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HomeMy WebLinkAboutMiscellaneous - 362 BERRY STREET 4/30/2018FAI MAP # LOT # PARCEL # STREET CONSTRUCTION APPROVAL�--__ HAS PLAN REVIEW FEE BEEN PAID?YES NO PLAN APPROVAL: DATE / �Z �C�� APP. BY /G DESIGNER: �. OG PLAN DATE CONDITIONS WATER SUPPLY: TOWN f WELL PERMIT DRILLER WELL TESTS :' - 4 PLUMBING SIGNOFF COMMENTS: FORM U APPROVAL: y DATE ISSUED CONDITIONS: CHEMICAL DATE APPROVED BACTERIA I DATE APPROVED BACTERIA II DATE APPROVED WIRING SIGNOFF APPROVAL TO ISSUE YES NO BY` FINAL APPROVAL: ALL PERMITS PAID 'YES NO WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: fp I SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW_ REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW '- YE�O CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? YES NO DWC PERMIT NO. INSTALLER: S ✓ BEGIN INSPECTION YES 0: EXCAVATION INSPECTION: NEEDED: PASSED -I/OI y BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: C/YES: APPROVAL "t0 BACKFILL: DATE:Q/ // BY FINAL GRADING APPROVAL: DATE BY / FINAL CONSTRUCTION APPROVAL: DATEBY Commonwealth of Massachusetts` A _ . City/Town of NORTH ANDOVER System Pumping Record Form 4 r " DEP has provided this form for use by local Boards of Health. Other corms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms 1. System Location: on the computer, use only the tab 362 BERRY STREET key to move your Address cursor - do not NORTH ANDOVER MA 01845 use the return City/Town State Zip Code key. 2. System Owner: VILA KARL ARSENAULT Name aarn Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 11/3/14 Date State Telephone Number 2. Quantity Pumped: 3. Component: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Observed condition of component pumped: GOOD CONDITION 6. System Pumped By: JAMES H CURRIER II Name X SEPTIC & DRAIN Company 7. Location where contents were disposed: GLSD 1 Signature of Hauler Zip Code 2000 Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 11/3/14 Date Signature of Receiving Facility (or attach facility receipt) Date t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 Location No. �� Date /- 01 NORTHA TOWN OF NORTH ANDOVER � • OOL 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �` Check # Building Inspec�6-r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: a�-6, Date Issued: // 3'd IMPORTANT: LOCATION 3 b Z l Date Received // must complete all items on this Print PROPERTY OWNER �c-1 A rsPn cJ Print MAP NO: .PARCEL: ZONING DISTRICT: Historic District 60-t7— !Machine Shop yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne farril Addition Two or more family Industrial Alteration No. of units: Commercial Others: Repair replacement Assessory Bldg Demolition Other Septic Ae I JC Floodplain Wetlands Watershed District VV-a-fe-r/Sewer ur-a%omir i Fun ur vvuKm I u tat vtnvuvmvD: \cek- az� ttr-, K L Identification Please Type or Print Clearly) OWNER: Name: pari 1-L Phone:' 7e -6g3 Address: Z Q <-S . AA 0 0-((- CONTRACTOR -erCONTRACTOR Name: 7vc owner Phone `Y 7t -693 -S03 & Address: ov-(r Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ D (D 6c7 FEE: $ _�0 W Check No.: Receipt No.:� ' NOTE: Persons contractin wit nregist redc actors do not have access to tie guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 0 TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools We Tobacco Sales Food Packaging/Sales Privateseptic tank " tc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Conservation Decision: Com Zoning Decision/receipt submitted yes Water $ Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: '+F FIRE DEPARTMENT - Temp Dumpster on site yes. Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Usgood 5treet no µORrH TOWN OF NORTH ANDOVER O z,Eo N6'4H °0 OFFICE OF 46 p BUILDING DEPARTMENT a + 1600 Osgood Street Building 20, Suite 2-36 p cauiro:•a yq��q,�, PatcS North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please »Tint DATE: �' 3 JOB LOCATION: 3 C Z, J6 er c>7- <G, 0 9'c. V CC -1-7 J� Number HOMEOWNER Kr- � f Name Street Ai iL/I_� �-2g- 6g3 - SC) 3 Home Phone PRESENT MAILING ADDRESS _ 3 4� Z Q Cmh Map/Lot 978-x02'230_7 Work Phone /"C+ti 4411Q-ir /i9 o(a4s City Town State Zip Cede The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures an requirements. zl / A HOMEOWNERS APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 x w A d m .c Z7 w° v Cf') .; cin o w cit z z A OZ G w° a°' v U Cd w w pq �'-� on w i� aa U '�p.GW; w m cn w x o a rn nn a°' w z x a W A w C ° cn O o c� D J w O �I 0 O z 0 �v G �LLuml LLCL c o m c o � c � O N VO V •dam C C ev cc O c ;L O o 40= Ea O O O. co E5 LZ :.o m :oma C.3 O cm :oc N R o m 3N � m m N O : � N a�` N O i 13 = O �� :� a N CL CD O'C R �Z H a Q N 4—D G = O m... 3 H r y mom~ W G Cc CD P •N O �+ oc �E w .o i CO m ca C _ W � HBO r~ s Sa4m E y L N O N C O cm CD cm 'O m `O cm C �G N CD t 0 Z O CD .i MI ts 6 am O 03 L O Z CD CL O h o c CD cm I � C V2 0 'C C COD O O ■i m m CL ~_ O � O O d o *-a� c eccc V J.O CS C CD 0 CL V CO) O C C� ■ C c COD rMb7 LLI 0 W W 19 W LLI 19 W U) V_ 0� it �z H `NG Q w O �I 0 O z 0 �v G �LLuml LLCL c o m c o � c � O N VO V •dam C C ev cc O c ;L O o 40= Ea O O O. co E5 LZ :.o m :oma C.3 O cm :oc N R o m 3N � m m N O : � N a�` N O i 13 = O �� :� a N CL CD O'C R �Z H a Q N 4—D G = O m... 3 H r y mom~ W G Cc CD P •N O �+ oc �E w .o i CO m ca C _ W � HBO r~ s Sa4m E y L N O N C O cm CD cm 'O m `O cm C �G N CD t 0 Z O CD .i MI ts 6 am O 03 L O Z CD CL O h o c CD cm I � C V2 0 'C C COD O O ■i m m CL ~_ O � O O d o *-a� c eccc V J.O CS C CD 0 CL V CO) O C C� ■ C c COD rMb7 LLI 0 W W 19 W LLI 19 W U) Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NUTE5 and DATA — (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 N Q2 r O v I CQ Q 31 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 05/03/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired ( X ) by Ben Osgood, Jr. at 362 Berry Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 915 dated 11/12/97. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector NEW ENGLAND Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 362 Berry Street, North Andover Dear Sandra: ENGINEERING SERVICES INC ' r TOWN OF NORTH ANDOVER/ BOARD OF HEALTH I APR 2 7 1999 April 27, 1999 Enclosed is an as built septic system design plan for the septic system at 362 Berry Street, North Andover. As you may recall this plan was submitted previously but it had errors in the lot lines as compared to the original design plans. Since that time this office has conducted a new lot lime survey and the lot lines shown on this as built are correct. One result of the lot line adjustment was the system is now 5 feet further from the wetlands than previously proposed. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, 4;2 Benjamm C. OsgooJr., EIT President 33 WALKER ROAD - SUITE 23 - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; fix) repaired; by Benjamin C. Osgood, jr located at 362 Berry Street, North Andover was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #_9 15 , dated with an approved design flow of 770 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. Bed inspection date: a xs7 e Engin er Representative Final inspection date:9Z 1 9 Xe,'<A Engineer Representative Installer: , Lic.#: Date: �J2 Design Engineer: Date: 4z11g% /3 y AS -BUILT CHECKLIST v TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA 1/ LOCATIONS OF DEEP HOLES & L&C T'E�s -er* ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. v NORTH ARROW r / FINAL CONTOURS V LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE v TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA 1/ LOCATIONS OF DEEP HOLES & L&C T'E�s -er* ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. v NORTH ARROW r / FINAL CONTOURS V LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN NORTH o � w F s�CHUS Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant "--f' k-41 PC-,( JL.