW ENGLAND ENGINEERING SERVICES INC October 23, 2000 , Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 0 1845 Re: 262 South Bradford Street, North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. I . 5 sets of design plans with original signatures. 2. Soil evaluator forms. 3. Application for approval. 4. Check to cover the fee. Also enclosed is a priority envelope with postage addressed to Port Engineering. I have enclosed this to hopefully speed the delivery process to Port. If you have any questions please do not hesitate to contact this office. Sincerely, BeWjja - CCO-sgo ir., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 No. FORM 11 - SOIL EVALUATOR FORM Page I of 3 Date-A7/�010 Commonwealth of Massachusetts MO. , Massachusetts Soil Suitabft Assessment f-Qr On-site.Sewage-Disposal Performed By: ...... :7�� ... * ...... �� �e- 4�9 --1�0 ........... Date: / / WitnessedBy: ...... . . .......... .. .... ........................ . ..... ......... ............................. . . ... ....... Lmllan Addras or owmrs Nam, A;0.� Z�P, z Aftess. aM TckpMne New construction El Repair E3 6-? -7 Office Revie*v Published Soil Survey Available: No 0 Yes ZS Year Published ................. Publication Scale Soil Map Unit .. .... ..... .. .... z . ..... ...... . 5Z Drainage Class ..... Soil Limitations �4,P �7 Surficial Geologic Report Available: No An Yes Year Published Publication Scale GeologicMaterial (Map Unit) .. ...................................................... ........ . .................................... .... ..... .. Landform. .. ...... I ............................ ................... ................................................................................. 11 ............................. .. - ........... .. Fl�od Insurance Rate Map: Above 500 year flood boundary No E]Yes N Within 500 year flood boundary No EJ Yes D Within 100 year flood boundary No []Yes El Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) -'5� Current Water Resource Conditions (USGS): Month Range :Above Normal ONormal R13ekwNormal El Other References Reviewed: NoDEP APPROVED FORM - 12107195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number Date: Time:. Weather�/_Vl_ Location (idgatify on site plan) Land Uso Slope Surface Stones Vegetation. Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line ��.tF feet Drinking Water Well_ feet Other...,.._.—-..-... ­ DEEP OBSERVATION HOLE LOG* Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color iMunsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) "d ef:�z5 :5 7 Parent Material (geologic��/,Py Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: -46'1 DEP APPROVED FORM - 12107195 Weeping from Pit Face: — FORM 11 - SOIL EVALUATOR FORNi Page 2 of 3 :�50 Location Address or Lot No. ­�6-2- On-site Review DeepHoleNumber ime: Weather��// ........... Location (identify on site plan) .... ...... .... . Land Llse� Slope Surface Stones Vegetation . Landform Position on landscape (sketch on the back) Distances from: feet Open Water Body -4 ��o feet Drainage way . 7 Possible Wet Area !��Ae> feet Property Line feet Drinking Water Well ., -7... f eet Other... .... . .. .......... . DEEP OBSERVATION HOLE LOG* Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color iMunsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) .5:4r �-216; _5 jo veryRtw - miimivium vr 4 nuLco nrwvinry P%p cvrni rnwvw,�vv wfor Parent Material (geologic) ��71 / /- Z— Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 1210719S M"Lm Weeping from Pit Face: — y12 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 2C,2 jo.e 0 On-site Review Deep Hole Number Date:.Ae/`/`­I�� Time: /0: /0 Weather Location (identify on site plan) .......... . .. . ... ... ..... Land Use SlopeM -4, Surface Stones Vegetation . Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line f eet Drinking Water Well feet Other, DEEP OBSERVATION HOLE LOG* Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color iMunsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 7-4 W 494 ::14 C, gY C'0N*fV# 1/9. 2)1 lvcr mimmum tir z MULCO nrUVInCLI P% I rvr"T F"WFW'JQW W50F Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: 4 W ' DEP APPROVED FORM - 12107/95 MnQ� Weeping from Pit Face: Y Y/e FORM 11 - SOIL EVALUATOR FOJINI Page 2 of 3 Location Address or Lot NQ9�Alo. �V�Elv On-site Review Deep Hole Number Date Time:/41.