Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 34 RALEIGH TAVERN LANE 4/30/2018
North Andover Board of Assessors Public Access yvRTy ��&sACNtJs Y• Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales Tovrn of Aiorth Amdave_ r Bcmwd Of Assessors Parcel ID: 210/107.A-0105-0000.0 SKETCH Click on Sketch to Enlarge Page 1 of 1 Property Record Card Community: North Andover PHOTO No Picture Available Location: 34 RALEIGH TAVERN LANE Dwner Name: STIGLIN, FRANCES D Dwner Address: 34 RALEIGH TAVERN LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7 - 7 Land Area: 1.05 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1800 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 441,500 408,400 Building Value: 204,600 193,000 Land Value: 236,900 215,400 Market Land Value: 236,900 2-hapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 04/04/1999 Arms Length Sale Code: F-NO-CONVNIENT Grantor: JOHN P STIGLIN Cert Doc: Book: 05389 Page: 0280 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=991523 9/14/2007 RY OF INVERTS BUILDING TI DTN. `IG, ES BLDG. CORNER A g N JK IN D—.—.���� THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK a -r 1G,7 16,3 A WARRANTY OF THE SUBSURFACE DISPOSAL JK OUT , 21 PUMP TANK ovr z5.ti 13.1 SYSTEM. IT IS A RECORD C IN Zv DIST: BOX sZ.l 33.5 AND ELEVATION OF THE EXISTING THE LOCATION IN Oq TING SYSTEM OUT COMPONENTS. WBER V1BER b I hereby certify the locations, elevations, ties, cover material, exposed components etc.; shown on this As -Built substantially agree with the approved plan and have determined that the Break Out Elevations, if applic tiSN OF M een met. VIL 0 V y No. 39840 Ss�QNAL E�4 JA ,tet • ZA � I f . . i'I •- but �... LEs,�,t.► F+ Et.0 'I 2a ��ruHr 9Gl'FT. p�..tFrU.' `c (RECEIVED JUN 19 813 TOWN OF NORTH ANDOVER HeAL.TH DEPARTMENT AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN 0OeTA ,4�JDA/ERj VKAI.0l44 Tb-VP-V� ISE AS PREPARED FOR �IZaI-AGES iTib LIQ SCALE: 1"=40' Th 107A .lwu� 12�Zo1?i -fL l06 1 I �ERRIMACK ENGINEERING SERVICES aNnavEx, MnssncxusET°rs 01810 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/20/2013 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Complete Repair and Construction of an On -Site Sewage Disposal System By: James Kellett At: 34 Ralei2h Tavern Lane Map 107A Lot 0105 North Andover, MA 01845 of thisCcertf& to shall not be construed as a guarantee that the system will function satisfactorily. Miclele Grant — Public Health Agent FI! GORY 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER RECEIVED JUN 19 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SEPTIC DISPOSAL SYSTEM —INSTALLATION CER IFICATION The undersigned hereby certify that the Sewage Disposal System ( constructed; ( ) repaired; By: IrNj 4LLC-ri " nnl. (Print Name) I Located at: ?j I:o�c 16 H"&,)Eh (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 3_ Ul ^ 11r;' and last revised on -4— 1&" I, , with a design flow of 444 n 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:_ [N i_ L VU_ FMS 01✓ And - Print Name Final Construction Inspection Date: kIL, t_ rwop'r And - Print Name (Signature) Enginer: V1,401"d /Wjt(ClL *4 ignature) Engineer Representative (Signature) e Engineer Representative (Signature) Date: (,- 1 Z - And - Print Name Date: And - Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com W , 1 North Andover Health Department fommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 34 Raleigh Tavern Lane MAP: 107A LOT: 105 INSTALLER: James Kellett DESIGNER: Merrimack Engineering PLAN DATE: 4/23/13 BOH APPROVAL DATE ON PLAN: 5/8/13 INSPECTIONS TANK INSPECTION: 6/4/13 DATE OF BED BOTTOM INSPECTION: 6/4/13,6/6/13 DATE OF FINAL CONSTRUCTION INSPECTION: 6/12/13 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK 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 ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged X 1500 gallon tank has been installed H-10 loading 10.6 from corner of house X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots Comments: PUMP CHAMBER X Bottom of tank hole has 6" stone base ® Weep hole plugged X 1500 gallon Pump Chamber installed ® H-10 loading 1000 gal. X Monolithic tank construction Z Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ® Inlet baffle wall ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) Comments: K 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) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: Engineer did not stake out B/B, went out to do it after 1 st inspection (2 inspections needed). B/B 27wx34'6"L. 28" in TP1, 30" in TP2 Corner of house to system 28.8 first inspection/32" 2nd inspection. SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Low Profile Infiltrator Chambers ® Number of chambers per row: 6 ® Number of rows (trenches): 6 Comments: Total Chambers = 36 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer J ❑ As -Built Plan