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Miscellaneous - 450 BOSTON STREET 4/30/2018
450 BOSTON STREET 2101107.D-0075-0000.0 i 1 f i i r 4 i i i i Commonwealth of Massachusetts N W City/Town of North Andover System Pumping Record Sep 12 N11 Form 4 TOWN OF NOATIq AM DEP has provided this form for use by local Boards of Health. tWE►4f0%Wqj1* but the information must be substantially the same as that provided here. Be ore s 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 1. System Location: ��� �)..J forms on the r' '�{�� computer, use `-�' 1�, only the tab key Address to move your N.Andover Ma 01845 cursor-do not ---- use the return City/Town State Zip Code key. 2. Owner: VQ " A<---"S Name ' Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped. L� Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. em Pumped Bv. Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: S art's P - tment Plant, 20 So. Mill Bradford, Ma 01835 Sin aurEer Date. 9 .// Signature o cility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 • �, C +�5 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 1/16/2015 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Construction of an On-Site Sewage Disposal System By: Mike Cove At: 450 Boston Street Map 107.D Lot 0075 ,�� North Andover, MA 01845 The Iss ce of this ceqi€i�ate shall note construed as a guarantee that the system will function satisfactorily. G � Michele Grant ' I Public Health Agent v 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i Jan.15.2015 08:55 AM SkyQuip 9784227812 PACE. i fSL i a f PtBUC HEA117H DEPARTIMN7 (aconwhy Development Division. t TOWN OF NORTH ANDOVER SSMC n111:5P ISAL SYSTEM-INSTALLATION CE22TIVICATION The undersigned hereby serf fy that ilte Selvage Disposal System(X )constructed;{ j repaired; By, cove septic i.ocasodah �lA ,L./t�' .- ' - i (installation Adutreg) Was Installed in cot f rntance with the North Andover Board of Elcotit17) rove plan,originally stated and last revisal on Q� ,with a design flow of gallons per day. The rnaterialc used were in conformance with those specified on the l approved plan;the system was installed In accordance with the provisions of310.CMR 15,000.Title 5 and local � regulations,and the frnal grading rgrees substantistty with the approved plan.All work is amtrately represented on tite As-buiit which W bean submitted to the Boo-rd of Health. Bottom of Bed Inspection Bate: Engineer Representative(Signature) And—print Name knai Construction Inspection Date: FAgineer Repreaentativ©(Sigaotare) And—Print game lnstt,lttr, (Signature) Date: 9114115 And—Prin#"Nacre l9ngtneet°s . Date: ' 1 And—Print Name 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 97$.686.4540 Fax 478.68$.4476 Web bttp.//www.townarfoorthandaver.com Received Time J.ao. 1 . 2015 8:53AM Ra. 1064 Blackburn, Lisa From: Blackburn, Lisa Sent: Tuesday,July 22, 2014 3:17 PM To: Dan Ottenheimer;Isaac Rowe; Pam Lally Subject: 450 Boston St. Attachments: 450 Boston St..doc Good Afternoon, Please give Mike Cove a call at 508-523-2671 for final construction inspection at 450 Boston St. 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 Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com . I � S coy� I (1Ye- S 6M ve c)c � � � � , •. 7 Grant, Michele From: Gary Grant <ggrant2l@comcast.net> Sent: Tuesday,January 13, 2015 2:46 PM To: Grant, Michele Subject: 450 Boston St Septic System Attachments: Design-l.pdf, Design-2.pdf,Jim's Contract-l.pdf,Jim's Contract-2.pdf, Cancelled Checks.pdf Good afternoon Michele, I was wondering if you heard from Jim Morin. I have attached Jim's initial design contract and his construction contract. Mike Cove was his sub-contractor. In addition, I have attached a copy of all the cancelled checks that I paid to Jim, including$8900 for a final payment. Thank you very much Michele, Gary 978-390-0065 1 NorthEast opA,-# 5 Engineering TERMS OF AGREEMENT North East Classic Engineering agrees to conduct a system design for an upgrade of an existing septic system located at 450 Boston Street North Andover, MA 01845 REQUIREMENTS:Payment schedule (totaling$2,800.00) for the septic design and soil testing. PAYMENT SCHEDULE: Pa ment #1 = 1,400.00 Due at signing of agreement) y � ( 9 9 9 ) Payment #2=$1,400.00 (Due when plan is submitted for approval) PERFORMANCE: North East Classic Engineering will complete the work as described in the scope of service. All work will be done in a good and workmanlike manner in accordance with the requirements of the State Sanitary Code. All payments are due according to the above schedule and should be made payable to North East Classic Engineering. North East Classic Engineering is not responsible for damage to bushes, shrubs,flowers,walls,trees, driveways,sidewalks,fences, etc. All material is guaranteed as specified. All work to be completed in a good and workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. North East Classic Engineering will not be held liable for strikes,accidents,weather or other delays beyond our control. Note:This Proposal is valid for 30 Days. Acceptance of Approval: The above prices,specifications and conditions,are satisfactory and are hereby accepted. I authorize North East Classic Engineering to do the work as specified. Payment will be made as outlined above. NE Classic Engineering Representative: Date of Acceptance: i Client Signature: NorthEast 42 Sylvan Drive V 774-696-2246 Stow, MA 01775 "' = Engineering neclassicengineering.com SERVICE AGREEMENT dated_3/2412014 BY and BETWEEN: Gary Grant AND North East Classic Engineering 42 Sylvan Drive, Stow, MA 01 775 North East Classic Engineering is pleased to provide a Service