HomeMy WebLinkAboutMiscellaneous - 271 BOSTON STREET 4/30/20184-.P- I."
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Commonwealth of Massachusetts
City/Town of
S item Pumping- Record DEC, 15 2014
YS 4
- J�LR
Form 4 T0VVNU�-NjK1F AN-,�
HEA;'!-'
DEP has provided this form'for use- by local Boards of Health. Other forms may be'used, but the
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1 . System Location: Left / Right front of house, Left I 6���Left- right side of house, Left
Right side of building, Left Right front of building, Left / Right rear of building, Under deck
Address
adyrrown Ttite Zip Code
2. System Owner
Name'
Address Cd different from location)
cityfrown State Code
-7
Telephone Number
B. Pumping Record
1. Date of Pumping
3. Type -of system,* E]
I a -(a -(Y
2. Quantity Pumped:
Cesspool(s) eptic Tank
Other (describe):
4. Effluent Tee Filter present? 3-1'-- �C]No
Gallons
El -right Tank
If yes, was it cleaned? D-Yeis'E] No,
5. Condition of.System:
(A'-
6. System Pumped By.
7.
Nell Batewn F5821
Name Vehicle License Number
Bateson Enterprises Inc
mpany
contents. were disposed:
4%4x)(z�
( a -67
Date
t5fbrm4.doe- 06/03 System Pumping Record - Page 1 of 1
Commonwealth of Massachusetts
City/Town of 1-5 2014
System Pumping- Record EC
Form 4
DEP has provided this fbrTn'fbr use.by local Boards of Health. Other forms may be'used, but the
information must be substantially the same as that provided here. Before using.this form. , check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left / Right front of house, Left / Q;Et r "ofho Left/ right side of house, Left/
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
Cltyf-rown State Zip Code
2. System Owner
Name'
Address (if different from location)
Cityfrown stat9w-, Mp
17
—r?Cod
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
3. Type -of system� Cesspool(s)
0 Other (describe):
('6:>
Gallons 17--7
Tank Tight Tank
ki-11 --M� -
4.. Effluent Tee Filter present.? Yes 0-14�0 If yes, was it cleaned? [] Yes E] No
5. Condition of.System: "4v-� ( -
— . Njc�) - Uj�8) ' 4z7�
6. System Pumped By.
Nell Bateson
Name
Bateson Enterprises Inc-
mpany
7. Loco '
ffion contents were disposed:
Lowell Waste Wc
F5821
Vehicle License Number
((—/-I Al,
7
Date
t5fbrm4.doc- 06103 System Pumping Record - Page 1 of 1
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
fyPRTI(FIC A..A-j
k, Aj --AqtF OE C0914TLIANCE
As of. -
October 19, 2007
q�is is to certify that the individualsubsurface Pposa(system receiveda
SAMEACTORTlYSTEMOYof the:
Tuffy RepairedSeptic System
Yohn Soucy
-A t:
271 Ooston Wpad
9Wap 107.B,- Tarce[58
Xorth,4ndover, WX 01845
The Issuance of this certificate shad not 6e construed as a guarantee that the system wiff
function satis/4ctorify.
Susah T Sauyer
PuAic Wealth Director
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES Z
.HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 0 1845 S40W
978.688.9540 - Phone
Susan Y. Sawyer, REHSIRS 978.688.8476 - FAX
Public Health Director E-MAIL: healthde t ownoffo—rt0andover.com
TOWN OF NORTH ANDOVER W�j
207
SEPTIC DISPOSAL SYSTEM - INSTALLATION CE TIFICATION
k-ro'!�Nc*
A'I'TH
The undersigned hereby certify that the Sewage Disposal Systekj(jy��e6n§tffc-ted; ('�Q repaired;
by -Z-OKA/ SoclC:t SOuCYC, SeQAP—
(Print Name)
located at Z,7) go S7 -6A-) S -r.
(Installation Address)
was installed in conformance with the North Andover Board of Health approved plan, originally
dated 9-16-01 and last Revised on 4 *7 with a design flow of
330 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 3 10
CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the
approved plan. All work is accurately represented on the As -built which has been submitted to
the Board of Health.