BM = _100.00 HR = 2.12 HI = 102.12 SYSTEM ELEVATIONS SKETCH PLAN ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT 5.18 96.59 96.60 Septic Tank IN 5.35 96.42 96.40 Septic Tank OUT 5.61 96.16 96.15 Pump Chamber IN 5.63 96.14 96.10 2" Pump Chamber OUT 5.45 96.50 ----- 4" Distribution Box IN 0.83 100.94 101.00 Distribution Box OUT 0.92 100.85 100.83 Lateral 1 TOP 1.05 Lateral 1 INVERT 100.72 100.78 Lateral 2 TOP 1.05 Lateral 2 INVERT 100.72 100.78 Lateral 3 TOP 1.05 Lateral 3 INVERT 100.72 100.78 Lateral 4 TOP 1.05 Lateral 4 INVERT 100.72 100.78 Lateral 5 TOP 1.04 Lateral 5 INVERT 100.73 100.78 Lateral 6 TOP 1.05 Lateral 6 INVERT 100.72 100.78 Top of Chamber 1.02 101.10 101.17 Bottom of Bed/Chamber 1.70 100.42 100.52 SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ® Wetlands bordering surface water supply or trib. (in Watershed) 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 75 100, 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface 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 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 Blackburn, Lisa Subject: FW: 34 Raleigh Tavern Lane From: wrdufresne(c)comcast.net[maiIto: wrdufresne(a)comcast.net] Sent: Thursday, June 06, 2013 1:48 PM To: Blackburn, Lisa Cc: Sawyer, Susan Subject: 34 Raleigh Tavern Lane I performed an excavation inspection at the above site today and found it to be satisfactory. Additionally I staked out the proposed leach field. Susan had informed me that the area was excavated incorrectly but I staked the field out at 32 feet from the nearest house corner and 17 feet from the side property line per plan and found the area to be excavated accurately. The proposed field fell approximately 5 feet inside the excavated area as required. Please pass this information along to Michelle if she is the BOH Agent dealing with this matter. Thank you and have a Great rest of the Day Lisa Blackburn. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: _h_ftp://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. I 3 jP Pag I of I ag I ck I i i3 http:llweb.mail-comeast.netlservicelhomel—lphoto.JPG?auth=co&loc=en—US&id=16664l&... 6/6/2013 Commonwealth of Massachusetts Map -Block -Lot 107.A0105 BOARD OF HEALTH -"""-""--------------- Permit No North Andover BHP -2013-0729 ----------------------- F.I. FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James Kellett to (Construct) an Individual Sewage Disposal System. at No 34 RALEIGH TAVERN LANE ----------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2013-072'``DATR ----------------w Printed On: May -28-2013 ---"---"---"------ -------------------------- BOARD OF HEALTH W e ap t - Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 1 AM :X Application for Septic Disposal Svstem (Construction Permit - TOWN OF Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑■ Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information 34 RALEIGH TAVERN LANE Address or Lot # NORTH ANDOVER City/Town MAY 23, 2013 TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component 2.- *TYPE OF SEPTIC SYSTEM*: ❑■ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) K Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information FRANCES STIGLIN ��rm Name SAME M Ay Address (if different from above) City/Town 3. Installer Information JAMES KELLETT Name 400 SALEM STREET Address LYNNFIELD City/Town 4. Designer Information BILL DUFRANE Name 66 PARK STREET Address ANDOVER City/Town OF NORTH ANDOVER State 0 MEA Telephone Number KELLETT EXCAVATING Name of Company MA 01940 State Zip Code 781-953-7146 Telephone Number (cell Phone # if possible please) MERRIMACK ENGINEERING SERVICES Name of Company MA 01810 State Zip Code 978-475-3555 Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 y r 7 :;;, ApAlication for Septic Disposal System sConstruction Permit - TO�'K1N CJF 34 RALEIGH TAVERN LANE PAGE 2 OF 2 A. Facility Information continued.... s. Type of Building: WResidential Dwelling or []Commercial B. Agreement MAY 23, 2013 TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has be sued by this oard oft^ -7—y r3 Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes L/ No 2. Project Manager Obligation Form Attached? Yes L'� No 3. Pump S sty tens? Ifso, Attach 12gaY ofElectrical Permit Yes NoL.,11 4. Foundation As -Built? (hew construction ronl y): Yes No (Same scale as approved plan) ` S. Floor Plans? (new construction only): Yes N Application for Disposal System Construction Permit - Page 2 of 2 Commonwealth of Massachusetts Official Use Onlv Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfornied in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 37 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of s or her intention to perform the electrical work described below. Location (Street & Number) RP.i i p Owner or Tenant ; F((zN,0GuS S T t [ i 1 j Telephone No. Owner's Address 