Agreement for a septic system design, upgrading an existing septic system located at 450 Boston Street North Andover, MA 01845 Design Services Scope of Work • Soil evaluation by a Massachusetts DEP certified soils evaluator • Coordination of soil evaluation with town Board of Health • Topographic survey for the purpose of sewage system design • Sewage disposal system design on 24 inch by 36 inch plan prepared by a Massachusetts Registered Sanitarian in accordance with State and local regulations • Submittal to town Board of Health • Attendance at town Board of Health meeting,when necessary • Submittal to the MA DEP for variances,when required • Final inspection of the installed system and "as-built" plan $2,800.00 is North East Classic Engineering's fee for the above Design Services. *Town fees, permits, etc. to be paid by Customer. "Backhoe or Excavator required for digging test holes price not included and to be paid by Customer. Septic System Design • .Soil Evaluation • • MA Title V Inspections • Expert Consulting. . Effluent Testing 11 kearney Square,3rd floor NorthEast Lowell,MA 01852 �° 5t°`o O R Service Tel:774-696-2246 www.neclassicengineering.com �#Engineering Estimate Jim@'neclassicengineering.com s IF /Y Submitted to: Job Site: Gary Grant 450 Boston Street 450 Boston Street North Andover, MA 01845 North Andover MA, 01845 Ggrant21 @comcast.net Date: 5/15/2014 North East Classic Engineering is pleased to offer pricing to replace your septic system. Scope of Service Total price 1. Dig Safe property(3 working days to legal date) 2. Approximate days for installation(10days) 3. 4"Sch.40 PVC pipe and fittings 4. Excavate, remove and replace existing material within a 5' perimeter over dig using 200 Cu Yds of Title 5 approved fill 5. H-10 Concrete 1,500 gallon septic tank per plan 6. 5-hole concrete D-box(H-20) 7. 4 rows of 4; Cultec C4 leaching chambers in a bed configuration $17,800 8. 4oz non-woven filer fabric 9. Cover system approximately 12° 10. Furnish and install 3"of loam 11. Hand Seed with perennial seed mix with mulch hay for stabilization 12. Restoration of all areas affected b installation to their previous state Y 13. Plumbing change will be arrange but the price not included in agreement Qualifications: 1. Hazardous materials(if any, not expecting)is not included. 2. Gallons pumped beyond scope of work is the responsibility of the property owner to cover the costs 3. If existing line from foundation found to be unsuitable and a core drill of the foundation for a new line out of the building(if any,not expecting)is not included 4. With the new system location partially in the area of the old system we are making an assumption on how much material needs to be removed.Any additional removal and replacement of material beyond the 425 Cu Yds that we have included in this Service Estimate will be charged$35.25 a cu yd. Change Order Process Additional charges will be submitted on a Change Order during construction as unexpected issues arise. Payment for the change order will be due at that time and to be given to a representative from North East Classic Engineering. Change order Requirements:Timeline change, costs and impacts to project Cd 0A (A A — i v NorthEast Service Engineering Estimate page 2 of 2 Payment Schedule A 50%deposit is required along with the signed service estimate.A second payment of 40% is due once we have the new system operational and the fill is in place. The remaining 10% is due upon completion of the clean-up phase. 1s`-deposit 2"0-system Vf-clean-up operational Payments $8,900.00 $7,120.00 $1,780.00 **All change order payments are due at issuance of change order** The pricing on this quote is valid for 30 days. All materials guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications involving extra cost will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents or delays beyond our control.Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. `acceptance of(Utimate:The above prices, specifications and conditions are satisfactory and are hereby accepted. I authorize North East Classic Engineering to do the work as specified. Payment will be made as outlined above. Client Signature Deposit Title Date wG1 — 2 r. 'Avasa''�aoeorw r j1�'��-'i.1�,�#!� _- F� ��X• 1xNtacax�Q /;.8/14 15:30 009 0297 860,00 - H 3.89000.1"7s3.89000.1"7s89000.17s 5eq 0108 I l:BL107St5D�: 3$9II003492!}r $84 38900019928 #8845 04/18/14 3360.00 CJ / /V/C7 �12 r f O 88RQ _ _ -;_=- 8853 �maaxnsr{.•'.x`'0 _ - ..+a.-at- ". ��.47>a#�'�c__:,::�-_ -_____ `-�^:;; -,^a`�=. ...,- : nor�ax ��fz. w'd' - _T °��;�^'�.._J_$i�r10_-.�.-'.. ��+�c: --'• .. _-^_:q :.._.-_r:....-.:�.�:.. . ._'=-^-i_iF': :y�,�y.^•Ti.C./"R."rr'�'��y�.-`a'�'l�- �.,'�'.=W f-.a�+���F�'��M�'.�O g•"= �.:_ _..r..`.�!-- _ _ -- __��_. '::R.:''• F:IILLO?SL5D�: 3&9DQOi49B&a' 864[{ -.._.,.^.