Bed inspection date: (0-5'e>7
Final inspection date:
And - Print Name
16 - 16 - 07
d"
e
I A-,,,
Enaeer lWr sentative (Signature)
0- �_
�_fo e
And - Print Name
Engineer lCepresentative (Signature)
And - Print Name
O*w
(Signature) ate:
Engineer: (Signature) Date:
And - Prin(Name
AS -BUILT CHECKLIST
/col
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDR4G-RE9E-RVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVAnON
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
ORIGINAL STAW & SIGNATURE
INVERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
LOCATION & ELEVATIONS OF BENCHMARK USED
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 271 Boston Street MAP: 107B LOT: 58
INSTALLER: Soucy Sewer Service
DESIGNER: New England Engineering
PLAN DATE: August 16, 2007
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
TANKINSPECTION: 1611jorl
DATE OF BED BOTTOM INSPECTION:) 01 Ll 0-1
DATE OF FINAL CONSTRUCTION INSPECTION 0 tober 5, 2007
DATE OF FINAL GRADE INSPECTION: joji�161
SITE CONDITIONS
Z Existing septic tank properly abandoned
Z Internal plumbing all to one building sewer
Z Topography not appreciably altered
Comments:
SEPTIC TANK
t2s Bottom of tank hole has 6" stone base
E] Weep hole plugged
Z 2000 gallon tank has been installed
H-10loading Monolithic construction
Z Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
Z Inlet tee installed, centered under access port
Z Outlet tee (gas baffle or effluent filter) installed,
centered under access port
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
tkORT11
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PUBLIC HEALTH DEPARTMENT
Community Development Division
Z 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
Z Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
F-1 Bottom of tank hole has 6" stone base
E] Weep hole plugged
Z Combo Tank installed. Size: 2,000 Gal
F� 1000 gallon Pump Chamber installed
H-10 loading Monolithic construction)
F� Inlet tee installed, centered under access port
Z Pump(s) installed on stable base
Z Alarm float working
Z Pump On/Off floats working
Z Separate on/off floats
Z Drain hole in pressure line
Z 24" inch cover to within 6" of final grade installed over
pump access port
Z Watertightness of tank has been achieved
Visual testing
Z Hydraulic cement around inlet & outlet
Comments: Barnes Pump Installed
DISTRIBUTION -BOX
Z
installed on stable stone base
Z
Inlet tee (if pumped or >0.08'/foot)
Z
Hydraulic cement around inlet & outlets
Z
Observed even distribution
Speed levelers provided (not required)
Comments:
1600 Osgood Street, North Andover, Mosso(husetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townof north a ndov er.com
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0
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
SOIL ABSORPTION SYSIEM
(General)
ZN
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
F-1
Retaining wall (boulder / concrete / timber/ block)
F�
Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
Z Brand and Model of Chamber: Infiltrator Quick 4 Std
Z Number of chambers per row: 9
Z Number of rows (trenches): 2
Z Laterals installed and ends connected to header (and
vented if impervious material above)
Z Elevations of laterals and chambers installed as on
approved plan
Comments:
CONTROLPANEL
Z Alarm & Pump are on separate circuits
Z Alarm sounds when float is tripped
Z Location of control panel: Exterior
Z Rated for exterior if placed outside
Z Alarm signal located inside
Comments:
SYSTEM ELEVATIONS
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
itORTH
0
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
INVERT IN FIELD
PLAN INVERT ELEV.
Benchmark
104.34
100.00
Building Sewer OUT
97.36
N/A
Septic Tank IN
96.79
96.65
Septic Tank OUT
96.49
96.40
Pump Chamber IN
N/A
N/A
Pump Chamber OUT
N/A
N/A
Distribution Box IN
101.91
101.87
Distribution Box OUT
101.77
101.70
Lateral 1 TOP
N/A
N/A
Lateral 1 INVERT
101.66
101.67
Lateral 2 TOP
N/A
N/A
Lateral 2 INVERT
101.11
101.17
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
J*
E
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
1 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 3 10 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.townofnorthandoyer.com
Tank
SAS Sewer
Property line
10
10
Z
Cellar wall
10
20
El
Inground pool
10
20
F�
Slab foundation
10
10
F�
Deck, on footings, etc
5
10 --
F-1
Waterline
10
10 101
Fj
Private drinking well
75
1002 50
Fj
Irrigation well
75
100
F�
Surface Water
25
50
F-1
Bordering Vegetated Wetland
Salt Marsh, Inland / Coastal Bank3
75
100
R
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
F�
Trib. to surface water supply
325
325
F�
Public well
400
400
F-1
Interim Wellhead Prot. Area
F1
Reservoirs
400
400
F1
Drains (wat. supply/trib.)
50
100
F�
Drains (intercept g.w.)
25
50
F-1
Drains (Other) Foundation
10(5)
20(10)
F
Drywells
20
25
1 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 3 10 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.townofnorthandoyer.com
z
AS -BUILT CBECR
LOT NUMBER, STREET NAM
ASSESSORS MAP & PARCEL
LOT LINES & LOCATION OF I
LOC -0;NS-&-DIN-1EN-�IONS
T" 'S &J
INC UDING RESERV.E,,,,� :;)
TIES TO LOT LINES & DWELL
a. FROM SEPTIC TANK
U. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
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
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
LOCATION & ELEVATIONS OF BENCHMARK USED
NO
Commonwealth of Massachusetts Map -Block -Lot
+ 107.B- 0058 -
-----------------------
Board of Health Permit No
BHP -2007-0266
North Andover -----------------------
P.I. FEE
F.I. $250.00
-----------------------
Disposal Works Construction Permit
Permission is hereby granted John SOUCY -------------------------------------------------------------- ------------------------------
to (Repair) an Individual Sewage Disposal System.