3'$ -tA'Vea l J Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ -__Existing ,_ Existing Service Amps / Volts Overhead ❑ Date., .1.1 ...................... OF 14ORT{�,� o�?' °°m TOWN OF NORTH ANDOVER a PERMIT FOR WIRING ,BSACMusEt4g Undgrd ❑ No. of Meters "= ' '1 No. of Meters C,'o *1 nrav be Siaived b1, the Inspector qjN%firer. L ALARMS No. of Zones o Detection and This certifies thatbo VkL Initiating Devices .... ......................... . P Q't 1 G,—.3 .......................................................................... has permission to perform Lof Alerting Devices ,J� P (�1 1, . Self -Contained ...... tection/Alertin Devices wiring in the building of., .tel 1 �, Municipal ......................... . ........... .................... cal Connection Other at .............. �v7'et... urity ystems:% i No. of Devices or Equivalent North Andover, Mass. ee............................. Lic. No.�.�..1. � (o �j to Wiring: 7 !.. No. of Devices or Equivalent ................................. Et. c,me nt'&SP POR .....................• lecommunications Wiring: /Check # -`' oc No. of Devices or Equivalent 61 n `r ed or ns required by the Irrspecrnr of H7res, policy.) or o Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for t e pe ormance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certifT under thepains andpena�ltnies orperjure, that the information on this application is true and complete. FIRM NAME: LIG NO.: Licensee:M Signatu e rl r �; ,� LIC. NO.: (Ifappl/cable, enter "exempt .. in the license rnrnrbe. - lirr .J Bus. Tel. No.: Address: �-i�// �w 6A Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, 9ecurity work requires l5epartment of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner .❑ owners Owner/Agent ' agent. Signature Telephone No. PERMIT FEE: $ g 4) A we. North Andover Health Department (ommunity Development Division April 4, 2013 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 34 Raleigh Tavern Lane, Map 107A, Lot 105 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated March 26, 2013 and received on April 1, 2013 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. A Local Upgrade Approval for using a sieve analysis and reduction of the 12 -inch separation between inlet and outlet tees (septic tank in/out and pump chamber in) and high groundwater must be requested. Please revise the Form 9A and note the Local Upgrade Approval requests on the design plan (3 10 CMR 15.405(1)(k)). 2. The bottom of the septic tank is below the high groundwater elevation and requires buoyancy calculations. The note provided on the plan is not sufficient (3 10 CMR 15.221(8)). 3. Please note that the pump chamber shall be watertight (3 10 CMR 15.221(1)). 4. Please indicate on the plan the depth at which the soil sample was taken and the determination of the soil compaction. 5. It appears that no wetlands exist within 100' of the proposed septic system. If so, please revise note #14 on sheet 1. 6. Please indicate if the tree in the southwestern corner of the proposed leach field is proposed to be removed. 7. Note #1 on sheet 1, should indicate ASTM C33 sand. 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 e ..10 . 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. Sily, 4 Susan Y. awyer HS/RS Pnhlir Palth Petnr cc: Frances Stiglin 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 MERRIMACK ENGINEERING SERVICES, INC, PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineering.com April 23, 2013 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE: 34 Raleigh Tavern Lane Dear Ms. Sawyer, RECEIVED APR 2 4 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT We are in receipt of your review letter dated 4-4-13 for the above referenced project. The plan has been revised with regard to items 1, 2, 5, 6, & 7 of your letter. With regard to item 3, pump note #6 the already states that the pump chamber shall be watertight. With regard to item 4, the soil sample was taken from a clump of the "C" soil horizon out of the test hole, the soil evaluator asked the Inspector if he felt it was a representative soil sample from the parent soil and he confirmed that it was representative and un - compacted as the soils logs indicate. The soil logs also indicate the soil to be friable which is contrary to compacted. Enclosed please fmd 3 copies of the revised plans and Form 9A. We feel that the revised plans adequately address your concerns and respectfully request the revised plans be approved as submitted as the owners have a sale pending and are anxious to begin construction. Yourgtruly, William Dufresne Merrimack Engineering Services r 14 1, OF NORT/� qti COPY L7E O � LSSA C H US�� North Andover Health Department (ommunity Development Division May 8, 2013 Francis Stiglin 34 Raleigh Tavern Lane North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 34 Raleigh Tavern Lane, Map 107A, Lot 105 Dear Mr. Stiglin: The proposed wastewater system design plan for the above site dated March 26, 2013 with a final revision dated April 18, 2013, received on April 24, 2013 has been approved. The design has been approved for use in the construction of a replacement onsite septic system. 