� Test No. Site Location Q l9 Reference Plans and S ENGINEER �/Z Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. 4 Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. 9 915 North Andover Board of Health 384 Osgood Street North Andover, MA 01845 To: Ben Osgood Jr. Fax: 685-1099 From: Susan Ford, Health Inspector �ate: August 17, 1998 Re: 362 Berry Street Pages: 2 CC: file ❑ Urgent ❑ For Review X Please Comment ❑ Please Reply ❑ Please Recycle ew the as -built for 362 Be Street. The plan does not overlay with the lot lines nY P Y on f J 'i.. o the wetlands. Was this surveyed properly. In addition, I have attached the hWtheck off list. There are more some items missing. This list is in line with Title V for as - requirements. m I3e�&- >( AS -BUILT CHECKLIST !% LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS /1/r rGs�r✓z og- LOCATION & DEMENSIONS OF SYSTEM, a INCLUDING RESERVE e/ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM 10 �-- TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER S, ELECTRIC LINES, CABLE 12 DISTANCES FROM CORN ERS-9F4OU-S-E TO CENTER OF TANK & D -BOX STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. _lll� NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ZO f Z" -7 LOCATION: A Z I LICENSED INSTALLER: CURRENT INSTALLER'S LICENSE# , ! S 'S260C�/ `J/ SIGNATURE: TELEPHONE# F76- 6a6 /76 g CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -built? Floor plans on file? Administrative Use Only Yes l/� No Yes No Yes No Approval Date: / hi NA Town of North Andover, Massachusetts BOARD OF HEALTH �n 1/. / 19 DISPOSAL WORKS CONSTRUCTION PERMIT Form No. 3 Permission isherebygranted to Construct ( ) or Repair an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. �/ S , t'l CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. 7 p . ,i, r ea 40R7p 1 tt. SACHU56 -- Applicant_ Site Location. NA Town of North Andover, Massachusetts BOARD OF HEALTH �n 1/. / 19 DISPOSAL WORKS CONSTRUCTION PERMIT Form No. 3 Permission isherebygranted to Construct ( ) or Repair an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. �/ S , t'l CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. 7 p . ,i, r ea PLAN REVIEW CHECKLIST ADDRESS_, ENGINEER 05 GENERAL 3 COPIES STAMP LOCUS 1"I NORTH ARROW SCALE CONTOURS if PROFILE L,"'- SECTION BENCHMARK "4L SOIL & PERCS ELEVATIONS WETS. DISCLAIMER & WETS WATERSHED?A/O DRIVEWAY (Elev) WATER LINE '-� FDN DRAIN � A10 SCH40 '� TESTS CURRENT? SOIL EVAL9 SEPTIC TANK PL MIN 150OG .17 -.INVERT DROP ✓ G7GWW, DER (2 comps +200) 10' TO FDN � MANHOLE-- ELEV # COMPS. GB D -BOX G� SIZE' # LINES ,. FIRST 2' LEVEL STATEMENT INLET 00,S3 - . OUTLET /BU•d OR .17 FT) TEE REQ' D? LEACHING MIN 440 GPD? • RESERVE AREA, 4' FROM PRIMARY? 2a SLOPE _ 100' TO -WETLANDS 100' TO WELLS 4' TO S.H.GW ' 20' TO FND.& INT.RCPTR DRAINS 400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER/ FILL?� BREAKOUT MET? TRENCHES -MIN 440 gpd SLOPE (min _005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN":& RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4' PEA STONE? VENT? (>3' COVER; LINES >50') BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1996 by S.L. Starr PITS MIN 440 LEACHING GW MIN 4' BELOW BOTTOM :M CHAMBERS MIN 1 (13'x16') PIT EXC 2x EFF W OR D MANHOLE/PIT 12"-48" STONE + SIDE x LOAD = TOTAL (2x(L+W)xD x.#) (G/ft2) MIN 440 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE.—__ SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT :•_ FIELDS + SIDE _ X LOAD = TOTAL (2 x (L+W)xD x #) (G/ft2) MIN 440 GPD 90U ft2 BED_ � GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? �� 4" PEA STONE?