•��}�' - . :Q►1iy.QSY$0� 389DDDiQ9;28rc8B53 38900019928 #8840 03/31/14 $1.400.00 38900019928 #8853 05/14/14 41,400-00 4 y Rr 8873 �::coyGGnne�:y+mr6e5:_; e sleaG 9•Jt. :'.E_ ---------------- - -- -_ - -_ --:•_i.a+.b-:'_' fs�aew.n p� , u v O E LSC f �nC�bCll a`•: DO:: :? t8.,�,7 �vLt�•� �'-t .. .. axc.ns 8873 38900019928 #8861 06/12/14 $8,900.00 38900019928 #8873 08/06/14 $8,900.00 rX -77; Blackburn, Lisa From: Blackburn, Lisa Sent: Wednesday, November 05, 2014 2:58 PM To: jim@neclassicengineering.com Subject: 450 Boston Street Attachments: Installation Certification.doc Hi Jim, We were going through our files and noticed that we don't have the attached installation certification form for 450 Boston St. signed by both you and Mike Cove. Could you please sign it and get it to Mike Cove to sign? We can't issue the COC until we have this form. Thank you. O 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 Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com 1 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Thursday,July 31, 2014 3:40 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE:450 Boston St. Attachments: 450 Boston St - Final Inspection Form.doc Susan/Lisa, Attached is the final inspection form for the above referenced property.Sorry for the delay. Everything looked good but a couple things to note on the as-built plan.The septic tank and building sewer line changed location compared to the approved plan. Also the building sewer line does not have the 2%minimum slope but it does meet the Title 5 requirement of 1%.We checked this a few times to confirm. Please let me know if you have any questions. thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax:978-282-1318 irowe(cD..millriverconsulting.com www.miliriverconsultin-g.com From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Tuesday, July 22, 2014 3:17 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: 450 Boston St. Good Afternoon, Please give Mike Cove a call at 508-523-2671 for final construction inspection at 450 Boston St. 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 Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com i S IVED jays . North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 450 Boston St. MAP: 107D LOT: 0075 INSTALLER: Michael Cove DESIGNER: Jim Morin PLAN DATE: 5/2/14, Revised 6/1/14 & 6/10/14 BOH APPROVAL DATE ON PLAN: 6/10/14 INSPECTIONS TANK INSPECTION: 7/9/14 DATE OF BED BOTTOM INSPECTION: 7/15/14 DATE OF FINAL CONSTRUCTION INSPECTION: 7/23/14 DATE OF FINAL GRADE INSPECTION: 7/29/14 SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Tank and building sewer moved SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® 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 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 finish grade installed over outlet access port ® Hydraulic cement around inlet & outlet Comments: Needs to bed pipes properly. Completed. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 32'x16', with over dig 43'x26' SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Cultec C4 Chambers ® Number of chambers per row: 4 ® Number of rows (trenches): 4 Comments: Total Chambers = 16 FINAL GRADE X Loamed X Seeded X Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As-Built Plan ,1\ BM = 102.30 HR = 3.35 HI = 105.65 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 4.50 100.80 101.16 Septic Tank IN 4.86 100.44 100.86 Septic Tank OUT 5.08 100.22 100.61 Distribution Box IN 5.18 100.12 100.11 Distribution Box OUT 5.35 99.95 99.94 Lateral 1 TOP 5.62 Lateral 1 INVERT 99.68 99.74 Lateral 2 TOP 5.62 Lateral 2 INVERT 99.68 99.74 Lateral 3 TOP 5.62 Lateral 3 INVERT 99.68 99.74 Lateral 4 TOP 5.62 Lateral 4 INVERT 99.68 99.74 Top of Chamber 5.54 100.11 100.19 Bottom of Bed/Chamber 99.41 99.49 0.36/34' = 0.0105 *Building sewer has minimum 1.0% slope as required by Title 5. l CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws . 1• d I I-� I ( I I I W� - o .- �o. , . ,, , I * 0 1500 GALLONS � \ OULEfS CRAVES CONCONCRETE94.00 I >Ff 2 CD SEPTC TANK TH ( SET LEVEL MONOLITHIC p 4wrt O 310 CMR 15.= t H-10 LOADED . o 'Si GRAVES CONCRETE f 978-939-5717 I OPTIONAL KNOCKOUTS I INSPECTION PORI I DETAIL EXISTING C • - 10 O O. 5.5' •x9;.� I MANHOLE COVER 1 24'DIAMETER HIN. #440 1 ----------- ' SITE IS NOT WITHIN Wj FRANCISCO L LLALOBOS ATERSKED OF LAKE I _I LINDA VILLALOBOS ! 1a.s� 4"SCM.40 PVC PIPE COCHICHEWICK1O 96.06 2.18±ACRES x9447 / . . _-- - - ...--• Z N CULTEC C-4(H-10) co 2 ' / x 98.35 - m Ff Ff •.` �_ LEGEND / .is�/ e/ x9891 c e � STONEWALL 414 WL WETLANDS TREE LINE • WF7t WETLAND F \ mow/ - 'r' 2-i SS STATION SE !- m � --u�- PROPOSED CONTOUR +� W WELL EXISTING `V \ // // 101.16 ,�� Ln-<M 100-- EXISTING CONTOUR BM BENCHMAR 99.95 W WELL PROPOSED x9b�`3 / / 15•NAPLE .-O OVERHEAD LINE ---- WETLANDS BOUNDARY LINE HYD FIRE HYDRANT L7 BD BOUND C- ( #450 rr > - - WETLAND BOUNDARY 100' O PRC PERC TEST METAL/CHAIN LI�aCJ> y`1• 1 / 1271NE 1- Q GARY GRANT Zo --o--�- WOODEN FENCENK FENCE DH DEEP HOLE GS GROUNDS. 100.66 'OVER DIG -as- GAS LINE EDHAYBALES/SILT FENCE DH DRILL HOLE x100.32 6"MAPLE SISTINGTANKANDLEAC:HPITS MERCIA GRANT -W- WATERLINE �s SMH SEWER MANHOLE IP IRON PIN �'.'�PERC- 101.40 TO BE DECOMMISSIONED PER 1.11 f ACRES xrxN�N............ STRAW WATTLE D DMH DRAIN MANHOLE LE x 9i 51 I 11 PE PORT 10 TITLE 5 STANDARDS 301 CMR 15.354 L _ -- - - �Q.>UP# UTILITY PO UPGRADE APP • ,pj ) 1 / rp Commonwealth Of Massachusetts Cit!Town of NORTH ANDOVER -• •00 `rad 1 / \ / x 101.58 Form 11-Soil Suitability Assessment for On Site Sewage Disposal LOCAL 101.50 eep Observation Hole Number:TH1 Elevation:100.27 DATE:4/152014 ZVPINE OD CY,�� > o.nn Nxm wawa sume.a• y co Yavo` a saes s•.aa. cv�x�..P am ser 3.OFFSET TO GROUNDWATER SUPPLIED 4'R " a } .._ ml ear• aW.en tiara cav P•x•n a+su1 oras a oma c-e a I-vs sea 93x 36`.1.1 C M.- Sl an / oC'ezF / w 514,1023 3'I'VOO tor.79 STATE -, '` I / o, DFNF PxmlMawdN D•PniP9aa.Pa 9am,n9W m9wxn EStDw �* 9IJFD0 I t�F\� 1 / e FNC f 10 HED My u- NONE � ax w..Pso• 4s 21t, Commonwealth of Massachusetts O Q� p •`,� ! I '� ` y 101.86 Clty/rown of •(x 92.E ti O \ Sn Form 11-Soil Suitability Assessment for On-Site Sewage Disposal `� ///y.• I w ' q O Deep Obsembcn Hole Number-.TH-2 Elevation:99.73 DATE:41152014 COmrom 1 NORTH ^' f p ` ' E•'��' nmy�m+ rt.m. ,wPf.x,... as cora•F.,-. aM Ciryrtav15.n NORTH AI sin hroola8on Tess 1 '/ x94.52py<Pmia sea sew+a. edam o Famrz 14P. pian m cvsw pater a n 0.00 WETLANDS' DELINATED B (x96.17 MSILL ELEVATION BUOYANCY CALCULATIONS .