atNo--2-7-1- BOSTON- S-TREET ------------------------------------------------------------------------- ----------------------------------------
as shown on the application for Disposal Works Construction Permit No. .13HP-20077026. Dated ---- Septembe-r-1-8,200-7
-----------------------------------------------------------------
Issued On: Sep- 18-2007 Board of Health
----------------- — — ------------------------ - - - -- ------------- —
I&ORT4 Map -Block -Lot
Commonwealth of Massachusetts 107.B- 0058 -
-----------------------
Board of Health
North Andover
A Certificate of Compliance
A w
THIS IS TO CERTIFY That the Individual Sewage Disposal System (Repair)
by____John_Soucy -----------------------------------------------------------------------------------------------------------------------------------------
Installer
atNo-2-7-1-BOST-ON-STREET ------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. - BHP -2-007---026- - Dated ... SepWmber _I 8, 2007
----------------------------------------------------------------
Printed On: Sep- 18-2007 Board of Health
----------------------------------------------------------------------------------
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Town ef North Andover
'TS4 U i
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HEALTH DEPARTMENT
CHECK#:
19-757 D A T E: 9
LOCATION:
0271'
H/O NAME:
CONTRACTOR NA&:
;Z-4
TYRe
of Permit or License: (Check box)
0
Animal
$
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$
0
Food Service - Type:
$
0
Funeral Directors
$
0
Massage Establishment
$
0
Massage Practice
$
0
Offal (Septic) Hauler
$
0
Recreational Camp
$
0
Sun tanning
$
0
Swimming Pool
$
0
Tobacco
$
0
Trash/Solid Waste Hauler
0
Well Construction
$
SEPTIC Systems:
0 Septic - Soil Testing
0 Septic.- Design Approval
0" Septic Disposal Works Construction (DW0
0 Septic Disposal Works Installers (DWI)
0 Title 5 Inspector
0 Title 5 Report
0 Other (Indicate) $
2596
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Application forSeptic Disposal System
0 - rmit —TOWN OF
%,Construction Pe
ORTH ANDOVER, MA 01845
S CJHU5
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Application is hereby made for a permit to:
E] Construct a new on-site sewage disposal system*
4Repair or replace an existing on-site sewage disposal system*
[I Repair or replace an existing system component — What?
A. Facility Informa
Address or Lot #
S -(o "A
Ci own A), Mot -
C
2V. TYPE OF SEPTIC SYSTEW:
m
Pump E] Gravity (choose one)
*.r p
f
***(f pu no system, attach copy of electrical permit to application***
TODAY'S DATE
$ 250.00 - Full Repairv,.,-/
$125.00 - Component
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)
F-1 Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
Name
CS04
Address (if different from above)
(AAA7
City/Town
State
Zip Code
6 (72 Fd -7(- -
&e6�0
Telephone Number
3. Installer Information
90-tt
C
Name
Name of Compar'�
Address
N44
City/Town
State
Zip Code
4. Designer Information
Name'
Telephone Number (Cell Phone # if possible please)
" -1/ - _-, '_'4_ -, t & �% �
Name of Company 1V
Address Vx:> t>s G6.0 �4- c� ( Y5�_
A - P f 4AAt-
City/Town t 4,� State Zi C d
-76
Telephoni'-Number (Best # to Reacy))
Application for Disposal System Construction Permit - Page 1 of 2
Application for Septic Disposal System
-Construction Permit -TOWN OF
ORTH ANDOVER, MA 01845
PAGE 2 OF 2
q, /1-1 �07
TODO'S DATE - - --.
1250.00 — Full Repair,�/
$125.00 - Component
A.facility Information cOntinued....
5. Type of Building: L
C; /esidential Dwelling or FCommercial
B. Agreement I I
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 Andover, and not to place the system in operation un rICertificate of Compliance has
been issued by this Board of Health.
t Z 47.
Name A Dal
Applicatio 'Approved Byi- 'Board of Health Representative)
7
Date
7/
isa ove f— S:
A: �I/cation D_ _�o d or e following reason
For Office Use 2UIL
1. FeeAttached? YeV/ No
2. Project Manager ObAgation Form Attached? Yes - No
3. Pumj2 Sys ? If so, A tiach coQV ofElcarical Permit Yes V/
es 0
4., Foundation As -Built? (new construction ronly): Yes L No
(Same scale as approvedplan)
0
9. Floor Plans? (new construction only): es No
Application for Disposal System Construction Permit - Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andov�r licensed installer for the construction for the septic system for the property at:
0 r
�7 9i__
(Address of septic system) For plans by /V
Relative to the application of 4A, LA, C (Engineer)
(Installer's name) And dated &�(-_ �&
�ynginaf date)
Dated
�Ioddy-s date) 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 pEor to
perfo i any work on a site. I must have the approved 121ans and the pen -nit on site when ap work is
rming
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 re!�uesting an insi2ection, without completion of the items in accordance
with Title 5 and the Board of Health kegOations nigi result in a $50.00 fi�e being levied against me and/o
my co=aqy.
a. Bottom of Bed — Generally, this is the first (1'� 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.coID) from the engineer must
be submi*tted 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 sel2tic systems in North Andover can constitute
reasons for denial of the system and/or revocation or susl2ension of 1Dy license to ol2erate in the Town of
North Andover, significant fines to all persons involved are also 12ossible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Detennination 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 Instabation of tank, D -Box, pipes, stone, vent, pump chamber, retaini#W waLf and other
components.
6. As the installer, I understand that I am sole1v tesnonsible for the installation of the system as ner the,
me of this obligation.
Undersigned Licensed Septic Installer: oday's Date) 0`2
-Name — print) —7—ame — �iigted)
0*
The Commonwealth of Massachusetts 772-5-0
Department of Public Safety 00&jpWjW & fts Cheftd
130ARD OF FIRE PREVENTION REGULA71ONS 527 CMR 12:00 3/90, On" Wok)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL V�?Rk
NI wo* to to pft*x� in 8=rdWpc9 *ft the ManaChUMM 86WkW Code, 527 641R 12-W
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date q17-
Toqt4 tj t�j
City or Town of
The undersigned applies for a permit to perform the elseVical work descr[W below.
-V '-7 SEp 9 2007
Locatim (Strest & Number)
Owner or Tomuit On A t, nC&F.R
luvvl,4�,�'bL��RTMEN-i
0wrWs Addrea HEALT ------
Is #ft permit In conju!ZF� with a bukWV peen it Y" No (Check App!" Box)
Purpow ol'Building Utft Authorlipftn, No.
