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HomeMy WebLinkAboutMiscellaneous - 317 RALEIGH TAVERN LANE 4/30/2018 (2) ' I i s a Residential Property Record Card PARCEL ID:210/107.A-0126-0000.0 MAP:107.A BLOCK:0126 LOT:0000.0 PARCEL ADDRESS:317 RALEIGH TAVERN LANE FY:2014 PARCEL INFORMATION '096--Gd—de- 11011—Sale Price: 413;500�Book` X06800 -W Road Type: T- �'"�"�Inspect Date: 904/08/2010 Tax Class: T Sale Date. 04/25/02 Page 0125 Rd Condition: P Meas Date 04/08/2010 Owner: _�--� — - CAMPION, MICHAEL Tot Fin Area: t800Sale Types s P y Cert/Doc: Traffic: M ` Entrance X � w._ �: ,�, �_ .� , , . Tot Land Area: 1.03 Sale Valid: Y $1Nater: Collect Id RRC Address: .----- -_� — _ 317 RALEIGH TAVERN LANE Grantor: LEPINE;RICHARD L Sewer. Inspect Reas: C NORTH ANDOVER MA 01845.1Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L%a / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: '9 Main Fn Area: 972 Attic Y s NBHD CODE 7 . NBHD CLASS: 7 ZONE: R2 - Se T e Code Method , Ft Acres Influ-Y/N Value Class StoryHeight: 2.00 Bedrooms 4 Up Fn Area 828�Bsmt Area 972 �9,�r. YP , , 9- -�, Roof;;_ �G—Full Baths " 1 P 101 S� � 435601.000. 223,713 Fn Area: ;" Fn Bsmt Qrea: .. _�._-_ _ -__ e: 2 R 101- . A . . . .0. 0.030 .. 228 Ext Wall: FB�HaIf Baths. 1 Unfin Area: Bsmt Grade: - Masonry Trim Ext Bath Fix 0 Tof Fin Area., 1800 VALUATION INFORMATION Foundation: CN -Bath QualT RCNLD 206914 Current Total:. 430,800., Bldg: 206,900 Land: 223,900 MktLnd: 223,900 p .. . =Ketch Cual �� ,T Eff Yr Built:'X197 Mkt Adt Prior Total:. 442,400 . Bldg:. 206,900 : Land: 235,500 MktLnd: 235,500 Heat Type:' ER- Ext Kitch Year Built: 1976 Sound Value. Fuel Type: E Grade: G : Cost Bldg:. 206;900 - Fireplace: -1_Bsmt Gar Cap: Condition: A Att Str Val1: -. p Central AC�" N Bsmt Gar SF z Pct`Com ewe. Att Str;Val2 - - Att Gar SFS 484%aGood P/F/E/R: /100/100%80 Porch Type Porch Area Porch Grade Factor W 256 SKETCH PHOTO 16 W` 16 256 S1 Jk - 4' G FMJB FU M • �e, 484 5 .. q 972 94A 828 Sq Ft 22 z2 231 _ `. '7 �it 3: 317 RALEIGH TAVERN LANE Parcel ID:210/107.A-0126-0000.0 as of 4/2/14 Page 1 of 1 oo -- 1 Ord W1 . .fA a� . Piz —�� t ,� Vic. PROP t` . '4 -� p � � off' - `" .. ,�`'_ ,.INSPECTION �- PORT PROP. 1 00 G L. 3�oy '^,MQNOL-IT Ito.✓rr SEPTIC-TANK ` , _ PROP 2iiyF ,. o VENT 7,. .sa /. PR01�. r� . f 51.60 (H-2b) -rx PROP. LIMIT bFf k r EXCAVATIQ�I 5' ALL ROUN r� EROS 0 CONTROL BARRIER, I y COM OIT FIVTER SOCK 1 C)` BB FI=ER O14E t - ` x 136.46 x 1350 w (60 L.F:f) PROP. LECH. FIELD ' (20 Wx35'L 700 S.F.) 45� is3.3r 138.90 f 132.80 33-W 137.0010 1 RALEIGH w �s :3 A • S� De i ♦ 5 d, PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: l' 1/18/2015 1 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: I Complete Repair of an On-Site Sewage Disposal System By: James Kellett At: 317 Ralei!h 'Tavern Lane Map 106B Lot 144: North Andover, MA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Ntichele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com • �4�'fI�17,'/off � 0 RECEIVED NOV 16 2015 J4 ' 4rrc,+ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CE TIFICATION F:mom The undersigned hereby certify that the Sewage Disposal System( constructed;( )repaired; By: (Print Name) Located at: d 07 �,A,�W Ue ` (Installation Address) Was installed in conformance with.the North Andover Board of Health approved plan,originally dated L V-'I ` . and last revised on =�(1''� �� ,with a design flow of /1/1 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) And—Print Name. Final Construction Inspection.Date:.1 S Engineer Representative(Signature) And—Print Name Installer: (Signature) Date: 0 /3 H{ � And—Print Name Engineer: ,,,�VL ` 'yE h� *Z (Signature) Date: r And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com t SUMMARY OF INVERTS BUILDING TIES f SEWER ® FDTN. 139.48 BLDG. CORNER A B C D THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 138.31 SEP11C TANK OUT 39.8 15.5 — — A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 137.96 DIST. BOX 57.0 32.5 — — SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 136.02 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 135.79 COMPONENTS. BEG INV. 135.72 END INV. 135.53 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS—BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE E A A,)' LQT (46,164 S.F.) i VENT t500EMC TAG�►L. MNK INSPECTION O o PORT (TYP.) D-BOX 35' GEO-MEMBRANE LEACH FIELD t (20'x35'-700 S.F.) 3 ' 1 6g 45' � . 