� A 1.YR3t R. Test R.suas t 1 I C2 =10230 TANK HEIGHT ST ESH4/r 46" stw s !arm ss 1 1 s'- c U- \� JA ` Qc1v +�MES MpRIN RS#11�2 LEAVES A WATER COLUMN 1.91' a asyRos � 0-1 90.07 \ \ \ C� I Y (1.911(5.57(11.5)(62.43LBS/FTCUBm)=7,542LES-FB atter•.�.. Pt HEIGHT OF 1500 GALLON SEP71C TANK 10.820L13S=FG Px.ni nuuw o.wn lP e.an,a a.na�e wa w..vuo wait Esncw 45• O FG>FB BUOYANCY OK s4NwlnAv xtr+E sr sv 4c 12:33 J _ 12:49 p h,' 119 ro ryh.�• F. Certification 2:01 I „y 1mniyraxl have psssedmesal-al...oramnaam'apprnseoved%ax Dapanmra andmrmrraa El pro....ane rhxtmeabove -W- 42 MIN O amMsavvaspedomxd by me eonifteN wpm mereq.ored bardna,expeantl oyaAnee&-bed n 310 CNR 15017 a t,nq is MPI QO an ou epWua•sot Eauam Oar MfHAN 9na 3amvPa.m cutin n #50 WILLOW RIDGE ROADTUNG S. NG °T6°"E x dn•�. N.ANDOVER _ 7f Netr This lam nett be..trnae0 to me apPmvng aumsnry Wyn Percanoon Test Foran 12 UKYELUI ALL WETLANDS ETC ARE 1.07±ACRES DESIGN DATA SHOWN THAT ARE WITHIN 150' OF THE SYSTEM PROPOSED �>>� / TYPE OF BUILDING:SINGLE FAMILY HOME REQUIRED LEACHING AREA(S.F.) NO.OF BEDROOMS: 4 `'•. DESIGN FLOW/ LTAR NO GARBARGE GRINDER(DISPOSAL)ALLOWED. 440 / .56 = 785 S.F. _`- -•---- - ---- - _ •••• DESIGN PER(RATE:15MPI #464 ••, CULTEC C4 CHAMBER PANELS=8 L.F. I CERTIFY THE LOCATIONS, ELEVATIONS AND TIES SHOWN ON THIS LTAR PAUL FORMAN -� •56 GPD/SF 1.01±ACRES " PLAN RESULT FROM AN ACTUAL SURVEY MADE ON THE GROUND DAILY FLOW a X 110 GAL= 440 (16 CHAMBERS)(8 L.FJCHAMBF-R)(6.7 S.FJL.F.)=804 S.F. INSTALLATION OF STRAW WATTLE SEPTIC TANK VOLUME 1500_ GALLONS SIGNATURE OF DESIGNER: DATE: •-•USE 16 CULTEC 04 CHAMBER PANELS TRENCHING •' For had.rocky SOUS:wg•3-5 inchbanch. DESIGN FLOW=>DAILYFLOW 480 GPD => 440GPO - For hard.rocky lolls:dig a 2.3 inch trench. INSTALLIN Lay the first straw wattle snugly N the trench.No daylight should be seem under the-Wo.Pack •� soil from tranching against the wants on the upwu side.When Installing running leng0u of strew watnes,you must bull the second wants tlgh y against the first wattle.00 NOT overlap the ends on top of each oth-Overlapping behind each other has been done with some=me=.Stake I DESIGN ELEVATIONS the stray wattles st each and and four row on amen GRAPHIC SCALE TOP OF CHAMBER(1) 100.19 sO•a For exempt I r 0 0 1 m 25 foot.. uses 6 slakes - 20tratwemeuses5stake. NVERTO FOUNDATION 101.16 - 12 foot wattle u...4 stake. NVERT @SEPTIC TAN KINLET 100.86 !NVERT OFCHAMBER(1) 99.74 Stakes should be driven through the middle ofllu wame,?saving 2-3 Inches rfihe stake pratnraing ( IN FEET NVERT @ SEPTIC TANK OUTLET 100.61 shove me wattle.When straw mules are used for Pat ground applications,drive the stakes straight don;when Installing wattles on slopes,drive the stakes perpendicular to the Stop&.Drive the Prat I ! Hach= 20 it wNVERT @ D-BOX INLET 100.11 and stake ofthe second mhte at an angle toward the M1 wattle In order!.help but them righty NVERT D•80X OUTLET 99.94 OTTOM OF CHAMBER 1 99.49 together. () • S�TTED'y�6 ELE JCOPY • North Andover Health Department Community Development Division June 10, 2014 Gary Grant 450 Boston Street North Andover, MA 01845 r Disposal 4 Re: Subsurface Sewa e D s osa System Plan for 50 Boston Street May 107D Lot 0075 _ � u v n , Dear Mr. Grant: The proposed wastewater system design plan for the above site dated May 2, 2014 with a final revision date June 1, 2014 and June 10, 2014 (erosion control per conservation) has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom (max 9-room) home. This plan is generally good for 3-years from the date of approval however, as this is for a repair system, this is reduced to 2- years. The plan received the following local upgrade approval. 1) Separation from Soil Absorption System (SAS) to Estimate Seasonal High Water Table (ESWT) from 4 feet to 3 feet 2) The use of a single test pit in the leaching area instead of the required two 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. This system utilizes an infiltrator system and the owner has certified the understanding of this system, as found in the document submitted (see attached) 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 i 1 , 450 Boston Street June 10, 2014 3. 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)). 4. 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. Sincere , Su a,. er, HS/RS Z41ic He th Di ctor Encl. Form 9B Local Installers List cc: James Morin, RS File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts F . City/Town of North Andover Local Upgrade Approval Form 913 GSM DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Gary Grant key to move your Name cursor-do not 450 Boston Street use the return key. Street Address North Andover MA 01845 ISI City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address Cityrrown State Zip Code Telephone Number 3. Type of Facility (check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 1 5. System Designer: James Morin Name PE ®RS 11 Kearney Square Lowell MA 01852 Address Cityrrown State,ZIP I B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: I i I ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction I 450 Boston Street Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover u I Local Upgrade Approval Form 913 G„M SV ey`ev B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft ft. 15 min Percolation rate min./inch Depth to groundwater 3 ft ft. ❑ Relocation of water supply well (explain): I ❑ 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): i i List variances granted requiring DEP approval: i North Andover Health Dept Approving Authority Susan Sawyer June 10, 2014 Print or Type Name and TitlejSi nature Date 450 Boston Street Local Upgrade