ExIsft Service OL -V Amps =?=C2 &Q Voft Overtmad 9-' Undqrd C3 *.:of
0 MeWn
New Senda - Amps VORS Owtead Undgrd
Number of Fbefts 77
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
September 11, 2007
Thomas Cusson
271 Boston Street
North Andover, MA 0 1845
RE: Septic System Design; 271 Boston Street, North Andover, Map 107B, Lot 58
Dear Mr. Cusson,
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 New England Engineering
Services, dated August 16, 2007, last revised September 6, 2007. This plan has been approved.
Th e approval includes a local upgrade approval.
1) A reduction in separation distance between tank and inverts and the estimated high
ground water from 12 inches required by Title V to 6 inches.
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 3 -bedroom house (maximum 7 -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 . Please keep the attached DEP Form 9b for your records
2. If.site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
3. 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 Fox 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.
ySincer
us
usan Y. Sawyer, REHS/
Public Health Director
Encl: list of licensed septic system installers
Cc: New England Engineering Services, Inc.
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978,688.8476 Web www.townofnorthandover.com
knpwtaft
V*= filling out
fb"ns on ft
cornputer, use
only ft* tab key
to move your
cursor - do not
use the return
key-
�Q
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Appiroval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
1. Facility Name and Address
Thomas Cusson
Narna
271 Boston Street
Strest Addrm
North Andover
CftYfT0=
2. Owner Name and Address (if different from above):
Name
Crity/Town
MA 01845
stale
StrW Address
stake
ZJp Code Telephone Number
I Type of Facility (check all that apply):
Zip Code
0 Residential [I Institutional 0 commercial School
4. Design flow per 310 CIVIR 15.203: 330
gpd
5. System Designer Ben Osgood Jr. —
Narne 0 PE RS
1600 Osgood St North Andover 01845
Address Cfty/Twn State, ZIP
B. Approval
1. Local Upgrade Approval is granted for:
0 Reduction in setback(s) — specify:
0 Reduction in SAS area of up to 25%:
SAS size, sq. ft. % reduction
271 Boston St. fbm0b - rev. 7= Local Upgraft Approval* Page I of I
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
B. Approval (continued)
[I Reduction in separation between the $AS and high groundwater
Separation reduction
Percolation rate
Depth to groundwater
0 Relocation of water supply well (explain):
mInAnch
ft.
Reduction of 12 -inch separation between inlet and outlet tees and high groundwater
Use of only one deep hole in proposed disposal area
El Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CNIR 15.412(4):
List variances granted requiring DEP approval:
N. Andover Board of
Approving AUftft
Susan Sawyer, Health Dir.
Print or Type Norm and Tft
Sept. 11, 2007
Date
271 BOSWn St. lbraft - raw. 7/06 Local Upgrade Approval* Pop 2 of 2
Important:
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Commonwealth of Massachusetts
City/Town of No. Andover
Form 9A - Application for Local Upg
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
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 CIVIR
15.404(l), is not feasible.
System upgrades that cannot be performed in accordance with 310 CIVIR 15.404 and 15.405, or in full
compliance with the requirements of 310 CIVIR 15.000, require a variance pursuant to 310 CIVIR 15.410
through 15.415.
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 an on-site system constructed in accordance with either the 1978 Code or 310 CIVIR 15.000.
A. Facility Information
1. Facility Name and Address:
Thomas Cusson
Name
271 Boston Street
Street Address
No Andover
City/Town
2. Owner Name and Address (if different from above):
Same as Above
Name
City/Town
Zip Code
3. Type of Facility (check all that apply):
N Residential El Institutional
4. Describe Facility:
Sinde Familv Dwel
5. Type of Existing System:
El Privy El Cesspool(s)
MA
State
Street Address
State
Telephone Number
El Commercial El School
01845
Zip Code
M Conventional [] Other (describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach Field
Form 9A Application for Local Upgrade Approval revised.doc - rev. Application for Local Upgrade Approval* Page 1 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
Application for Local Upgrade Approval
Form 9A
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: 330
gpd
1111n
Design How ol proposed upgraded system
Design flow of facility:
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
gpd
330
gpd
El Voluntary El Required by order, letter, etc. (attach copy)
Required following inspection pursuant to 310 CMR 15.301: Unknown
date of inspection
2. Describe the proposed upgrade to the system:
Replace leach field and system components
3. Local Upgrade Approval is requested for (check all that apply):
El Reduction in setback(s) — describe reductions:
El Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction
El Reduction in separation between the SAS and high groundwater:
Separation reduction ft.
Percolation rate min./inch
Depth to groundwater ft. .
Form 9A Application for Local Upgrade Approval revised.doc - rev. Application for Local Upgrade Approval* Page 2 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
Application for Local Upgrade Approval
Form 9A
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
D Relocation of water supply well (explain):
E Reduction of 12 -inch separation between inlet and outlet tees and high groundwater
F-1 Use of only one deep hole in proposed disposal area
El Use of a sieve analysis as a substitute for a perc test
F1 Other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the
Code:
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 CIVIR 15.405(l)(h)(1). The soy evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Randy Burley
Evaluator's Name (type or print)
C. Explanation
Signature
7/31/07
Date of evaluation
Explain why full compliance, as defined in 310 CIVIR 15.404(l), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CIVIR 15.000 is not feasible:
No other location on the lot
2. An alternative system approved pursuant to 310 CIVIR 15.283 to 15.288 is not feasible:
N/A
Form 9A Application for Local Upgrade Approval revised.doc - rev. Application for Local Upgrade Approval* Page 3 of 4
7/06
Commonwealth of Massachusetts
City/Town of No. Andover
x
Form 9A — Application for Local Upgrade Approval
o
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
.No other adjacent is available
4. Connection to a public sewer is not feasible:
Public sewer is not available in the area.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
F� Application for Disposal System Construction Permit
El Complete plans and specifications
El Site evaluation forms
El 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 CIVIR 15.405(2).