147.02,: r JME V9 "- ��tk OF MW3 111 q s . �WGX ,�, �� �� VLADIMiR L. �yN V NEMCHENOK FCS/STEP�G����c, NA 4-A EN 4-A 7-A WETLAND BY NORSE ENVIRONMENTAL A AS BUILT PLAN ' AUG. 204 g OF o "EC"I!!ED SUBSURFACE DISPOSAL SYSTEM NOV 1 g 2015 LOCATED IN TOWN OF NORTH ANDOVER NORTH ANDOVER, MASS./317 RALEIGH TAVERN LANE HEALTH DEPARTMENT AS PREPARED FOR F KIM CAMPION TM: 106B DATE: 10-22-15 TL: 144 SCALE: 1"=40' 0 20 40 $o MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 RATEDA f North Andover Health Department ' Community and Economic Development Division ONSITE WASTEWATER:SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 317 Raleigh Tavern Lane MAP: 106B LOT: 144 INSTALLER: James Kellett DESIGNER: Merrimack Engineering PLAN DATE: 5/16/14, rev 10/14/14 BOH APPROVAL DATE ON PLAN: 10/23/14 INSPECTIONS TANK INSPECTION: 10/9/15 DATE OF BED BOTTOM INSPECTION: 10/13/15 DATE OF FINAL CONSTRUCTION INSPECTION: 10 22/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: L� SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Watertightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 20" inch cover to finish.grade installed over outlet access port ® Neoprene boots around inlet & outlet Comments: Waterline moved to be 10`-2" from.septic tank. DISTRIBUTION-BOX Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe 'Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 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 Laterals installed and ends connected to header(and vented if impervious material above) Z Elevations of.laterals and chambers installed as on approved plan N/A iRetaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 46L x 31W. Electric line.moved outside of the new leach field area FINAL GRADE Loamed Seeded Cover per plan omments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by ngineer and installer As-Built Plan BM = 141.10 HR = 1.46 HI = 142.56 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 2.74 139.47 139.5 Septic Tank IN 4.10 138.11 138.25 Septic Tank OUT 4.27 137.99 138.00 Distribution Box IN 6.20 136.01 135.90 Distribution Box OUT 6.41 135.80 135.73 Lateral 1 TOP 6.52 / 6.70 Lateral 1 INVERT 135.69 / 135.51 135.68 / 135.50 Lateral 2 TOP 6.52 / 6.70 Lateral 2 INVERT 135.69 / 135.51 135.68 / 135.50 Lateral 3 TOP 6.51 / 6.68 Lateral 3 INVERT 135.70 / 135.53 135.68 / 135.50 Lateral 4 TOP 6.51 / 6.69 Lateral 4 INVERT 135.70 / 135.52 135.68 / 135.50 Bottom of Bed 135.01 135.00 i CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325. ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 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 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws • ;x EXED Commonwealth of Massachusetts Map-Block-Lot 107.A0126 w BOARD OF HEALTH Permit No ----------------------- BHP-2015-0403 North Andover --------_------------- P.I. FEE F.I. $250.00 ----------------------- . DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James Kellett to(Upgrade)an Individual Sewage Disposal System. at No 317 RALEIGH TAVERN LANE ---------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2015-040 Da ober 0I 2015 v Issued On: Oct-01-2015 'O ARD OF HEALTH All 05 -------------- --------------- i • .� '%k, Commonwealth of Massachusetts Map-Block-Lot .� n ' 107.A0126 BOARD OF HEALTH ----------------------- Permit No North Andover BHP-2015-0403 FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James-Kellett to(Upgrade)an Individual Sewage Disposal System. at No 317 RALEIGH TAVERN LANE as shown on the application for Disposal Works Construction Permit No. BHP-2 -04 ated( October 01,2015 LE Com'F I --------------- ------------------- ------------------------------------ - On: Oct-01-2015 ----------------------------------------------------------------- BOARD OF HEALTH • ,�:r°�� •. Application for Septic Disposal System TODAY'S DATE Construction Permit - TOWN OF $250.00-Full Repair NORTH ANDOVER, MA 01845 $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component-What? cursor-do not use the return A. Facility Information key. 3 t -1 /4 1'�tlep-n r)-L Address or Lot# % ;�2j 4/241ea z' 9yk�CYL.Y�tI �I City/Town i 2.