Approval, Page 2 of 2 a 6/10/2014 TOWN OF NORTH ANDOVER t PERMITTED SEPTIC INSTALLERS - RENEWED FOR 2014 Doing Business As Phone City Angelo Petrosino (978) 664-2030 NORTH READING, MA 01864 Bill Hall (978) 689-3711 METHUEN, MA 01844 Chad Jablonski (978) 360-9358 NEWBURYPORT, MA 01950 Daniel A. Giard (978) 686-7653 NORTH ANDOVER, MA 01845 David Maynard (978-375-7228 BARNSTEAD,NH 03225 David V. Zaloga, Jr. (603) 765-9296 EXETER,NH 03 83 3 James H. Currier (978) 774-6685 MIDDLETON, MA 01949 James Kellett (781) 953-7146 LYNNFIELD, MA 01940 John Butt (978) 815-5754 BOXFORD, MA 01921 John J. Soucy (603) 216-7175 SALEM,NH 03079 John L. DiVincenzo (978) 372-7471 HAVERHILL, MA 01835 Joseph Surianello (978)458-9117 DRACUT, MA 01826 Joseph Watson (978)475-3262 ANDOVER, MA 01810 Matthew Manning (603) 329-5077 ANDOVER, MA 01810 Michael W. Reilly (978) 375-4811 ANDOVER, MA 01810 Peter Breen (978) 265-7580 NORTH ANDOVER, MA 01845 Robert Daigle (978) 887-3703 HAVERHILL, MA 01830 Robert T. Amor (978) 948 3341 BOXFORD, MA 01921 Robert L. Innis (978) 663-6006 BILLERICA, MA 01821 Rocci DeLucia, Jr. (603) 974-1580 SALEM,NH 03079 Serge Beaulieu (603) 235-3740 DERRY, NH 03038 Stephen Iacozzi (978) 479-4407 METHUEN, MA 01844 Timothy Quinlan (978)457-0528 HAVERHILL, MA 01830 Todd Bateson (978) 815-2703 ANDOVER, MA 01810 Warren Pearce Jr. (978)-664-5264 NORTH READING, MA 0 1.864 NORTH ANDOVER&KINGSTON,NH William(Tom) Sawyer (603) 642-8910 03848 • S�"C'1'"��.lfjg6 . i i BOARD OF HEALTH 1600 Osgood Street, Suite 2035 North Andover,MA 01845 978-688-9540 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 Of the State Environmental Code, Title V Name Phone Address40k)(14(l" Contractor hired for work: Name c r6,Q- I ENP--- CQN614�Phone ,-5 49 Address-71 S / M5 Date for scheduled abandonment The septic sys m at the ve address has been abandoned according to Title V specifications. Signature o Con ract k�5 CV-U6 k-C L- a/r��'( ' Method of septic tank ab onment(check one). ( ) r_ermoval ( ) sandfill ( ) crush ( ) other Name of Offal Hauler This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW \ HE TH REPRESENTS IVES ONLY J & I specting Agent Date j Commonwealth of Massachusetts M Map-Bloc 5Lot BOARD OF HEALTH Permit No North Andover -BHP-2014-0701-------- -------------- FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Michael_J. Cove ------------------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 450 BOSTON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2014-070- Ftted July 03,2014 -------------------- ----------------------- -- LE Issued On:Jul-03-2014 BOARD OF HEALTH r............... ..........................................................................................................................................................� 450 BOSTON STREET Reference No: BHJ-2014-000010 ................................... Department: Permit No: BHP-2014-0701 ................................... North Andover BOARD OF HEALTH Account No: Septic Account Rev I FeeType .................................... DWC-Full Repair PERMIT Receipt No: REC-2015-000014 Paid By: Paid in Full On: Thu Jul 03,2014 Michael J. Cove .................................... .......................... Check No: 1118 Received By: .................................... I Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $250.00 L.......................................................................................................................................................................... n 1✓ Application for Septic Disposal System 7 3�•`p° °c TODAY'S DATt ° = Construction Permit — TOWN OF ORTH ANDOVER, MA 01845 $ 250.00—Full Repair ^��•�•'" $125.00-Component SACH Important:p Application is hereby made fora permit to: When filling out forms on the ❑ Construct a new on-site sewage disposal system* computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return ey. A. FaC�li nf0 at1011 kVyy,,.��rr��J������ �I Address or L t# i 110'U'rully . � NN-S City/Torm - 1 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) ❑ 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 Name Gl S0 't-Ao�j sf coe. Ad ress(ififferent�,om agve) ()f ' MckJU— AA City/Town State Zip Code Telephone Number 3. Installer Information Name ��Cro�l� Name of Company 72 - Address City/Town State Zip Code V7 k Telephone Number(Cell Phone#if possible please) 4. Designer Information _ SSL Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 1 a� °RTS Application for Septic Disposal System 0 TODAY'S DATE ° Xonstruction Permit - TOWN OF ORTH ANDOVER MA 01845 $ 250.00—Full Repair '�+SSAeHUs,� , $125.00 -Component PAGE 2 OF 2 A. Facility Informationcontinued.... 5. Type of Building: Vesidential Dwelling or❑Commercial B. Agreement 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 b aanissued is Board of Health. Name Date Applicati pproved y: (Board of Health Representative) Nam4 Date 04,kation Disapproved for the following reasons: For Office Use Only: / Y 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit-Page 2 of 2 ' r SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: A �b R �tfc'e+ (Address of septic system) For plans by fy� � 1 i Cov Q (Engineer) Relative to the application of �`C, (j„Q,1 (Installer's name) And dated 0 V� C Z 1 L� (Original dart) DatedLL L.l - o a s `d-ate)- With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pnor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first (ls� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept&townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer.I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (To ay's Date) �J\l l �c \)e- ) taw (Name—Print) ( a e—Signed) 6720 MORTh F S Town of North Andover � '•�,',;, HEALTH DEPARTMENT ,SS�ICHUSt� CHECK#: 1619 DATE:. �(P LL LOCATION: ' qx:�) !