El Other (List):
D. Certification
1, 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."
FadlW(rwner's Signatur
Beniamin C. Osciood Jr. A. (Aaent for Owner)
Print Name
New England Engineering Services, Inc
1600 Osgood Streeet
Preparer's address
01845
State/ZIP Code
Form 9A Application for Local Upgrade Approval revised.doc - rev.
7/06
— 9/7/ 1 A)
Date
8/21/07
Date
No. Andover, MA
City/Town
(978)686-1768
Telephone
Application for Local Upgrade Approval* Page 4 of 4
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CWAC
PUBLIC HEALTH DEPARTMENT
Community Development Division
September 5, 2007
Mr. Benjamin Osgood P.E.
New England Engineer Services
1600 Osgood Street
North Andover, MA 01845
Re' Proposed Subsurface SOWM 9 WAosal System for 271 Boston
Map 107B. Lot 58
Dear Mr. Osgood:
The proposed wastewater system design plan for the above site dated august 16, 2007
and has been reviewed. Unfortunately, the plan cannot be approved until the following
items are corrected. The specific section in Tft 5: 310 CIVIR 15-000, or North Andover
(NA) regulation that has not met by this design follows each Itern for your convenience.
1 . Please revise the Infiltrator End Detail on page 2 and subsequent proposed grading on
page 1 to depict a 15'separation from the breakout elevation to the 3:1 slope or specify
an impermeable barrier (15.255)
2. The requirement for 24 hour storage of wastewater above the alarm on float is not met. It
appears your calculations used the outside dimension of the tank as well as a larger
distance from the outlet invert to the alarm on float than what is noted on the plan.
(15.231(2))
3. Please provide a note stating the pump must be equipped with a manual operating
switch (NA 12.01)
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.
Since
/-2-
san Y. Sawyer REHS�/
Public Health Director
cc: Owner
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
..
r'
r
DelleChiaie, Pamela
From: Sawyer, Susan
Sent: Monday, August 27, 2007 2:50 PM
To: DelleChiaie, Pamela
Subject: RE: 271 Boston Street - New Plan - LUA
The invert reduction I can do in house. I usually send the leach field reductions to them.
Any news from Ben on the Lacy SO He should be sending down a narrative explaining the issue or a changed plan
Susan
----- Original Message -----
From: DelleChiaie, Pamela
Sent: Monday, August 27, 2007 12:26 PM
To: Sawyer, Susan
Subject: 271 Boston Street - New Plan - LUA
Hi Susan,
Upon going through my inbox, I noticed that this one has an LUA notation on the plan:
"Reduction in separation distance between tank inverts and the ESHGW from 12" required by Title 5 to 6".
It states LUA, which you can approve?? but it has the ESHGW, which I thought the BOH needs to approve?? Let me
know if they need to be at the 9/27/07 agenda.
Tx,
P
----- Original Message -----
From: Sawyer, Susan
Sent: Thursday, August 23, 2007 11:42 AM
To: Marianne Peters
Cc: DelleChiaie, Pamela; dobrzut@miliriverconsulting.com
Subject: new septic plans for review
271 Boston and 469 Boston Street plans are on their way. Mailed 8/23/07
Susan
�0
4[1 -,d-. -V-ffi-
Atti 16krqp— A*
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
September 11, 2007
Thomas Cusson
271 Boston Street
North Andover, MA 0 1845
RE: Septic System Design; 271 Boston Street, North Andover, Map 107B, Lot 58
Dear Mr. Cusson,
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 New England Engineering
Services, dated August 16, 2007, last revised September 6, 2007. This plan has been approved.
The approval includes a local upgrade approval.
1) A reduction in separation distance between tank and inverts and the estimated high
ground water from 12 inches required by Title V to 6 inches.
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 3 -bedroom house (maximum 7 -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 . Please keep the attached DEP Form 9b for your records
2. If site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
3. 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 Fox 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.
Sincer
u us
san Y. Sawyer, REHS/
Public Health Director
Encl: list of licensed septic system installers
Cc: New England Engineering Services, Inc.
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
a
br*Wtam:
When filling W
15orms on ft
computer, use
o* the M key
to move YW
amr - do riot
use the return
key -
Commonwealth of Massachusetts
Cityrrown 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
1. Facility Name and Address
Thomas Cusson
Name
271 Boston Street
Shad Address
North Andover MA 01845
CRY/Tom stow
2. Owner Name and Address (if different from above):
Name Steet Address
Cfty/Town state
ZJp Code Telephone Number
I Type of Facility (check all that apply):
0 Residential [I Institutional [I Commercial El School
4. Design flow per 310 CMR 15.203:
5. System Designer
1600 Osgood St
Address
B. Approval
330
gpd
Ben Osgood Jr.