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 approvals. 1) The use of a sieve analysis in lieu of percolation test 2) Reduction in vertical separation between ground water for septic tank inlet and outlet and the pump tank inlet 3) Separation from S.A.S. to ESWT from 4 feet to3feet 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 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 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 34 Raleigh Tavern Lane May 8, 2013 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. Since ly, Susan Y. awyer, HS/RS Public Health ectcr Encl. Form 9B cc: Merrimack Engineering File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3 -��� t c✓r�i�"` NORTH O� itLED 16ga ,■ o y o A PROPERTY OWNER t--D1t,,ft-v \ Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑ Addition ❑ Two or more family El Industrial El Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑ Assessory Bldg Others. ❑Demolition ElOther Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershe District ❑ Water/Sewer - - L3G G OWNER: Name: Address: UtJGKir 11UN lir- vvvr[rx i v o- 1- I d e n ti fi c attio n, Identification - se ;1 or Print Clearly Phone:917 2-'Z-- na Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: ARCHITECT/ENGINEER . Date: Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �..T -�l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tannin TFood in Pools Tanning/Massage/Body Art ❑g ❑ Well ❑ Tobacco Sales ❑ Private (septic t ❑ ckaging/Sales ❑ (p tank etc. Pennauent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature, COMMENTS CONSERVATION Reviewed on�LJ �o / /,S - COMMENTS j COMMENTS HEALTH Reviewed on &, ��� Sian Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature nate Driveway Permit DPW Town Engineer: Signature: FIREIDEP �`�" _ Located 384 Osgood Street _ �ARyT�MENT TemprDumP$. -f ontsite Locatedjat 1241MaintSt�eet - _ n m Fire�Departmerit4ignature/date v �y Commom al i of Massachusetts City/Town f N lrth Andover Form r4 Application for Local Upgrade Approval M yV VJ DEP has provided this form for use 4y 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 above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. Important: When filling out forms on the computer, use A. Facility Information 1. Facility Name and Address: Frances Sti lin Residence APR 2 4 2013 TOWN OF NORTH ANDOVER only the tab key Name MALTHIVEPARTMENT to -Move your 34 Raleigh Tavern Lane cursor - do not use -the return Street Address key. North Andover MA 01845 Citylrown State Zip Code 2. Owner Name and Address (If different from above): c/o Marta Stiglin Same Name Street Address Cityrrown State (978) 609-7825 Zia Code Telephone Number 3. Type of Facility (check all that apply): Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom 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): Leach Field t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts CityfFown of North Andover 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 1. Proposed upgrade is (check one): Unknown .gpd 440 gpd 440 gpd ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: 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%: date of inspection SAS size, sq. ft. % reduction ® Reduction in separation between the SAS and high _groundwater: Separation reduction 1.0 Percolation rate Depth to groundwater ft. Sieve Analysis -min:/inch 3.0 ft, t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover e 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): S 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: Dan Ottenheimer Evaluator's Name (type or print) Signature C. Explanation 3-14-13 Date of evaluation 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: High Water Table 2. An alternative system approved .pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 3 of 4 X Commonwealth of Massachusetts City/Town of North Andover o 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. C. Explanation (continued) 3. A shared system is not feasible: NA 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 Z 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): C. 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. 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." Facility Owner's Signature el V Frances Stiglin Print Name Bill Dufresne/Merrimack Engineering Name of Preparer 66 Park Street Preparer's address MA / 01810 State/ZIP Code 3-29-13 Date 3-29-13 Date Andover City/Town (978) 475-3555 x-20 Telephone t5form9a.doc • rev. 7106 Application for Local Upgrade Approval• Page 4 of 4 Commonwealth of Massachusetts w W City/Town of North Andover a o Local Upgrade Approval Form 913 i M 5v0y`' 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. ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction 34 Raleigh Tevern Lane St form9b • rev. 7/06 Local Upgrade Approval• Page 1 of 2 A. Facility Information Important: When filling out forms 1. Facility Name and Address on the computer, use only the tab Frances Stiglin key to move your Name cursor - do not the 34 Raleigh Tavern Lane - use return key. Street Address North Andover MA 01845 _ I 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): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok ® PE ❑ RS Name 66 Park St Andover 01910 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 34 Raleigh Tevern Lane St form9b • rev. 7/06 Local Upgrade Approval• Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover o Local Upgrade Approval Form 9B GSM yw ° y0 B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): 1 ft. alt to pi min./inch 3 ft. ® 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: Health Department Approving Authority Susan Sawyer Print or Type Name and Title May 8, 2013 Date 34 Raleigh Tevern Lane St form9b • rev. 7/06 Local Upgrade Approval* Page 2 of 2 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS, RS 978.688.9540 – Phone Public Health Director 978.688.8476 – FAX www.townofnorthandover APPLICATION FOR SOIL TESTS EIVED FEB 26 2013 TOWN OF NORTH ANDOVER DATE: '��� 2—I MAP & PARCEL: I o� / / 0 9L=HEALTH DEPARTMENT l LOCATION OF SOIL TESTS: Ili' EALE 16 I A2 Fp,,kZ I -A t, V OWNER: S // I i 6L10 Contact#: APPLICANT: 1k9'r �m (a U Q Contact #: M 6,0 702 ADDRESS: -%_1 VAJ.C64 0 -ikJl;n ) LK . ENGINEER:I WC) W, -,_L tU jQ6" Contact CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Si�Familyme Commercial Is This: Repair Testing:ydeUndeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x M"Plot plan & Location of Testing (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 D e. jj l/ r–i)Signature of Conservation Agent: Q – - j 1 Aa, Date back to Health Department: (stamp in): e x r'R'� .. 'JL4 i , s,:. '# # j'"yy,� tts . 3 y} €"F47a r r { ����{grr �0 AS bgy ,i t y ) J7r,� x 7 1 4 R SC t i 1 t; .'2r' L -•hyy ,.y9,� },.�,r'',' �c a rT ,c i'+G� 4P + , �;.. t lu �r �'.45�r ��'��+,y t ,y �,�k1k � a •:' J`�"Or.{- y 7 . VN On l tN Ti �-� � �.� �A � { ts� '� a'ta -:.�3 r i § �} gym,. -..,F� � `� `� � 't•3 t� oft W f fit, { ' ,�;. ��� .'iri �`t�r,��& y(3y '� t'` +fig r•y ��•�k� ,a ht * �� �t 7� tt A �. s !t t Y p � T �3T S t xa r -a�Y r 1R p dt it 1 h r✓ �',i" `y '�� ¢ r 'i.', �.. �v}ai�a "aAWN +w' feF i r r k\ly CZ• r4, VN 'M,:+yy4 J s',q t ry�1�{�''Won,e i en �'� i''"'h? y�yk "_ �` � �� '� i i •� a� v .. a�:,1 r1 ,, 1 .+ Td na: t. [ist a ON ell t} t to f WIN .. ��'h`�h¢}� � ?k`a Y t ���' • s � '� � �,�u4e t% a Pk� fit'; �. .^, �� �� l? �� {�{a ' "" w ��� fr `t�� '} S `'.f1'41 v ' ,•r 1 3 fj ay i r b. t A sagt,� ta 0 all =1 Y•�.+..a.""+� Z� -+t^ x�+M' � � S �.�. _x 0 �T"S r \ �y`e' q/�y,� -••-,� , ;b 7�..ir�-.W. �K '7 t S Fe b N)T ,f T � i Tt �'a �S W ,•i \ F y £..� t f.. a ; � s \�� d , x d tv � '`"; ? or T �t �', }�' 8�-. tzyy.-�{ - x�s� �• �'.. ,� is h � �c�� s t�, R t}.t _�'o ,I.f`.1 a, •'"`.�.i <: x�^*'z>i ' �x`. +tc,'.Ft+s „..,.,.�:.-:�...i �4Jd .-?. ? �'".+w, ;;.. .. TerraRiter March 21, 2013 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 RE: Particle Size Analysis (Alternative to Perc Test) 34 Raleigh Tavern Ln., N. Andover, Mass. Dear Bill: Terrol'ilter, I.I.C. P.O. Box 227 10 Main St. Sturbridge, MA 01566 Tel: 1508) 347-5508 (877) 347-7263 Fax: (508) 347.9857 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 Anal sis Part 1. Physical and Mineralogical Methods 2nd Edition. Sand Silt Clay (2.00 to .05mm) (.05 to .002mm) (<.002mm) Portion Passing 84.5% 13.8% 1.7% #10 Sieve USDA Soil Textural Classfication: Loamy Sand MA Section 15.243 Soil Classification: Class 1 Based upon the DEP's Title 5 Altemative to Percolation Testing Policy for System Upgrades, the following effluent loading rates apply: Un -compacted Soil 0.66gpolsf Compacted Soil 0.15gpolsf Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, (\A ^\ CA At Mark Farrell, Soil Scientist !