�k I H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Septic-Soil Testing $� ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer i r F-I" TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,REHS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthdeptAtownofnorthandover.com www.townofnorthandover.com- APPLICATION FOR SOIL TESTS DATE: `5 a bol� 1h�A 2�14 MAP k PARCEL: V LOCATION O//F��SOIL TESTS: OWNER: l�Ck(rl �� `' �- Contact#: APPLICANT: l J �Pv l�d`� Contact#: ADDRESS: V✓©S� ENGINEER: J Alm Contact#: `'1 L4 Co a,� — CERTIFIED SOIL EVALUATOR: c /lit OVL.L^--- Intended Use of Land: Resi ntial Subdivisionamily Home1 Commercial Is This: Repair Testing: Undeveloped 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 11"Plot plan&Location of Testing(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: 3 Signature of Conservation Agent: Date back to Health Department: (stamp in): i t � � \ 1 LO-T 7 } i e -r-23 T tvj�\���� 1 V a a X.101 e To • � tom» r �' � � f! ' I �"--��c UOc�l�?rT.;�t';:r. t�ptII.'a c-;•-�+7 g•,.,., -. � , I• i1dIL IN cc1 circles n©. rCfr1a ' . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY c MA DATEPERMIT# "J JOBSITE ADDRESS �-/� ©,S/��=1:51 OWNER'S NAME POWNER ADDRESS S _ TEL —jFAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL © RESIDENTIAL Or PRINT CLEARLY NEW: RENOVATION:© REPLACEMENT:Q PLANS SUBMITTED: YES® N0E! FIXTURES Z FLOOR- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICEI DEDICATED SPECIAL WASTE SYSTEM _ __) ( __( _ _� ► _ �( �_ t ___1 _ _� �..1 I I, ! DEDICATED GASIOILISAND SYSTEM -FE DEDICATED GREASE SYSTEM J I DEDICATED GRAY WATER SYSTEM ( _ _—I _� _— I � � �[_ ) ( p DEDICATED WATER RECYCLE SYSTEM J —( ._ ( DISHWASHER DRINKING FOUNTAIN ! _.=._J i _( _...__I . _° f I i __-.__G ! C FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY —�( _— t .---_J. I .._._._ -( - ---- ROOF DRAIN Date�!�. �011'� ---) --- _..___1 ___....� __j I ,- _. j ► I , 1ot~ c �, .............. F I _t ( r r10R71y , _.__. _..! ._._. _. O �.■° .�� �?;• "ooL TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING t c r HU S 1 This certifies that...... ..V1r`- �� ? a S .... ........................................................... its of MGL Ch.142. YES __., NO 1 has permission to perform... .L !Q „m ,. ....0.�i c. : plumbing in the buildings of..................+! -�'" 0X BELOW _ ` ............................................................... at..... ........ a� -� �Np `-......-.......... .................................. North Andover, Mass. Fee..-)n.......Lic. No. 1i�7.6... !:�I) ge required by Chapter 142 of the PLUMBING fNSPECTOR Check# CK ONE ONLY: OWNER 0 AGENT 10 re true and urate to the best of my knowledge -omplian hall Pertinent provision of the p rn/� L'l fwb Cll'b� HMG"1`I'I'•" ...•"� _ _�.,c-i. i�i7 _ fICiV�:rvv�it'_f""Tr� "'-a-n'�..•.- JIG URE - 1' m �P El( CORPORATION 0# PARTNERSHIP r#=LLC S COMPANY NAME lq 1/ P/4 S-C_S 11ADDRESS JX 15 ,-/ CITY J//1 701') _ _JSTATE ZIP TEL . FAX s CELL EMAIL i The Commonwealth oflMlassachusetts - Department of IndustriglAccidents Office of Investigations 600 Washington.Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lee b1Y Name(Business/Organization/Individual): Address: el-o City/State/Zip: C Phone : 2' 36 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.I 7. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.[J Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner,doing allwork right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] `%ny applicant that checks box41 must also fill out the section below showingtheir workers'compensation policy information. 1 Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that 1sproviding workers'comPensation insurancefor my employees Below is thepolicy andjob site information. Insurance Company Name:. s Policy#or S elf-ins.Lie.#: v1/G '2�O _7D Expiration Date: Job Site Address: �! ��"-'`� � a ` City/State/Zip: fi o/Irb'L Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby Ce 21yy �id,0, 4zepalns and penalties o iary that the information provided above is true and correct. - Si afore• �7 � Date: Es I ' 2 S Phone#• 6 3 2 - Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other - - I COMMONWF-p►�TH OF MASSA CHUSETTS' me Mel • PLUMBERSAND G A FOLLOWI''N`G:'LICENSE ';;:,'' '`'`':``' r' I SSUES THE L: ;G'ENSED AS,.A.:MAS'fER RLUMBfR !� €`<J'A' :kS M BARRETT � z W U 4 H E ML'O C K LN 7 CASTE>k . <":`> _< M 5 €:COMMONWEALTH OF MAaC`HUSETG :. I BOARo:of PLUMBER>S> ANb 6ASF .:; SUES:;., FOLLOWING'`LICENSE '>`;'.. ` IS Q LICENSEQ RN AS A JpUE.YMAN .PLUMBER`�. Z `LAMES M BARRETT:::> N Z 47 HEMLOCK LN 'N1A 0152371.7:47 c RECEIVED � Commonwealth of Massachusetts JUN1 16 Q14 w C ity/Town of NORTH ANDOVER TOWN OF NORTH ANDOVER System Pumping Record HEALTH DEPARTMENT ` Form 4 'I,N Sey`e DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority 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 450 BOSTON STREET key to move your Address cursor-do not NORTH ANDOVER MA 01845 use the return key. City/Town State Zip Code 2. System Owner: r� GARY GRANT Name eurl Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 6/13/14 2. Quantity Pumped: 1000 Date Gallons 3. Component: ❑ Cesspool(s) E Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Obsen/ed condition of component pumped: GOOD CONDITION 6. System Pumped By: JAMES H CURRIER II H79 406 Name Vehicle License Number X SEPTIC & DRAIN Company 7. Location where contents were disposed: GLSD 00156/13/14 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1 f Commonwealth of Massachusetts City/Town of 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 M 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. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Guy G PGtn,. only the tab key Name to move your y S n 9ot-r -'1 `it cursor-do not Street Address use the return A key. (�0 u� ISN r4 ov,e d2►- MA $ U City/Town State Zip Code at 2. Owner Name and Address (if different from above): + Name Street Address City/Town State Zip Code Telephone Number 3. Type o Facility(check all that apply): Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: S••� �.e �Kw� � �oJ 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) onventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): P i+i� t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of 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 M 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: `t` o Design flow of existing system: gpd Design flow of proposed upgraded system gpd l J Design flow of facility: d —` 9p B. Proposed Upgrade of System 1. Proposed upgrade is (check one): oluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection I 2. Describe the proposed upgrade to the system: IiN,e.Lj 1 S u `--+o 4 L'(- -wj k- 4",rA . 3. Local Up 'de Approval is requested for(check all that apply): eduction in setback(s)—describe reductions: i ❑ Reduction in SAS area of up to 25%: sas size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft l Syv. Percolation rate min./inch Depth to groundwater ft t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 I, Commonwealth of Massachusetts City/Town of 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 M 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): ❑ eduction of 12-inch separation between inlet and outlet tees and high groundwater Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of valu tion C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: P 1A 61 iftNeN CRtt.oa d✓wIJ A- 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: VV v �- - ��, i t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 t � I Commonwealth of Massachusetts City/Town of Po Form 9A — Application for Local Upgrade Approval pproval M ,0 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: W/A 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appr,opriate boxes): LTJ Application for Disposal System Construction Permit L"J Complete plans and specifications Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. 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." 6 /�, / cility ner's ignature Date Print Name 3 c-,,A s w1 Name of Preparer Date Preparer's address City/Town rA `lZ'1 -- Q ef — `-( State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval- Page 4 of 4 9� SITE IS NOT WITHIN j� �/v� �� i WATERSKED OF LAKE i �,�v FRANCISCO /Y 2.18±$ COCHICHEWICK • ' �J�O 1x 96.06 x94.47 `/ N83°5 'S1 g,.E M'�n co x 98.35 • c2- f / J f / x 98.911700 y 101.16 x 99.95 i �- x9� I !0 15"MAPLE rr� � / v4✓ ,Q C-J C`/64; 12"PINE a �' i i 100.66 a DIGj 01.40 XSISTING TANK AND LEACH PITS II i _ - ERC- TO BE DECOMMISSIONED PER PE Po 0 � TITLE 5 STANDARDS 301 CMR 15.354 x91.51 !v I IN SEPTIC SYSTEM 9j�2 x 101.58 ! / x1 101.50 WO 24"PINE vp 00 r / s0•g3 � f �� f+ o A'�VFO 1 F\��'� i � 9� � pFNfiEIVCF NEp A. 102.15 f45 0 1� t °4'' I co 4/ `� 101.86 9.90 S 2 x 92.06 O x! 94.52 1 i 90.00 I x 96.17 M SILL ELEVATION `, WETLAND , DELINATED i R �1 ESE Address: 450 Boston Street JUN j4 TOWN OF HEALTH Oct'%iST Certification of Owner In Regard to use of Cultec C-4 Chambers Innovative/alternative Technology I Herby Certify and attest as the present owner of the property listed above that: • I have received a copy of the Title 5 I\A technology approval and the owner's manual for the proposed Cultecc-4 chambers to be installed. • That a garbage disposal will not be installed. • That the SAS will be replaced, modified or other actions taken as required by the Board of health or DEP if the system is determined to be failing to protect human health and safety and the environment. • That the system will only be installed by an installer licensed by the Board of Health who has received appropriate training by Cultec. • That prior to the issuance of a certificate of compliance the designer and installer will certify that the system has been installed in accordance with all necessary requirements. • That If I find the SAS has ponded 3" or more I will measure the ponding level within 30 days and report to the Board of Health the ponding level if it remains at 3" or more. This measurement is made via the observation port shown on the plans. • That when a sanitary connection becomes available I will connect to the facility within 60 Days. By Date: Certt'vft'Frate of ComplettFon CULTEC Recharger® & Contactor® Plastic Septic Chambers This is to certify that jimm Morion, RS # 1132 has satisfactorily completed a training course on the use and design of CULTEC Recharger@ and Contactor® Chambers for use in septic systems as of the date below Certification No.: MADT-050814-MOR Certifying Agent: Gina Carolan Date: May 8, 2014 b, „sd Signature: -------------------------------------- CULTEC Commonwealth of Massachusetts City/Town of North Andover w Percolation Test Form 12 GSM Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important:When filling out forms A. Site Information on the computer, use only the tab Gary Grant key to move your Owner Name cursor-do not 450 Boston Street use the return key. Street Address or Lot# North Andover MA 01845 Cityrrown State Zip Code James Morin 774-696-2246 Contact Person(if different from Owner) Telephone Number B. Test Results 4/15/2014 11:00 Date Time Date Time Observation Hole# Perc-1 