Nam
North Andover 01845
Cityrrown State, ZIP
1. Local Upgrade Approval is granted for
[I Reduction in setback(s) — specify:
[I Reduction in SAS area of up to 25%:
271 Boston St. krm9b - mv. 7/06
Zip Code
0 PE [:1 RS
SAS size, sq. ft. % reduction
Local Upgrade Approval- Pop I of I
Commonwealth of Massachusetts
Cityrrown of
Local Upgrade Approval
Form 913
B. Approval (continued)
0 Reduction in separation between the $AS and high groundwater
Separation reduction
Percolation rate
Depth to groundwater
El Relocation of water supply well (explain):
ft.
mInAnch
ft.
Reduction of 12 -Inch separation between inlet and outlet tees and high groundwater
0 Use of only one deep hole in proposed disposal area
0 Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
N. Andover Board of Health
Apprwng Auftft
Susan Sawyer, Health Dir.
print or Type Narne and Me
Sept. 11, 2007
Dele
271 Boston St. form9b - rev. 7/06 Local Upgrade Approval* Page 2 of 2
DelleChiaie, Pamela
From: Sawyer, Susan
Sent: Wednesday, September 05, 2007 2:59 PM
To: kbrown@neengineeringinc.com
Cc: DelleChiaie, Pamela
Subject: 271 Boston
Re: Proposed Subsurface Sewage Disposal System for 271 Boston Street
Map 10713, Lot 58
Dear Mr. Osgood:
The proposed wastewater system design plan for the above site dated august 16, 2007 and has been
reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific
section in Title 5: 310 CIVIR 15.000, or North Andover (NA) regulation that has not met by this design follows
each item for your convenience.
1. The requirement for 24 hour storage of wastewater above the alarm on float is not met. It appears your
calculations used the outside dimension of the tank as well as a larger distance from the outlet invert to
the alarm on float than what is noted on the plan. (115.231 (2))
I am sending this instead of the full letter since it is one item. Please respond or send down a corrected version
thanks
Susan Sawyer
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Monday, August 27, 2007 12:26 PM
To: Sawyer, Susan
Subject: 271 Boston Street - New Plan - LUA
Hi Susan,
Upon going through my inbox, I noticed that this one has an LUA notation on the plan:
"Reduction in separation distance between tank inverts and the ESHGW from 12" required by Title 5 to 6".
It states LUA, which you can approve?? but it has the ESHGW, which I thought the BOH needs to approve?? Let me
know if they need to be at the 9/27/07 agenda.
Tx,
P
----- Original Message -----
From: Sawyer, Susan
Sent: Thursday, August 23, 2007 11:42 AM
To: Marianne Peters
Cc: DelleChiaie, Pamela; dobrzut@millriverconsulting.com
Subject: new septic plans for review
271 Boston and 469 Boston Street plans are on their way. Mailed 8/23/07
Susan
TOWN OF NORTH ANDOVER
Mee of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORT1.1. ANDOVER, MASSACHUSETTS 01845
978.688.9540 - Plime
Susan Y. Sawver, REHS/.RS 978.688.8476.... FAX
Public Health Director E-MAIL: licalthdel)tLitowiiofnorthaiidovei-.coiii
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: Auus-� 7- 1
&
Site Location: �0 WOVCI(-
Engineer:
New Plans? Yes $225/Plan Check # (includes Is' submission and one re-
review only)
Revised Plans?Yes $75/Plan Check #
Site Evaluation Forms Included? Yes L,-' No
Local Upgrade Form Included?
C4,
Yes__LZ," No
Fax #: Q79 -3 U - W39
'ding check):
Id letter
I Receipt
t�Copy File; Forward to Consultant
Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of A)6C4
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment tor Un -site z)ewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important: A. Site Information
When filling out
forms on the Tom Cusson c/o 271 Boston Street Realty Trust
computer, use
only the tab key Owner Name
to mnvp. your 07! Pncte-)n -qtrppt
cursor - do not Street Address or Lot
use the return MA 01845
key. North Andover State — Zip Code
Cityrrown 978-683-8076
tGa — — — — — — Telephone Number
Contact Person (if different from Owner)
B. Test Results
t5form12.doc- 06/03
Date Time
Test Passed: El
Test Failecl� 11
Perc Test - Page 1 of 1
1/1) I/V1 —
Date Time
PT1
Observation Hole #
22"/20"
Depth of Perc
9:45
Start Pre -Soak
10:00
End Pre -Soak
Time at 12"
_10-.00
10:11
Time at 9"
10:24
Time at 6"
13 min.
Time (9"-6")
5 min. per inch
Rate (Min./Inch)
Test Passed:
Test Failed:
Thomas Hector
Test Per—formed By:
Randy Burley, Mill River Consulting
Witnessed By:
Comments:
t5form12.doc- 06/03
Date Time
Test Passed: El
Test Failecl� 11
Perc Test - Page 1 of 1
Page I of I
DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.com]
Sent: Tuesday, July 31, 2007 4:45 PM
To: Daniel Oftenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela;
Sawyer, Susan
Subject: 271 Boston Street Soil Eval attached
Soil Results for 271 Boston Street done today, July 31st, attached.
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 N
www.millriverconsulting..com
8/1/2007
FW: 271 Boston Street - Soil Test Application - Notes from Conservation Page I of 2
1.
DelleChiaie, Pamela
From:
DelleChiaie, Pamela
Sent:
Tuesday, July 17, 2007 9:52 AM
To:
Osgood Ben (E-mail)
Subject: FW: 271 Boston Street - Soil Test Application - Notes from Conservation
Hi Ben,
See very bottom notes re observations from Conservation. Thanks.