* _�10 Weathe Location (identify on site plan) Land Use . Ap-&55�POV7�� Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) 1-7r"l-P - 5_7,4 Distances from: Open Water Body -- feet Drainage way eet Possible Wet Area feet Property Line .... feet Drinking Water Well feet Other ... ... .... ... . ...... DEEP OBSERVATION HOLE LOG* Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) Woe '00 IL < - ivmvuvivrA vr 4 riuLco nrwwricu j6% i L;v rn i rnwr%jorw wior%jN�%6 P%"FP% Parent Material (geologic) DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12/07195 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.,-'�'4:�;.2 Determination for Seasonal.High Water Table Method Used: 11 Depth observed standing in observation hole ................... inches r 1 Depth weeping from side 0 observation hole ........... .... inches W1 Depth to soil mottles inches -F&= El Ground water adjustment ................... feet 4!5"' 4"' Index Well Number .................. Reading Date .................. Index well level ....... . ... ... Adjustment factor ................... Adjusted ground water level ...................................... . .............. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on: (date) I have passed the soil evaluator examination "--6z -5— 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. WX 9ionature WDEP APPROVED FORM - 12/07195 May,27-99,12:4SP Nor -t -h Andover- Com. Dev- jS08 688 9542 SEPTIC PLAN SUBMITTAL FORM LOCATION.- 2(,Z -S NE NV P L AN S: $12 .00/1'1, q REVISED I'LkNS: YES S 60.001P Ian—. SITE EVALUATION FORMS INCLUDED: NO DATE:.. DESIGNENGFNEER: ,DATE TO CONSLrLTANT:—Lb *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secret:ary. P.01 V%ORT#t Fax 978-688-9542 Board of Appeals (978) 688-9S41 Building Department (978) 688-9545 Conservation Department (978) 688-9530 Health Department (978) 688-9540 Public Health Nurse (978) 688-9543 Planning Department (978) 688-9535 Town Of North Andover Community Development & Services 27 Charles Street North Andover, Massachusetts 01845 November 6, 2000 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, NIA 0 1845 Re: 262 So. Bradford Street Dear Ben: William J. Scott Director (978) 688-9531 This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: 1. Elevation of foundation drain is not shown as required by NA 8.02y. 2. Benchmark is not shown on the plan as required by 310 CMR 15.220(4)(q). 3. Distribution lines are not capped as required by 310 CXM 15.251(9) If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Tara Leigh Development, LLC file Town of North Andover, Massachusetts Form No.1 �40RTkj BOARD OF HEALTH 0 19- 0 13 APPLICATION FOR SITE TESTING/INSPECTION TED CHU Applicant NAME ADDRESS TELEPHONE G>Z Site Location 'Al J -4-0 r Engineer— NAME ADDRESSJ TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee— Test No. S.S. Permit No.-D.W.C. No.________C.C. Date-Plbg. Permit No. EA J.hl-i 9 7 40 tv Si� L Vl CO'd EICO-99V-SL6 Sld/3d lap�q-4njL G Lnvd dlt,:EO OIC - to - -V0.0 At = i - C.2 N qc QCA — ol- -TIT <r -4 1J, ci T ZO'd elco-99v-SL6 Sld/3d lap�q-An_L -0 LnPd dllt,:E:O 6o-vo--4DO Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1 . Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. BOARD OF HEALTH wD TEL. 21" 8-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 0 P - LOCATION OF SOIL TESTS- I-Crr 5��Jwf P-2 12 iq P f ba 0 Assessor's map& parcel number: loil-e loye- e 1 OWNER:a;,m&; 7#weojko TEL. NO.: ADDRESS: �? G -a -711,� 2p, rt--,cO Cp el, - ENGINEER: Nc--, &� V TEL. NO.: (�-1 7 G CERTIFIED SOIL EVALUATOR: Ct 00 CQ Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1 . Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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Zahorulko 262 South Bradford Street North Andover, MA 0 1845 Benjamin Osgood, Jr. New England Engineering Services, Inc. 60 Beechwood Drive N,orth Andover, ?vLA, 01845 September 6, 2000 Dear Be-,).: I hereby give you, Or any persons or organizations working with, for, or all your mquest, my consent to enter upon the pren-iises at 262 South Bradford Street, and to file all applications with the To,Am of North Andover or any other regulatory authority, for the purposes of performing, soil tests and other site evaluations associated with the research, design, and approval of a septic system. Since re John F. Zahoruiko ZO'd OtC3-699-809 oo ---�LudLAC] L16ta-1 le.,OL�J_ dl:q:E30 00-OT.