-*TYPE OF SEPTIC SYSTEM*: OCT 0 1 2015 ➢ ❑ Pump (Gravity(choose one) ***If pump system, Sttach copy of electrical permit to application*** TOWN OF NORTH ANDOVER ❑ Conventional System (pipe and stone system) HEALTH DEPARTMENT ➢AInfiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before D WC issuance) What is the Make? Z_a-O"// What is the Model. 2. Owner Information !CI .r. Name s,AM-e- , Address(if different from above) City/Town State Zip Code Email address Telephone Number 3. Installer Inform©ationr/ �1 me J l` r LC e 11-g7-t� 1C /r✓z �i��' ��r Name Name of Company jd S'* Address City own State Zip Code it/ - 9�5'3 - 7/ Telephone Number(Cell Phone#if possible please) 4. Designer Information4 PC — , ame Name of Company Address Alml City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: LA/. 1G�M►� � �r (Address of septic system) For plans by (Engineer) Relative to the application of��11�'1f'fj�`` (Installer's name) And dated q �q)riglnai catte) Dated O6�T- / Z�6 1 �(I'ocTay's- ate With revisions dated _j (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 prLor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally,this is the first(V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK(or e-mail to: healthdept(@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work(other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the .rand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) (Name— Punt (Name—Signed) •_� ° •. Application for Septic Disposal System ID Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER MA 01845 $250.00—Full Repair $125.00-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building:residential Dwelling or❑Commercial B. Agreement 777777���---''' 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 weas the Local Subsurface Disposal Regulations for the Town of North Andover. I understan at until a final Certificate of Compliance has been issued by Vofi Board H, the in tai system is not approved. me Date i n Appro y a Health Representative) am Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee.Attached? Yes/ No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S sy tem? If so,Attach copy ofElectrical Permit Yes_ No Applicantreceived copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approval letter, all paperwork received. Yes No Missing:' 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 S�STLED j • . : n t VC `^ ty�k'ITE xp��v North Andover Health Department Community Development Division October 23, 2014 Kimberly and Mike Campion 317 Raleigh Tavern Lane North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 317 Raleigh Tavern Lane, Map 106B,Lot 144 Dear Mr. and Mrs. Campion: The proposed wastewater system design plan for the above site dated May 16, 2014 submitted September 23, 2014, with a final revision date October 14, 2014 received on October 20, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom (max 9-room) home. This plan is generally good for 3-years from the date of approval however, as this is for a repair system,this is reduced to 2- years. The plan received the following local upgrade approval. 1) To allow only 1 deep hole in the disposal area rather than 2, as required by the code 2) To allow the use of a sieve analysis as a substitute to a perc test 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 also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records (attached) 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 317 Raleigh Tavern Lane October 23, 2014 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 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 and/or imply compliance with any of the aforementioned requirements. 