----- Original Message -----
From: Dan Ottenheimer [mailto: info@millriverconsulting.com]
Sent: Monday, July 16, 2007 8:12 PM
To: DelleChiaie, Pamela; 'Marianne Peters (E-mail)'
Cc: Merrill, Pamela
Subject: RE: 271 Boston Street - Soil Test Application - Notes from Conservation
Pam,
We'll keep an eye out when we are on the site, but I assume someone has notified the engineer about this,
correct?
Dan
IMill River<
,---'consulting
Daniel Ottenheimer, President
Mill River Consulting, Inc.
On -Site Wastewater Management Services
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsultin2.com
dano.@mtLIriverconsulting.com
From: DelleChiaie, Pamela [mai Ito: pdel lechiaie@townofnortha ndover.com]
Sent: Monday, July 16, 2007 11:23 AM
To: Daniel Ottenheimer (E-mail); Lisa LeVasseur (E-mail); Marianne Peters (E-mail)
Cc: Merrill, Pamela
Subject: FW: 271 Boston Street - Soil Test Application - Notes from Conservation
For some reason, my distribution list won't work — so I had to call names up individually. Let me know if anyone
else should be on the list. Thanks.
----- Original Message -----
From: DelleChiaie, Pamela
Sent: Monday, July 16, 2007 11:19 AM
To: Daniel Ottenheimer (E-mail); Marianne Peters (E-mail); McBrearty Andrew (E-mail)
7/17/2007
FW: 271 Boston Street - Soil Test Application - Notes from Conservation Page 2 of 2
W
4.1 Cc: Merrill, Pamela
Subject: 271 Boston Street - Soil Test Application - Notes from Conservation
per Conservation Department -
Wetlands along Boston Street - may be within 100 feet of test pits — if so, will have to file an RDA with NACC.
t6ksI,R.o6F.a.-,dk,
Aaft.0.44 zpoftedialo
Health Department Assistant
Town of North Andover
1600 Osgood Street
Building 20, Suite 2-36
North Andover, MA o1845
2978.688-9540 - Phone
r;� 978.688.8476 - Fax
http.1/y�y��.tow-noftiorthandover.com,
healthdept@townofnorthandover.com
7/17/2007
Page I of I
DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.com]
Sent: Monday, July 16, 2007 12:52 PM
To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer,
Susan
Subject: Soil Eval - 271 Boston St - sched for Tues, July 31 st @ 9:00
Soil Eval for 271 with Ben Osgood scheduled for July 31 st @ 9:00.
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 N
www.millriverconsultina.com
7/16/2007
H
TOWN OF NORTH ANDOVER 'I
Off iceof COMMUNITY DEVELOPMENT AND SERVICES 0
0 0
HEALTH DEPARTMENT
1600OSGOOD STREET� BUILDING 20-1 SUITE 2-36
NORTH ANDOVER, MASSACHUSETTS 01845 s C
Susan Y. Sawyer, REHS, RS 978.688.9540 -Phone VZFCF-NF-0
Public Health Director 978.688.8476 -FAX
heal thdept(dtownof north dov
www.townofnorthandover co
.r M OF NORTH ANDOVEF'
APPLICATI ON FOR SOI L TESTS O\N Tvi oepxf�TMENT
HEAL
DATE: (Ttj)u to, 2w-7 MAP&PARCEL:
LOCATION OF �l L TESTS: o?21 jC9to .% /06, &d6
OWNER: 0__As(�nn Contact # 6 93- RM16
APPLICANT:_'%J_nP_ Contact #
ADDRESS. L) I I �0. "Ove -e -
ENGINEER: 0 Contact# Q71-WIP-111d
0
CERTIFIED SOIL EVALUATOR: VLm t A
Intended Use of Land: Residentiai Subdivision �hgleFamil Commercial
IsThis. Repair Testing: bZUndeveloped Lot T esting:_ Upgradefor Addition:
In the Lake Cochichewiick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
> Proof of land ownership (Ta( bi I I, or letter from ownerpermitting test)
> 8.5-x 11- Plot plan& Location of Testinq(pl ease indicate test pit sites on the plan)
> Feeof $125.00per lot for newoonstruction. This coversthe minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.0 per I at for repairs or upgrades.
GENERAL I NFORM AT I ON
> Oril y Certif i ed Sol I Evai uators may perform deep hol e I nspecti ons.
> Only M ass. Registered Sanitarians and Professi onal Engineers can design septic plans.
> At least two deep holes and two percolation tests are required for each septic system disposal area
> Repai rs requi re at least two deep holes end at I east one percolation test, at the discreti on of the BOH
representative.
> Ful I payment wi I I be required for ai I additional testswithi n two weeks of testi rig.
> Withi n 45 days of testi ng, a scai ed 0 an (no smai I er than 1 �1 00) shal I be submitted to the Board of Health
showi rig the I ocation of all tests (i nd udi rig aborted tests).
> Withi n 60 days of test i ng soi I e./al uati on f or ms shal I be submitted.
PI Do Not Wr ite Below T his L ine
N.A. Conservation Commission Approval Date.