-ClaS BOARD OF HEALTH TEL. W8-'9540!;; NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TESTS: i—c7- 9 rvF2 Q Assessor's map & parcel number:,,oAjj9 loje pri;eeel OWNER:a-.,,-H&., -24woa )j)<L) TEL. NO.: ADDRESS: ENGINEER: /V TEL. N 0.:- 7 CERTIFIED SOIL EVALUATOR: Intended use of land:. residential subdivision, single family home, commercial Repair testing Undeveloped lot testing X N. A. Conservation Commission Approval: Zl�t'�Y THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or up -grades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 0 1845 J. William Hmurciak, Director TimotkyJ Willett Raff Engineer April 18, 2000 Ms. Heidi Griffin Town Planner 27 Charles Street North Andover, MA 0 1845 RE: Proposed house Lot A- 1-2, ' Adjacent to 262 South Bradford Street Dear Ms. Griffm: Telephone (978) 685-0950 Fax (9,78) 688-9573 The Division of , Public Works has reviewed the plan by Scott Giles, R.P.L.S., for John Zahoruiko, for the proposed house adjacent to 262. South Bradford Street and has the following comments to make. I . We are opposed to the construction of a roadway because it is an excessive amount of infrastructure for two houses. The existing driveway should be made into a common driveway as shown on the plan. 2. The current Town Sewer Project, known as Phase 3C, will not provide a sewer service to 262 South Bradford Street. The sewer will end in front of house 250 South Bradford Street due to elevation limitations. The Phase 3C. design was intended to reach 262 South Bradford Street originally, after which 250 South Bradford Street was built. The construction of 250 South Bradford Street took away some frontage from 262 South Bradford Street, where the sewer connection was supposed to go. The sewer main on South Bradford Street will be installed at great depth and expense to reach these houses. 3. If 262 South Bradford Street is determined to be within the Lake Cochickewick Watershed, (which is unclear at this point), then it should be connected to the new sewer along with the proposed house. There are two ways to accomplish this. The first way is to obtain a sewer easement from the owner of 250 South Bradford Street and run two 6" PVC sewer lines - one for 262 South Bradford Street and one for the proposed house. It appears from the topography of the lots that gravity lines could service both houses. If an easen. ent cannot be obtained, ther. sewer lines for 262 Soulki. Bradfor A Q—eet and t e prcposed hause must be installed through the proposed common driveway. Sewage will have to be pumped to the end manhole in front of 250 South Bradford Street. If you need more information, please contact me. Very truly yours, Timothy J V Willett Staff Engineer CC: Bill Hmurciak, Jim Rand, Sandy Starr, Richelle Martin, Ben Fehan AM TOWN OF till! SYSTEM PUMPING RECORD DATE: co SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house DATE OF PUMPING: 6 -,& QUANTITY PUMPED: CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: 6'. (— - 'sl . /0. CONTENTS TRANSFERRED TO: 6 20M GALLONS Samuel F. McCormack Co., Inc. Insurance Adjusters and Appraisers ADJUSTERS AND APPRAISERS Town of North Andover Board of Health North Andover, MA 01845 RE ASSURED: James Nyhan Gentlemen: 11/13/2003 . I V 7 , 'I" LOSS LOCATION: 270 South Bradford Street North Andover, MA 01845 POLICY NO: HP2168423 TYPE OF LOSS: Lightning DATE OF LOSS: 11/11/2003 OUR FILE NO: 2003-04141 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 319 is appropriate, please direct it to the attention of this writer and include a reference to the above - captioned insured, location, policy number, date of loss and claim or file number. Thank you for your anticipated cooperation. Very truly yours, Edward F. Bennett Adjuster cc: Building Inspector 222 Forbes Road m Suite 304 oBraintree, MA 02184 (781)-843-1222 m MA WATS 800-972-5399 oFax (781)-849-8191 Samuel F. McCormack Co., Inc. Insurance Adjusters and Appraisers .