—LfL-' DIST LINE SLOPE .005? v/ >31COVER-VENT L/ SCH 40_��/ MIN 12" COVER LI -1 RATE ( Jr� X 3,5" ) x = TOTAL L {i LDG 19.5 DOSING TANKS AND PUMPS DIMENSIONS X X_ PUMP CAPACITY /l/ _gpm L W D Vol. DISCHARGE SIZE DISCHARGERATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE - BLEEDER HOLE !/ MANUAL OP. SWITCH_ ENLF STORAGE'?-jjID TDHiEIGHTED?(�2/C Copyright 0 1996 by S.L. Starr p 7 717 71 F 777 77 7,7 77 All p I , � OSGDdb J - ---------- 9; t '— ^mr .. r `: } __ t� _. >�:, +� z �: �. 'ted S -.,. „s � .. a t i. k i lit . 't{Ta..A + •.Tin°• qt n±1�NY 1M:..�, s�W �3 r � _ - �-T r• a %--T '� �`W'A^ a 4 ..w• � +.ate' -� - - . d?t',yyfy. • it .... , • i� 1x '. 17 ��S!•�'h vitt ,. .. �. tfi ,_,� i Il 1 !t •.Tin°• qt n±1�NY 1M:..�, s�W �3 r � _ - �-T r• a %--T '� �`W'A^ a 4 ..w• � +.ate' - No. / FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: �/a�-/9 Commonwealth of Massachusetts A Dt;�!11 2 , Massachusetts Soil Suitability Issessmentfor OrL--si—t—eiSewage Disposal np .... 0. ............. ............................... Performed BY: All 77 ................ ...... .. .. .... ........ ....... .. ... ...... Witnessed BY: ....... owrer'& Nims. LAgaiicn Ad&. Lot Addrus. and Telephom I New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Fil 4��B Year Published W1 ........ Publication Scale ..... Soil Map Unit ..... .. ..Z).... ........ .... .......... .. Drainage Class Soil Limitations . .. Surf cial Geologic Report Available: No RI Yes 0 Year Published Publication Scale GeologicMaterial (Map Unit) ............................................................................................................... . .. . .... ....... ... Landform. ........................................................ ............................. ................................ Flood Insurance Rate Map: Above 500 year flood boundary No []Yes FKI Within 500 year flood boundary No 0 Yes ❑ Within 100 year flood boundary No Ryes 1:1 Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal ®Normal El Belc�v Normal El Other References Reviewed: WDEP APPROVED FORM - 12/0719S FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. -36z —Z • ey -5- 7- A4 Ai4pOvAe- On-site Review Deep Hole Number /— Date:.:. �Timer"fid.. P11- Weather,�/R— 36 Oje- Location (identify on site plan) ..: Land Use .zt$U�N....!/4.... Slope (%):.: Surface Stones . VegetationlDl/�........:.::.. ..._.....:.:.::.:.......:..::.:...:...:.:...:.:...:..:.::::.::...::...........:......:..::... Landform ..%`/ .:... Position on landscape (sketch on the back) Distances from: Open Water Bodyce""eD feet Drainage way/dam feet Possible Wet Area 60 feet Property Line 4.... feet Drinking Water Well feet Other .....:.:...,,..:..,.:.::.,.:::.:: DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) � "- Z�' Bim, �L rJyR f�fo /��ss•�-'�—�'�.4�G� 2&-46 C'/ L s 4l0' -'o C'2 4 5 2 �'J`9/3 �mw� � Nu�� z� 45- . - mllViivlVFvi ur L nVLCJ MCUUIrttV AI cvtnr rm%jr v-jtV u1JYVJALAntA y T�7`I Parent Material (geologic)dGL,,f3W 71 5EL4 7Gie DepthtoBedrock:X©— Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: `^ Estimated Seasonal High Ground Water: DEP APPROVED FORDS - 12/07/95 FORAM 11 - SOIL EVALUATOR FORM. Page 3 of 3. Location Address or Lot No. 3lvZ ,��.Q2y �j ,qti� aovs,� et *U ed• ❑ Depth observed standing in observation hole............... inches ❑ Depth weeping from side of observation hole .......... ... inches Depth to soil mottles .3 inches ❑ Ground water adjustment . ............... feet Index Well Number ._......... �.... Reading Date ....... .......... Index well level .............. Adjustment factor .................. Adjusted ground water level Death of Naturally Ocgurring_Pervious Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the .area proposed for the soil absorption system? No If not, what is the depth of naturally occurring pervious material? livcjl�&S Certification I certify that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described In 310 CMR 15.017. Signatur vDate DSP "PROYM FORM. I21070S e FORM 11 - SOIL EVALUATOR FORM Page I of 3 # Date: -7 z4 No. z Commonwealth of Massachusetts Massachusetts Soil Suitabili Assessment or On-si a Sewa a Dis oval ��,y,¢,e�............:.....G Performed B Date: ���1�9....