Signature of Conservation Agent:
Date back to Health Department: (starnp in):
TOWN OF NORTH ANDOVER
Off i ce of COM M U N I TY DEVEL OPM ENT AND SERVI CES
0
HEALTH DEPARTMENT
1600OSGOOD STREET; BUILDING 20-1 SUITE2-36
NORTH ANDOVER, MASSACHUSETTS 01845 SAC
EC
Susan Y. Sawyer, REHS, RS 978.68& 9540 -Phone
Public Health Director 978.688.8476 -FAX
heal t hc1eptCd)townof north dover.corn
www.townofnorthandovericom JUL
APPL I CATI ON FOR S01 L TESTS
DATE:— (Tidu joanin
LOCATION—OF 91L TE/STS. rn '?y
ORI.�, woovSR
TO\NN OF N EPP'R-TMC-.NT
ViE�L
*WNER: --f
ln 11szo Contact #. 0 V - 6 93 - &qu
APPLICANT:
ADDRESS.
Contact #
ENGINEER: &U-1ainjo Contad# q71-WIP-09
CERTIFIED SOIL EVALUATOR: J�f'UlLmjA
0
Intended Use of Land: Residential Subdivision Commercial
IsThig Repair Testing: Lll--"�'Uncleveloped Lot Testing:_ Upgradefor Addition:
In the Lake Cochichewick Watenshed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THISFORM
> Proof of land ownership (Ta bill, or letter from owner permittingtest)
> 8.5-x 11 -Plot plan & Location of Testing (please indicate test pit siteson theplan)
> Fee of SA25.00 per lot for new construction. This ooversthe minimum two deep holes and
two percolation tests required for each disposal area Fee of $360.0 per lot for repairs or upgrades.
GENERAL INFORMATION
> Only Certified Soil Evaluatorsmay perform deep hole inspection&
> Only Mass. Registered Sanitarians and Professional Engineers can design septic plzm.
> At least two deep holes and two percolation tests are required for each septic system disposai area
> Repairs require at least two deep holes and at least one percolation test, atthediscretionoftheBOH
representative
> Full paymentwill be required for all additi onal tests within two weeks of testing.
> Within45daysof testing, ascaledplan (nosmallerthan 1-A00)shall besubmiftedtotheBo2rdof Health
showi ng the I ocati on of al I tests (i nd udi ng aborted tests).
> Within 60 days of testing soil Lvaluation forms shall besubmitted.
Please Do Not Write Belaw This Line
.... . ... . ..... ...... . .. . .....
N.A. Conservation Commission Approval Date...
Signature of Conservation Agen
Date back to Healt Department: (starnp in):
0�; 0 (011q
iob,
6 0, c
00
V� J\ -I
53
j,jC)ac
7
I
ac,
I.Olac
",5-,
I
1,07 ac 1.0 oc Loac r B
11 I.Oac (I-
Page 1 of 1
0
DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.com]
Sent: Tuesday, July 31, 2007 4:45 PM
To: Daniel Ottenheimer; dobrzut@millriverconsulting.com; Grant, Michele; DelleChiaie, Pamela;
Sawyer, Susan
Subject: 271 Boston Street Soil Eval attached
Soil Results for 271 Boston Street done today, July 31st, attached.
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 fx
www-.millriverc-onsulti-nq-.c,om
8/1/2007
Vo
In \V
0-
7 E
pi J�)
j -J
,�J- \,-. �j �
k7
\O
i 1>
I
N q14 -11 �lt ti N v
Q�
Mr. Guglielamo
-c, 9/ Boston & Gray Sts*
APPLICATION FOR SEWAGE DISPOSAL IkSTALIATION
HEALTH DEPARTMENT - NORTH ANDOVER, MSS.
I hereby make application for a permit for a sewage disposal installation at
Boston & Gray Sts. _. I will install this system in ac-
cordance with all the laws of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. 1 will install a con-
crete septic tank of -750 gal. in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of 180 lineal (Q�UM feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of -these
pipes will be protected from clogging and before filling the trenchi2 inches of
gravel or stone 1/811 to 1A" (dia.) will be placed over the course' gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
Ifurther agree not to cover ajiy portion of this installation until approved bythe
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DA TE
if
Signature of\kFp—licant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATEQ�-
Si7knature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DA
Signature of Ihs�ecting OfficeY
Percolat ion Tes t 5 min. Soil -sandy
Garbage Grinder
May 28, 1960
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination was made as requested in order to determine the
suitability of the soil for the subsurface disposal of sewage on
the proposed building site of Domenic Guglielmino situated on Boston
and Grey Street, Lot #4.
The land in general is high.
The subsoil in the area was sandy and a 5 -minute percolation
test was conducted.
It it -recommended that a 750 gallon concrete septic tank be
installed together 'with 180 lineal feet of drain pipe.
Very",�truly yours,,
am j Driscoll
WJD:hd
TP ITO= OF HEALTH
TOWN OF N0,RT'll ANDOVER, MASS.
121�,L4 ;,�A / /
OL
lo
2.
r-,A� 6
NAIX -.'b . . . . . . . . . . . 'y
. . . . . . . . . DATE
ADDRESS J I LOT NO. I f..q. TEL.
NO. OF BEDROOMS . . . . . DEN YES** NO*
/*. GARBAGE GRINDER YES
5. SHOW DIIEVSIOM OF HOUSE
40-041
NO.. . . . .
6. SHON DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DDWISIONZ OF LOT
86 SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9, NOTE LOCATION AND DISTANCE OF V7ELL FROIJ SETERAGE SYSTEM
10. SH(AAl LOCATION CF BROOKSp STREAIVS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OF, CESSPOOL FROVI HOUSE
NOTE: LOCAL REGULATIO11S SHOULD EE READ CAREFULLY.