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. ZSincy, . Sa, er, HS/RS ealth Di ector Encl. Form 9B Installers list cc: Merrimack Engineering Services File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 913 M 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 Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Mike and Kimberly Campion key to move your Name cursor-do not 317 Raleigh Tavern Lane use the return Street Address key. North Andover MA 01845 r� City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir NemchenokName PE ®RS 66 Park Street Andover MA 01810 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 317 Raleigh Tavern Lane Local Upgrade Approval, Page 1 of 2 Commonwealth of Massachusetts W City/Town of North Andover Local Upgrade Approval Form 9B cc M SV a ye B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer October 23, 2014 Print or Type Name and Title ignature Date 317 Raleigh Tavern Lane Local Upgrade Approval* Page 2 of 2 10/27/2014 TOWN OF NORTH ANDOVER PERMITTED SEPTIC INSTALLERS- RENEWED FOR 2014 Doing Business As Phone City Angelo Petrosino (978) 664-2030 NORTH READING,MA 01864 Bill Hall (978) 689-3711 METHUEN,MA 01844 Chad Jablonski (978) 360-9358 NEWBURYPORT, MA 01950 Daniel A. Giard (978) 686-7653 NORTH ANDOVER,MA 01845 David Maynard (978-375-7228 BARNSTEAD,NH 03225 David V. Zaloga, Jr. (603) 765-9296 EXETER,NH 03833 James H. Currier (978) 774-6685 MIDDLETON,MA 01949 James Kellett (781) 953-7146 LYNNFIELD, MA 01940 John Butt (978) 815-5754 BOXFORD, MA 01921 John Chongris (508) 509-9443 ANDOVER,MA 01810 John J. Soucy (603) 216-7175 SALEM,NH 03079 John L. DiVincenzo (978) 372-7471 HAVERHILL,MA 01835 James Boraczek (978) 374-8803 HAMPSTEAD,NH 03841 Joseph Surianello (978)458-9117 DRACUT,MA 01826 Joseph Watson (978)475-3262 ANDOVER,MA 01810 Matthew Manning (603)329-5077 ANDOVER,MA 01810 Michael J. Cove (508) 523-2671 STERLING,MA 01564 Michael W. Reilly (978)375-4811 ANDOVER, MA 01810 Peter Breen (978)265-7580 NORTH ANDOVER,MA 01845 Robert Daigle (978) 887-3703 HAVERHILL, MA 01830 Robert T.Amor (978) 948 3341 BOXFORD,MA 01921 Robert L. Innis (978) 663-6006 BILLERICA,MA 01821 Rocci DeLucia, Jr. (603) 974-1580 SALEM,NH 03079 Serge Beaulieu (603)235-3740 DERRY,NH 03038 Stephen Iacozzi (978)479-4407 METHUEN, MA 01844 Timothy Quinlan (978)457-0528 HAVERHILL,MA 01830 Todd Bateson (978) 815-2703 ANDOVER,MA 01810 Warren Pearce Jr. (978)-664-5264 NORTH READING,MA 01864 NORTH ANDOVER&KINGSTON,NH William(Tom) Sawyer (603) 642-8910 03848 MCOPY North Andover Health Department (ommunity Development Division October 14, 2014 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 317 Raleieh Tavern Road,Map 106B,Lot 144 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated May 16,2014 and received on September 23,2014 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Based on the sieve analysis and the DEP alternative percolation guidance document, it appears the loading rate should be 0.74 gpd/sf instead of 0.66 gpd/sf. With this loading rate the leach field could be smaller in size. If your professional choice is to utilize the conservative rate, it would be appreciated if you could submit a brief note that can be placed in our files in an effort to avoid confusion in the future. 2. Please indicate the brand and model of the proposed distribution box(NA 3.2). 3. Please show the location of the existing water supply line(3 10 CMR 15.220(4)(m). 4. The existing spot elevations above the leach field on the northwest portion are greater than the maximum 36"of cover material(139.0'). Please indicate the maximum finish grade elevation above the leach field on the site plan to ensure compliance with the maximum cover requirement (3 10 CMR 15.221(7)). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. wyer,REHS �ubli ealth Dir for cc: Kimbe y im Campion Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT , .�w 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdeptgtownofnorthandover.com WEBSITE:httn://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM ED Date of Submission: f'—I6-j! - SSP 1014 TOWN UN NOR ANppVER Site Location: 171 � L Irit �gyri � HEALTH DEPARTMENT Engineer: r2 , "f2j � New Plans? Yes $225/Plan Check# _(includes 1st submission and one re- review only) i Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes V/ No Telephone#r ) j5j Fax#: 610 ��15r lggo E-mail:—W L12 LA r k y4-g Homeowner Name: El GA Hi2l00 OFFICE USE ONLY When the subm' sion is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database { Commonwealth of Massachusetts City/Town of North Andover w a Form 9A - Application for Local Upgrade Approval 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 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. 