-.._.. ......................._............._..................... ........... WitnessedBy: ��'Z,................................................................................... .. l,ocuion Address a 3 z `=;/—— /� Addross. and La Telephone / No. ,�f iv Dm✓/. / "� ew Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes ® Soli Map Unit �� C Year Published /9���.-.••• Publication Scale � -_ ---� •• /4yT� ................__......... Drainage Class .......am/���igoil Limitations ._......__._.... Surf cial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) .... ..................................................................... ......................... ......._............-...........__................ ............. ...... ... ... _ Landform T.. l............ P..4�.................................................... ........................................................ .. _..._ Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ ~ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ........................................... Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal RINormal ❑Belay Normal ❑ Other References Reviewed: kiDEP APPROVED FORM - 12107/95 FORM 11 -SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No. On-site Review Deep Hole Number .�.::: Date: S3/ C/ ..:�.. � Time:. Weather/�W_i,L — 7� Location (identify on site plan) ,..., Land Use .: � �/ �/ L Slope M 2.:a.. Surface Stones .....- Vegetation Landform..: .�L/'�/.... ......:.......::.::.....:....:.:...... .. ..:..::..:.:..:...:.... Position on landscape (sketch on the back) .:..::....:... .... ...:. :.,...:......: :..,....::...., . Distances from: Open Water Body . feet Drainage way .... feet Possible Wet Area feet Property Line ...:............ feet Drinking Water Well .:..,. . feet Other ..v.,,, ,....,v:..........:..... DEEP OBSERVATION HOLE LOG* Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munselq Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 2 i- ZO %o 7vs: 7/ GS 0 Parent Material (geologic) DepthtoBedrockr`ULC� I Death to Groundwater: Standing Water in the Hole: _ Weeping from Pit Face: Estimated Seasonal High Ground Water: --- 6, O Ate - DEP APPROVED FORM - 12107/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. X�U. On-site Review o Deep Hole Number : Date:. 3�Time:. !3O P� Weather /'e- . Location (identify on site plan) ..: :''....:.:_.::::..._:::::..::v ......:::...:... �.....:..: ::.::........... _ ..............._..,..... Land Use ���`5,' �!T� L Slope M .a : Surface Stones ....-..:..:.:.....:...... Vegetation ./�%D,� . ..:..:....::. :..:..:...,:.n..:.......,.....:.:...:... .. ....... ......... Landform Tic Acis) Position on landscape (sketch on the back) ........:. ..:....:.:.:. n...:.......................:......:.... Distances from: Open Water Body feet Drainage way .. feet Possible Wet Area feet Property Line .. ...... feet Drinking Water Well .:.:..... ... feet Other.........w.:.......:...:.....:....,...: DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) 14 -T4 .3 /- X76 (�Cl G S , -y w - i lzii6gaC6 - waimvlum ur L nVLCJ ncuulnru fit cvr:n, rnurwQLw Lo,arvar &. nnln Parent Material (geologic) GGACGQL. T G L DepthtoBedrock6�L'_ cz �G v Death to Groundwater: Standing Water in the Hole: _ Weeping from Pit Face: _ Estimated Seasonal High Ground Water: :�> (�; , b -7- DEP T DEP APPROVED FORM - 12/07/95 FORM 11 - SOIL L- VALUATOR FORM Page 3 of 3 Location Address or Lot No. -5��/ 5i,� /� ��Dc�✓r.