%mupl F Wrmmaek rA ine 11/13/2003 Town of North Andover Board of Health North Andover, MA 01845 RE ASSURED: James Nyhan LOSS LOCATION: 270 South Bradford Street North Andover, MA 01845 POLICY NO: HP2168423 TYPE OF LOSS: Lightning DATE OF LOSS: 11/11/2003 OUR FILE NO: 2003-04141 Gentlemen: Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of this writer and include a reference to the above - captioned insured, location, policy number, date of loss and claim or file number. Thank you for your anticipated cooperation. Very truly yours, Edward F. Bennett Adjuster cc: Building Inspector 222 Forbes Road m Suite 304 oBraintree, MA 02184 (781)-843-1222 m NIA WATS 800-972-5399 mFax (781)-849-8191 Commonwealth of Massachusetts City/Town of System Pumping Record RECEMW Form 4 17 _� I n 47,) JUL r- Lu I& DEP has provided this form *for use by local Boards of Health Othe forms may be 'used, but t e information must be substantially the same as that provided �ere. NjQInjCkhb#aMjW4 k with your local Board of Health to determine the form they use. The System 3.%jffffARTAffiMe s ibmitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right fron Left / Right rear of house, Left / right side of house, Left Right side o di W , , e / Right front building, 6�i �t rear of building, Under deck I QCityjrrown vs 2. Sys wrier Name Address (if different from location) City/Town Sul -A 1 Zip Code State _C06 ip Code Z20�3 R7Z Telephone Number B. Pumping Record 0 , / "� 2� 1. Date of Pumping Date--- 2. Quantity Pumped: Gallons 3. Type of system: El Cesspool(s) DIS—eptic Tank E] Tight Tank El Other (describe): 4. Effluent Tee Filter present? [] Yes D_iq_o� 5. Conditi no Systern.- 6. System Pumped By: . Neil Bateson Name Bateson Enterprises Inc Company . 7. Location pontents were disposed: G L S. � . L �Sp Lowell Waste Water t5form4.doc- 06/03 If yes, was it cleaned? [] Yes F� No F5821 Vehicle License Number e _(q - (1:4 Date V\ - System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use� by local Boards 6 f 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. A. Facility Information 1. System Location: Lefttj���h Left/ Right'rear of house, Left/ right side of house, Left/ Right side of building, Left Right ftbnt of building, Left / Right rear of building, Under deck Address '7- -7 4 Aj City/-rown State Zip Code 2. System Owner S-1ji" Name' Address (d different ftm location) Cityfrown Stat eoCode Telephone Number B. Pumping Record 1. Date of Pumping 2. Qu tity Pumped: Date Gallons 3. Type of systern. El Cesspool(s) 0 --Septic Tank Tight Tank Other (describe): 4. Effluent Tee Filter present? Yes If yes, was it cleaned? [:3 Yes F1 No, 5. Conditioij of.System: 6. System Pumped By. - Nell. Bateson -Rame Bateson Enterprises Inc- -dompany . 7. Locpfief�)�contents were disposed: Waste Water F5821 Vehicle License Number Date t5fbrm4.doe- 06/03 System Pumping Record - Page I of 1 TOWN OF SYSTEM PUMPING RECORD f;:�- �REC�EIVOD DATE: SYSTEM OWNER & ADDRESS z %n DATE OF PUMPING: L —)-9 - SYSTEM LOCATION (example: left front of house) QUANTITY PUMPED: f SEP - 7 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT �OW^Z5--C GALLONS CESSPOOL: NO j YES SEPTIC TANK: NO YES J NATURE OF SERVICE: ROUTE14E 7 EMERGENCY_ OBSERVATIONS: GOODCONDMON HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER. FULL TO COVER BAFFLES IN PLACE LEACIIF1ELD RUNBACK FLOODED OTBER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G-L.S.D V Lowell Waste commonwealth. of Massachusetts C' ity/Town of System Pumping Record Form 4 107 FEB 0 8 2007 1, VVJ DEP has provided this form for use by local Boards: of Health. h qj$ystdfhRPd T A ord must be submitted to the local Board of Health or other approving a th6 TH DEP", ..A. Facility Information Important: When filling out 1. System Location: forms on the computer, use only the tab key Address to move your OA -4%_k cursor - do not use theretum Cityrrown State 4. e key. System Owner: v -A Name Address (if different from location) City./Town State/I e, Telephone Number 13. Pumpifilg,.Red-ord Date of Pumping � -1 �V Date 2. Quantity Pumped: Gallons I Type of system.. EJ Cesspool(s) trSepric Tank TightTank: El Other (describe)� El Yes 4. Effluent Tee. Filter present? No If yes, was it cleaned? Yes:fl No 5. Condition of Sy V�- 6. System Pump Name Vehicle License Number Gompany Location whWe t t n, Pon s were dispo^, e3co Siqnaiure of Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. J*--- ----h Commonwealth of Massachusetts RECEIVED City/Town of I I System Pumping Record FEB 10 2009 Form 4 TOO OF NORTH ANDOVER &U DEP has provided this form for use by local Boards of HeaK Mq kw��� �s d, but the information must be substantially the same as that providea-r-ere. 