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 ah'-1 Astin Tappro ed capacity of an on-site system constructed in accordance with either the 1978 C de 0 (,00. A. Facility Information SEE r 1014 Important: TOWN OF NORTH ANDOVER When filling out 1. Facility Name and Address: HEALTH DEPARTMENT forms on the computer,use Mike& Kimberly Campion Residence only the tab key Name to move your 317 Raleigh Tavern Lane cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): SAME Name Street Address Cityrrown State (617) 852-3965 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 BDRM. House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval wM 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: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Total replacement (see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate min./inch Depth to groundwater ft t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 k ti Commonwealth of Massachusetts City/Town of North Andover m Form 9A - Application for Local Upgrade Approval 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) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test ❑ 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 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: N/A 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: N/A t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Commonwealth of Massachusetts Cityrrown of North Andover a Form 9A - Application for Local Upgrade Approval ^M s 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: N/A 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, 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. 1 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." 4 a 9-12-14 lii Ow er's Signature Date KimberlyCampion Print Name Bill Dufresne/Merrimack Engineering 9-12-14 Name of Preparer Date 66 Park Street Andover Preparer's address Cityrrown MA/01845 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 TerraFilter,LLC. P.O.Bax 227 10 Main St. Sturbridge,MA 01566 Tel: (508)347.5508 TerraTRker (877)347.7263 Pax:(508)347.9857 August 12,2014 Bill Dufresne �.. Merrimack Engineering RE �IVE1) 66 Park Street Andover, MA 01810 FSEP 21 ¢ 0�4 RE: Particle Size Analysis (Alternative to Perc Test) TOWN OF NORTH ANDOVER 317 Raleigh Tavern Lane, N. Andover, Mass. HEALTH DEPARTMENT Dear Bill: Below are the results of the particle size analysis from the sample submitted for the above referenced property. The analysis was performed utilizing the hydrometer method of Gee & Bauder (1986) in Methods of Soil Analysis, Part 1. Physical and Mineralogical Methods,2nd Edition. Sand Silt Clay (2.00 to.05mm) (.05 to.002mm) (<.002mm) Portion Passing 87.8% 9.5% 2.7% #10 Sieve USDA Soil Textural Classification: Sand MA Section 15.243 Soil Classification: Class I Based upon the DEP's Title 5 Altemative to Percolation Testing Policy for System Upgrades,the following effluent loading rates apply: Un-compacted Soil 0.74gpd/sf Compacted Soil 0.15gpd/sf Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, l`A U VAC 1;:--%A,(T� Mark Farrell,Soil Scientist www . TerraFiIter. com `r Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for OT tej a 99Disposal A. Facility Information a N14 H jojTOWN QlF NORTH ANDOVER Owner Name d 517 vjuly�iao Q-7A1 10& Street Add re s Map/Lot City State Zip CocTe B. Site Information 1. (Check one) ❑ New Constructio /upgrade El Repair 2. Published Soil SurveyAvailable? Yes ❑ No If es: ® I : y Year Published Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes 2 TIN"o If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? /Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): IwD" Near Range: ❑ Above Normal ["Normal ❑ Below Normal 7. Other references reviewed: Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 1 C Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): 2. Land Use �e✓�I M QVIAV (e.g.,woodland,agricultural field,vacant lot,etc.) Su 6ce Stones