���Illllllllllllllllllll�u� liiillllllM�' C Ol E C 0 U OL a 2 N _T U N co W - N N } () m :; Q O O. a) w U cm eC _O O a) :E ca Z U cn Cl) cri E w C m J N a7 m .0 c 0 0 m "O O a) � c m 0 IN >, Z. _(D 0 m > 0 m C C a) E m Z ca E O z O N m ❑ 0 m E E m L o Z 24 wo— C CL `m T L E 0 rn �� O a U C is m co o U y m c 0 0 m U U w 0 cc 7� c N 7 U C.6 3 N V) U C a) 12 a) L O r Go 0 a) rn m a 0 N 0 v tll LL 0 w 'o O Z Z 0 C a) > C C c c c o O ° 0 z O O (1) O O io NO O N LOQ (a a) a) 0 > c m 0 U0 O LL O r a) Q?i ui ca E O z O N m ❑ 0 m E E m L o Z 24 wo— C CL `m T L E 0 rn �� O a U C is m co o U y m c 0 0 m U U w 0 cc 7� c N 7 U C.6 3 N V) U C a) 12 a) L O r Go 0 a) rn m a 0 N 0 v tll LL 0 w 'o O N CL U) 8 0) d U) O I- 0 0 EwC W CD, Y/ Y/ to c c � }r 0 M '3 ca � O cc t � O C E4.0. L V U LL �����Illlllllllllllllluu III IIII��,�I' CID CD Y Q 0 p VANN m o N a) t m 1 a o o m ❑ cn m m m e LLa E _ AL cc tail Q N oQ m Q. 20 � ai U J c0 O � (p O ` O y ❑ 'd N U 0 a O c LLa E _ A� •� oQ m Q. 20 � ai w Q r. m (D.' > ` � >� > C CL O W Co � C O CL d 0 0 U J 7 o U) U Cn Cn_ 6 CU M r N 0 >, �% c C > M a3 '~ N Co o m •� Q E 3 Z p _ CN 0 0 2 o N U U) c •c C c m oA'o 3 r. m (D.' > ` � >� > C CL O Co o w, > o W Co � C O N O a N D 0 U J c O C7 D C J U) U Cn Cn_ 6 CU O Q- N M Co 7 0 CL E O Q- CO a3 o Z e N L a ❑ C_ U- 0 Z = y O C' O Q- CO 0 Z = y O o � � ElQ% Y Q m M � 3 c iri E �O Q- L-- w .4 L6 OD 0 N 0 rn m a O d U 0 U- 0 W_ 0 Co d N 3 t V N N N N O t cc d4- 0 C E 0 V U N CL N of CO) 4) Cl C O L 402 N d N N Q co cc 1 r r E U- � i �����IIIIIIIIIIIIIIIIIIIII IouIIIIIIIIIIIIIIIiiiii6ii � d t O o C fO 2 0 O U) ? Q 3 � e o� 0 o AO Im E U� tap U LL > m U C7 t d x o V` U) c a d LL^ aO `o U EE r� 0 =_ a a D Oc 0 N 0oa co w 0 M N tm m a Iliu��llllllllllhll A n L e� 7 0� E P O �N CL 0 N r O 7 � � w 0 0 00 _ c .d C 0 � C m o 0 0 U A 'A+ 1 C O m O Q N D J �N CL 0 N o O 7 � � w 0 0 00 _ co .d C N � C m o 0 .. A 'A+ 1 C O d O Q, o o c w C U O � c� �N CL 0 N N co o CL � w 0 0 00 E O \Z Y o c ?? N � C m *+ 0 .. ❑ I c m U) Q N d N } Y O r d p c m JN 0 � ElN ❑ o J p z N N �- 3 a a O c m a E � 3 n� co IL m d z Cf 0. d 7 C o O Q cOn C� S 0 f0 rn J U) = N C �C O O N co o CL � w 00 E � U � C 0 .. m d v > � N ❑ o � c �- N � 3 co d N co 0 CL E 0 .. d N L N ❑ c U - co C 7 O cOn C� rn ti O O 0 � � O a ❑ :? N N � 3 C � � }(� n. L- W 4 ori 0 v.� �lllllllllllllllllilluu� lliulllllllllllllliilli���ii°�` Al a`) m E Z a� 0 2 c 0 m m U) 0. (D a) 0 ro t w O m C.. omo m -w .03 M 0 m m m I I EE L� U LL 0> I O' U � I C7 3 Q �•n m m w m � LL W V m n.0 O E _ x U A 0 V � r m 0 � Q3� o N c 0 = J E _ � m 0 G OD 0 m rn m e 0 r-1 L L L L C m C m C m C J N N N N Q c Q c Q c Q c r N N O L O N N m 75 �O L L C N m N O N � L O m co m L U) Y m Q ° m 3 0 s C v U) 7 O E m � L X O O O 0 .a � m J TY Q ^V` W 2. O N m N w ❑ ❑ r N N W O o t Y L (D N m N � L L m � C Y 7 O � L � 3 0 0 L J TY ^V` W 2. O N m N m y m L t C c N X N m m E O Q •�O Q N � Q cm N j O U O N o m m CC c d N}' ` O m 3 Z C'. •� v E ❑ O o � v � m CL ta� 0 m Y m m m33e L CL fl 0.0 m >+ w 0 0 cu Q W O m U) O CL N 3 V� 1 L 0 d N Q N s N O � O s �a+ tv � 1 O r 3� E O L O .' O U U LL n E L O O U LL N N O_ a� c > U W O Co p ti N co O -E'O L6 - U O X Ir N v U -E o .S •- M N C r cr Q� O C +r •- .0 N � N d °5 > �o Z N V N ~O E N T O � M >� O� N W (D oEO w.L�w �'t-o E a o �cmL6 CLIE 2 N T is 0)U +� O_ t > Q W o>a -0 O >,ML cL� 0 UtU c E 'a Co co�CU Cc N C O N j r U N U O'D N 0 160 O O a 11 0 P m 0 m a� S N 0 'O m 0 in m E m z a C m o� c N v m w O N N '0 N r O c� a 0 co C t 3 O -o N �E ui o U- E E E a Q0. NO .L„ U L N d 0 t T w O LO CT Q% C U C:) a M O «_ Q, 3 (D U � m 0(D C C -o 0- Z.2 wz2 co 0 r- 4) d rn m a 0 m 0 a N LL 0 w 0 U) Blackburn, Lisa From: Dan Ottenheimer [dano@millriverconsulting.com] Sent: Monday, March 18, 2013 12:35 PM To: Sawyer, Susan; Blackburn, Lisa Cc: 'Pam Lally'; 'Isaac Rowe' Subject: soil test, 34 Raleigh Tavern Lane Attachments: 34 Raleigh Tavern Lane Soil Test 3-14-13.pdf Susan, Lisa — Attached are the soil test results for the test pits performed at this property last week. Water table and standing water was high and since this is an upgrade the soil evaluator took a representative sample for sieve analysis instead of performing a percolation test. Let me know if any questions. Thanks, Dan >mi, I I It, NPU i v e r cons u [ti rig �`• Civil Engir9t-Nrm i i [1Y�t Cin lYfY( t�) Ptrrsirtti its AAvntr,ipaI Eriviron mrntil mc-iIth Con t,uIIinI; Daniel Ottenheimer, President Mill River Consulting, Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 fax: 978-282-1318 www.millriverconsultin2.com dano@millriverconsulting.com Member: Yankee Onsite Wastewater Association, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association, Cape Ann Referral Group Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htta://www.sec.state.ma.us/l)re/preidx.htm. Please consider the environment before printing this email. f 1 { M t ^ P F i + �.... .�....�_._..� ----- -w_.......� 1 ! ( iI 44.11 € I1 _ i y a F : ... -.. .,.. _... .in,.,»ar W E 4 � p '�i i f i E E t 1 F � t- C LL,LV-1 zf; z • ! WOO C<L 1Ll 9 „�rUzot Axl �LLs leZIE i j r i j � E t i Blackburn, Lisa From: Blackburn, Lisa Sent: Wednesday, February 27, 2013 10:10 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Sawyer, Susan Subject: 34 Raleigh Tavern Lane Attachments: 20130227093923526.pdf Good Morning Isaac, Please schedule a soils test with Merrimack Engineering for the attached address. Thank you. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688-8476 Email lblackburn(atownofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: noreply(@townofnorthandover.com[mailto:noreply(@townofnorthandover.com] Sent: Wednesday, February 27, 2013 9:39 AM To: Blackburn, Lisa Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 02.27.2013 09:39:23 (-0500) Queries to: noreply(@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/Dreidx.htm. Please consider the environment before printing this email. aD i 2 � PUBLIC HEALTH DEPARTMENT Community Development Division Date: / 4�� Address: ffw d'i'm' c Dear Homeowner: U, We recently r9ceiv.ed a Title 5 Report for- your property for an inspection that was completed on: by: The report indicated that your septic system has failed inspection. By egulation, you have two years to have your system repaired, or to tie into Town water and sewer if available. There are several steps involved before you can actually have your system repaired. You will need to have soil tests done, as well as have a plan designed by an engineer that is approved by the Health Department. Enclosed is a brochure entitled: "My Septic System Has Failed — What do I do Now? " Please read this brochure, as it will outline the steps you will need to take to put your septic system in acceptable working order — required at the state and local level. If you have already completed one or two steps of this process but are delayed for some reason, please advise us of this fact. Please note that all of our applications and regulations can be found online: www.townofnorthandover.com. Please call the office if you have any questions, or require clarification of this information. Please respond to this office in writing within 30 days to acknowledge that you have received this information, and what your plan of action is to repair your failed septic system. You may send correspondence via e-mail if that is more convenient: healthdeptna townofnorthandover.com. Thank you for your prompt attention to this matter. Sincerely, 1 sayY. Sawyer Public Health Director ' Enc: Septic System Brochure Disposal Works Installer List 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 34 Raleigh Tavern Lane RECEIVE® North Andover, MA 01845 Owner's Name: Frances Stielin Owner's Address: Same SEP 12 2007 Date of Inspection: 09-05-2007 I TOWN OF NORTH ANDOVER HEALTH DtPAR_ M� ENT Name of Inspector: (please print) John Souc Company Name: Soucy Sewer Service, Inc. Mailing Address: 78 North Broadway Salem, NH 03079 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority 'Fail Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. NOTE: This Title 5 is NOT a guarantee/warranty of the future function of the septic system. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Raleirh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stidin Date of Inspection: 09-05-2007 Inspection Summary: Check A B,C,D or E / ALWAYS complete all of Section D A. System Passes: NO I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: NO One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements.lf "not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiglin Date of Inspection: 09-05-2007 C. Further Evaluation is Required by the Board of Health: NO Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiyft Date of Inspection: 09-05-2007 D. System Failure Criteria applicable to all systems: You must indicate `lyes" or "no" to each of the following for all inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6" below invert or available volume is less than '/s day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS, cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] YES (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: NO To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ _ the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area – IWPA) or a mapped Zone R of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiglin Date of Inspection: 09-05-2007 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health x Were any of the system components pumped out in the previous two weeks x J Has the system received normal flows in the previous two week period " X Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined? (If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up'? X _ Was the site inspected for signs of break out'? x _ Were all system components, excluding the SAS, located on site? xWere the septic tank manholes uncovered, opened, and the interior of the tank inspected for the ndi cotio_n of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? x _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No X _ Existing information. For example, a plan at the Board of Health. x Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)J Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stitdin Date of Inspection: 09-05-2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder (yes or no): no Is laundry on a separate sewage system (yes or no): no [if