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. A. Facility Information 1. System Location: Left front, left rear, left side of hour�-fkigh�tfr�� right rear, right s6jj:� Address D -"7D Cityrrown 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: 0 State MA k Date Cesspool(s) C Zip Code State a F. Zip Code C 0 _C�D 4� "7 Telephone Number 2. Quantity Pumped 0 Septic Tank ,4.) Gallons Tight Tank Other (describe): 4. Effluent Tee Filter present? Yes [9-11� If yes, was it cleaned? Ej Yes r] No 5. Condition of System: 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. LocatpiQ where contents were disposed: 7��. Ir-S-1,5�7- Lowell Waste Water N --f-1 A tignafu-re of t5for4doc- 06/03 / �) Date L, System Pumping Record - Page 1 of I RECEIVED Commonwealth of Massachusetts JU City/Town of JUN 2 4 2013 TOWN OF NORTH ANDOVER System Pumping Record LT r ::r Form 4 FHEALTHCDEPARTMENT 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 Ahis 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. A. Facility Information 1. System Locatior� eft i g h (:f:� :Kc i :n :hou �el-eft / Right rear of house, Left / right side of house, Left a. R It t:o:f s t; 0 116 ft / Right front o building, Left / Right rear of building, Under deck Right side of builc ing, Lei fron b Address r ��-) r7 D <q-�:)tAkA, , 6 4 1 f - — *L6� Cityrrown State Zip Code 2. System Owner uu I C Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: M State C e Telephone Number T Date 2. Quantity Pumped Cesspool(s) * 8 --Septic Tank Other (describe): 4. Effluent Tee . Filter present? Yes a-N-�o 5. Condilb. Unf System. - 6. System Pumlied By: t --1 ,!:) 4--e� Gallons El Tight Tank If, yes, was it cleaned? El Yes r-1 No vco� I (&e -a -p C-) �� t � C-�" \ V-\ Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: GL Lowell Waste Water Date t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 ICN Commonwealth of Massachusetts City/Town of RMBIVE11 System Pumping Record MAY ? 8 2010 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other f(jrmNUftTHb9E1WWNWMe I 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. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hous ht fro i� 11: of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address City/Town 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: F1 F-1 Other (describe): State Zip Code Date Cesspool(s) State Code az Telephone Number 2. Quantity Pumped: E—S—eptic Tank Gallons El Tight Tank 4. Effluent Tee Filter present? E] Yes 2-11�`o, If yes, was it cleaned? E:1 Yes 0 No 5. Condition of System- (\,ux�z� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locat ntents were disposed: L/(3. D Lowell Waste Water of Date C) t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 t ' r 1 r Commonwealth of Massachusetts City/Town of S item Pumping. Record RECEIVED YS Form 4 JUL DEP has provided this form'for use -by local Boards o f Health. Oth R.# TIN, jbq\q!jedFb.qt the information- must be substantially the tame as that provided here. 10elpl:p -gAhis.,ifbrM, check with your qn 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. A. Facility. Information 1. System Location: a)RIgh �o�lntof ho�usf, Left/ Right'rear of. house, Left/ right side of house, Left/ g M oq Right side of building, Left / R%1 7n uildifig, Left / Right rear of building, Under deck Address 01��- Cftyfrown State Zip Code 2. System Owner GX-)-J\ Address (if different from location) Cityfrown State Zip Code A Telephone Number B. Pumping 1. Date of Pumping 3. Type -of system-. E] 4. Date 2. Quarift Pumped: Cesspool(s) ' G-S'eptic Tank Gallons Lj Tight Tank Other (describe): Effluent Tee Filter present.? El Yap 0-9-0--� If yes, was ft cleaned? 5. Condition I Nem 6; System Pumped By. - 7. t5form4.doo- 06/03 Nell BatesFon Name Bateson Enterprises Ina Company contents- were disposed: El Yes El No.. F5821 Vehicle Ucense Number System Pumping Record - page I of I 41