Slope(% Lb'�'10 - ko%A�Cl2e hl irk Vegetation Land rof m Position on Landscape(attach sheet) 3. Distances from: Open Water Body �eeo Drainage Way �ee� Possible Wet Area feet d` Property Line fee Drinking Water Well 7e� Other feet 4. Parent Material: -I LLi Unsuitable Materials Present: LR Yes ❑ No If Yes: ❑ Disturbed Soil /Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes R"'No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 1` I ' _ inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for on-Site Sewage Disposal •Page 2 of 8 { Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist Munsell (USDA) Structure Consistence Other Y (Munsell) ) Cobbles 8 (Moist) Depth Color Percent Gravel Stones to-I-1� C �„�Y�/� s`�G/� >a�n �,L �oP• 10/„ iy+c�f, ins Additional Notes: Soil Evaluation Forms.doc•rev. 1/10 form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches [Depth to soil redoximorphic features (mottles) A. � B. inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does t least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abs tion system? Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: in,-7b Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts C ity/Town of r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator �� Date r Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam y ku >A\QW Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Percolation Test 7 Form 12 GSM Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the L computer,use r It V,,pW &A��) only the tab key Owner Name - , , to move your 1 I-7 41_"f'A A` ) '�e cursor-do not Street Address or Lot# ' use the return key. kok City/Town State r�6 Zip Code �• <® 1�5 Contact Person(if different from Owner) `�elephone Number B. Test Results Date Time Date Time Observation Hole# �� Depth of Perc � t"� �CxI?.,s" Start Pre-Soak End Pre-Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate(Min./Inch) Test Passed: ❑ Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Thursday,June 26, 2014 3:59 PM ` To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE:317 Raleigh Tavern Lane Attachments: 317 Raleigh Tavern Road - Soil testing results 6-26-14.PDF Susan/Lisa, Attached are the soil testing results for the above referenced property. I let Bill do a soil sample because there is 8' of fill material above the natural soil layer and it would have certainly been unsafe to conduct a perc test. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe@millriverconsulting.com www.millriverconsulting.com -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Friday,June 13, 2014 8:59 AM To: Isaac Rowe (irowe@millriverconsulting.com) Subject: 317 Raleigh Tavern Lane Good Morning, Attached is an application for soil testing at 317 Raleigh Tavern Lane. Please contact Bill Dufresne to set up a date.Thank you. Have a great weekend! -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Friday,June 13, 2014 9:02 AM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 06.13.2014 09:01:30(-0400) 1 ad7r'l�;�,j Q TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES Asa' HEALTH DEPARTMENT ry 1600 OSGOOD STREET; SUITE 2035 �"'"�Im"O•''� NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,RENS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX healthdeptatownofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: (�,' I d- 1�- MAP&PARCEL: I 07,4 I 7Zi& LOCATION OF SOIL TESTS: �nwcm4j LIP. OWNER: f--f J:iC eA k-1 f 1011 Contact#:�/p f V 6 5z APPLICANT: *K-t Contact#: ADDRESS: ENGINEER: CP-0, kAer- "49(��� /1 _, Contact#: (1.79j Ll 75— 7,!2-5 V-�® CERTIFIED SOIL EVALUATOR: _VAJ�U/ t%X'2 RECEIVED Intended Intended Use of Land: Resid tial Subdivision Single Family Home Commercial _ JUN 1 2014 Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Mil TOWN OF NORTH ANDOVER In the Lake Cochichewick Watershed? Yes No HEALTH DEPARTMENT THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testin-e(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date. U 1 Signature of Conservation Agent: d-- t or e- r�p C) A-Cj Date back to Health Department: (stamp in � M To r , d x } t �- •Ir �1 { f wed if I VAR wo �n 1-44.. 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