yes separate inspection required] Laundry system inspected (yes or no): no Seasonal use: (yes or no): no Water meter readings, if available past 2 years usage (gpd)): N/A Sump pump (yes or no): yes Last date of occupancy: recent COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgketc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Home Owner Was system pumped as part of the inspection (yes or no): no If yes, volume pumped: 1000 gallons — How was quantity pumped determined? Gage on truck Reason for pumping: N/A- TYPE /A TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: Septic Built 1970, trenches installed 1986 Were sewage odors detected when arriving at the site (yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiglin Date of Inspection: 09-05-2007 BUILDING SEWER (locate on site plan) Depth below grade: 30" Materials of construction: _cast iron _44 PVC other (explain): Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: _14" Material of construction: X concrete _metal _fiberglass polyethylene _other (explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 4'.8" x 8' 6" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 38" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Tape & Sludge Tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP: _(locate on site plan) N/A Depth below grade: _ Material of construction: concrete metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiglin Date of Inspection: 09-05-2007 TIGHT or HOLDING TANK: _ (tank must be pumped at time of inspection)(locate on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other (explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alar level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Flow checked okay PUMP CHAMBER: _ (locate on site plan) N/A Pumps in working order (yes or no): _ Alarms in working order (yes or no): _ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc) Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances SdrJin Date of Inspection: 09-05-2007 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, member: leaching galleries, number: X leaching trenches, number, length: (3) 50' trenches leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Found bottom of leaching trenches to be below seasonal high ground water table. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N/A Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) N/A Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 34 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name: Frances Stiglin Date of Inspection: 09-05-2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a 75 R W/L0 39va e. m S rn t� 9NI?J93NI9043 3N Y SES9LLESG6 00:EI ,.0RZ/9R/FR Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner's Name: Date of Inspection: SITE EXAM Slope Surface water Check cellar x Shallow wells 34 Raleigh Tavern Lane North Andover, MA 01845 Frances Stielin 09-05-2007 Estimated depth to ground water 48" . Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: x Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: Dug (2) test holes. One by driveway, and one by leaching trenches. North Andover MIMAP March 28, 2016 107.A-0198 140 3OHNNY CAKE'ST 103 3OHNNY CAKE ST 107.A-0197 107.A-0184 23 GILMAN LN �09 JohnnY+C 107.A-0152 a ket5tree'c 147' 115 JOHNNY CAKE ST 107.A-0185 125 3OHNNY CAKE ST 107-A-0151 107.A-018 307.A-0186 R2 i { 107.A-0105 f 107.A-0070 107.A-010434 RALEIGH TAVERN LN 1 • 22 RALEIGH TAVERN LN 4 f j 107.A-0103 46 RALEIGH TAVERN LN 107.A-0106 107.A-0139 17 RALEIGH LN. TAVERN V.) �s 107.A-0119 9 �a 107:A-0107 107.A-0102 107.A-0118 70 RALEIGH TAVERN LIN E3 MVPC Bo Zoning Overlay Zoning E3 Municipal Boundary Q Adult Entertainment Distric Busine s 1 District 0 Machine Shop Village Ove C Busine s 2 District Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, — Rail Line m Watershed Protection Dist Interstates 0 Historic Mill Area — 1 0 Medical Marijuana — SR © Downtown Overlay District B Historic District d Busine ® Busine ® Genera O Planned ' Comido s 3 District s 4 District Business DistrictOf Commercial Dev Development Dist NQRT#4 sato r• q� 2, a+i .e OQ Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is Roads U Osgood Smart Growth (40 Easements ❑ Corrido II Como Development Dist Development Dist j. L Q to 'p for planning purposes only. It may not be adequate for legal boundary definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER Hydrographic Features ® Parcels Streams Industri :. Industri 11 District 12 District MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT -: Wetlands C Industri 13 District k o �� • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF .: Exempt Lands Industri Reside Reside I S District'►+ ce 1 District ce 2 District «-•.,. 1 �+ +rio ��� ' S$�tCH THIS INFORMATION Recide ce 3 District " dece de Ede 4 District ce 5 District 1 = 95 ft ce 6 District ,a a esidential District