� /YI�9 .Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole .................. inches ❑ Depth weeping from side of observation hole ................. inches ® Depth to soil mottles inches /\/0 lVm7760�5 mps��v ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date .................. Index well level ............. Adjustment factor ................... Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y4-5 If not, what is the depth of naturally occurring pervious material? Certification certify that on P/'66 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. X�6 Signatur Date d4w- DEP APPROVED FORM . 12/07/95 I FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. #,7,4 Determination .Determination for Seasonal Lb h Water. Table Method Used: ❑ Depth observed standing in observation hole .................. inches ❑ Depth weeping from side of observation hole ................. inches © Depth to soil mottles .::.........:::.: inches Ale, 1/o rrC,6=,S ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date .................. Index well level ................. Adjustment factor ................... Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 9 q� (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DEP APPROVED FORM - 12/09/95 Y d z r� lb a t,..t r .r i 4.r NEW ENGLAND ENGINEERING SERVICES INC April 28, 1997 Gayton Osgood, Chairman North Andover Board of Health Town Hall Annex Main Street North Andover, MA 01845 Re: 362 Berry Street Dear Mr. Chairman: Enclosed are three copies of a design for a septic system repair at 362 Berry Street in North Andover. This design meets all of the design requirements outlined in Title 5 and the local bylaw except the offset distance to wetlands. The required offset distance according to the local bylaw is 100 feet. The plan is designed with an offset of 50 feet. This offset meets the Title 5 requirements. The purpose of this letter is to request a variance to the local bylaw for the reduction in setback from the wetlands from the required 100 feet to 50 feet and to request that a hearing be scheduled with the Board of Health regarding this request. If a hearing can be scheduled, please inform this office of the date and time. If you have any questions, please do not hesitate to call. Yours truly, Benjamin C. Osgood,�IT J, President CC: Elizabeth Poirier 33 WALKER RD. - SUITE 22 - NORTH ANDOVER,. MA 01845 - (508) 686-1768 Ir 4 Acnv18 i: tj Ex d 46' , i Af— 01.0 ti C> V-' 71 oe Ir 4 Acnv18 i: tj Ex d 46' , i Af— 01.0 C> V-' 71 oe Ir 4 Acnv18 i: tj Ex d 46' , i Af— 01.0 V m Err-, Ai C> V-' 71 'D V m Err-, Ai 71 Board ce Flealth 4' 411 / M S?,?TIC SYSTEM j,'L,AT,7A'11C'4 t ffKK LIST DSI SAi•YiGy_� ~ IIATi� . LOT 1. Distance To: a. WetLmds b. Drains c. Well 2. Water Line Location 3. No PPC Pipe 4. Septic Tank --- a. Tees --Length & To Clean Out Covers b. Cement Pipe to Tank - On Both Sides of Tank = 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Filo Amg dual Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone ?. Leach Pits a. Dimen 'ons b. Sto Depth c. ash Pads d. eas Cent Pipe to Pit -Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location Xlth Regard -to Pere Test d. Elevations e: Water Table Benchmark Elevation Location Datum Percolation Tests -Date -6:7.1/4 T..i� Pit Number 1 SOIL: -PROFILE & PERCOLATION TEST DATA S Start Saturation q;50 North Andover,T:2*8s. No.&Street Lot No. � Loc./Subdiv.' Gey -y Plan OwnerL=/ Drop of 311 -Time - "-Time-Dro Invest_gator , ue u ,^.c; 10 Observer- w, Ur }11. 4- 611 1-11ins. lst. 3"Dro SOIL PROFILES -DATE Z - 1. Elev. z'3. Elev. Elev. 4'Elev. 0 0 0 0 1 1 1 1 Ties to Test Fits 2 2 2 2 3 3 3 3 - -' 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 8 8' 8 8 9 _ _ 9 9 9 -0 10 10 10 Benchmark Elevation Location Datum Percolation Tests -Date -6:7.1/4 T..i� Pit Number 1 2 3 4 S Start Saturation q;50 Soak -Mins. / M, Start Test -Time Drop of 311 -Time - "-Time-Dro Drop of 6" -Time 1-11ins. lst. 3"Dro Mins.2nd 3"Dro Z - Percolation Rate ,„ i Rotes & Sketches on Back A Board of M:alth Norah Andovori?'ass' APPROVED DATE_ Provided: SUBSURFACE DISPOSAL DESIGN CHWK LIST DISAPPROVED DATE Reasons: LOT # Title W Reg 2.5/ Reg 6 Reg 10.2 Reg 10.4 FAIL OK The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot #abutters location and log deep observation hoes -distance to ties location and results percolation tests -distance to ties d design calculations & calculations showing required leaching area location and dimensions of system -including reserve area °f) existing and proposed contours (g) location any vat areas within 100, of sewage disposal system or disclaimer -check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer location any drainage easements within 1001 of sewage disposal system or disclaimer -Planning Board files (j) knoun sources of vater supply within 2001 of sewage disposal system or disclaimer (k) location of arq proposed well to sorvc lot -1001 from leaching facility (1) location of water lines on property -101 from leaching facility ) location of benchmark ) driveways (o) garbage disposals (p no PVC to be used in construction (q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and *' Other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks (a) capacities % of flow, water table, tees, depth of tees, access, pupping () cleanout C) 101 from cellar wan or inground sw3miring pool (d) 251 from subsurface drains stribution Boxes slope greater than 0.08 (b) sump -01"c woe �(i) ' ^' ' A 0 subsurface Der-ig� FAIL r Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 14.4 14.6 14.7 11.10 Reg 9.1 9.6 Check List I '0K 2 Leaching Pits Leaching pit are preferred where the installation is possible 'a) Cal culati s of leaching area -minimum 500 sq ft 'b) spacing 'c) surface e 2% ,d) cover terial e) 21x2 l n splash pad f) tee t elbow g) no ends in pipe from d -box to pipe e Leaching a) no greater- t an 20 minutes/inch b) area-rAnimum 900 sq ft c) construction of field d) surface drainage 2 % e) 201 from cellar wall or ingrovnd swimming pool a) c c a on `off` -leaching area -rain 500 sq ft b) spacing -4 md.n 6 ft with reserve between c) dimension d) construe on e) stone f) surfa drainage 2% "' Dosnhi. ! Slo e 6) slope WX = to be shown) b) y/x X150 = (to be shown) a) approval b) st�°d-by power r�. Ni s 6 rrR ErNovE a r' J � � r • 1 � 1V z _'411 P„ rte c i comAt y { A 0 rm . I � T(9Nk s- Town of North Andover, Massachusetts Form No. 1 G XAORTH .1" BOARD OF HEALTH ,..:...,,..,..�:_.�....�-�-- 0 19 o s� A APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location - i Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time F S.S. Permit No -'S/ D.W.C. No 9 7 CHAIRMAN, BOARD OF HEALTH Test No. C.C. Date Plbg. Permit No. 5 7 Q Vi 04 (.% { tv oil Ian F?T Or Y ' I • 4 a i► --at .r '-Y - - -� .. _. ..... • - .j.v_y tel„ .c...i- 4-__�-.". .� �_ --- �. .-i.a Q } + s L�tl6sLCnllllG _ -- , � � � - w! c�` : ion, ►� � 1 � � � i� .. Q Vi 04 (.% { tv oil Ian F?T Or Y ' I • 4 a 0 Description of Work: /� / Town of North Andover, Massachusetts Form No. 1 )RT H BOARD OF HEALTH /� ED ,6qOL /'� 19 y1. P RQDRATE D wPPR i�y/ Applicant -Y APPLICATION FOR SITE TESTING/INSPECTION NAME Site Location U a Engineer dS NAME Test/Inspection Date and Time Fee ki CHAIRMAN, BOARD OF HEALTH Test No. —)- 9 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts NORTH BOARD OF HEALTH E D IC 0 CO 3 0h �ti4Ao atEwoa ^.* APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.