Depth of Pere 45" Start Pre-Soak 12:33 i End Pre-Soak 12:48 Time at 12" 12:48 Time at 9" 1:19 Time at 6" 2:01 Time (9"-6") 42 Min Rate(Min./Inch) 15 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ James J. Morin Test Performed By: Issac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 k Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Gary Grant Owner Name 500 Boston Street Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Soil Survey Available? ® Yes ❑ No If yes: web soil survey 711 B Source Soil Map Unit Charlton Hollis none Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ❑ No If yes: 2013 MA605 Year Published/Source Publication Scale Map Unit Sandy Loam drumlin Geologic/Parent Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No Within the 500-year flood boundary? ❑ Yes ® No Within a velocity zone? ❑ Yes ® No 5. Wetland Area: Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): 3/2014 Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Year 7. Other references reviewed: Local Board of Health t5form11 •rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: TH-1 4/15/2014 11:OOAM SUNNY COOL 60F Date Time Weather 1. Location Ground Elevation at Surface of Hole: 100.27 Location (identify on plan): YES 2. Land Use EXSISTING HOME NO 8 (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) TREES DRUMLIN Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100' Drainage Way feet Possible Wet Area >100 feetfeet Property Line 6 feetDrinking Water Well feet Other feet 4. Parent Material: SANDY LOAM Unsuitable Materials Present: El Yes No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 46" 92" 5. Groundwater Observed: ® Yes ❑ NO If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 46" 97.30 inches elevation t5form11 -rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusetts -upCity/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TH-1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix: Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent Gravel Cobbles& (Moist) Stones 0-6" A 10 YR3/2 FSL 6-38" B 10YR5/6 SL 36-120" C 2.5Y 6/4 SL Additional Notes: t5form11 •rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 �L\ Commonwealth of Massachusetts City/Town of North Andover r� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TH-2 4/15/2014 11:00 SUNNY COOL 60F Date Time Weather 1. Location Ground Elevation at Surface of Hole: 9973 Location (identify on plan): YES 2. Land Use EXSISTING HOME NONE 8 (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) TREES DRUMLIN Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body feet Drainage Way feet Possible Wet Area feet Property Line >11 feet Drinking Water Well feet Other feet 4. Parent Material: SANDY LOAM Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 90" 92" 5. Groundwater Observed: ® Yes ❑ No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater. 46" 95.90 inches elevation t5form11 •rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover 9 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TH-2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix: Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) ( )USDA Structure Consistence Other y ( Depth Color Percent Gravel Cobbles& (Moist) Stones 0-6" A 10 YR 3/2 FSL 6-36" B 10 YR 5/6 SL 36"-120" C 2.5 Y 5/6 SL Additional Notes: t5form11 •rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 46" B. 46" inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary. inches inches boundary: aches t5form11 •rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator Date James J. Morin 12907 3/16/2014 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Issac Rowe North Andover Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. t5forml 1 •rev. 3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 s Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: t5form11 •rev.3113 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 • 9R SITE IS NOT WITHIN #� WATERSKED OF LAKE // FRANCISCO COCHICHEWICK LINDA VI ��� )x 96.06 2.18± oI J / / x 94.47 / N83°51'58"E C�' � // - - - - - - - x98.35 220.00' / x 98.91 101.16 �� _x 99.95 x 9� \ // Joa 15'MAPLE 12"PINE TOVER DIG 100.66 AA x 100.32 6"MAPLE PERC- 101.40 XSISTING TANK AND LEACH PITS IV a' x ©99TO BE DECOMMISSIONED PER x 91151 N PE PORT x 10 PL .TITLE 5 STANDARDS 301 CMR 15.354 / 14, � � N a SEPTIC SYSTEM x 101.58 W xl I x 101.50 rn �� 0 0 0 O, 24"PINE 4 co W 101.79 AqV 1 O / �`� 2.3 OOD �. F �F��CE 102.15 SHED \O s.90 �� I /� Co v 1 o1.8s x 9206 N (. s1 / x 94.52 I `90.0WETLAND� DELINATFD R I x 96.17 4L, M SILL ELEVATION i North Andover Health Department (ommunity Development Division May 23, 2014 James Morin, R.S. NorthEast Classic Engineering 11 Kearney Square, 3rd floor Lowell, MA 01852 Re: 450 Boston Street(Map107D, Lot 75) Dear Mr. Morin: The proposed wastewater system design plan for the above site dated May 2, 2014 and received on May 12, 2014 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. A. Please provide the date of the soil testing on the design plan (3 10 CMR 15.220(4)). ' The soil evaluation and percolation test results need to be submitted on current DEP forms 11 & 12 (NA 2.3). of Please provide a cross section of the proposed leaching facility (NA 3.2). 4. Please provide more detail on.the scaled profile of the system. At a minimum the existing gr--ade, finish grade and ESHWT elevations should be depicted. r On the scaled profile,the vertical distance from 100.00 to 102.00 does not scale correctly. 6,-,O"A Local Upgrade Approval request is required to have only one test in the proposed leach field area(3 10 CMR 15.405(1)(k)). 7?The form 913 submitted with the application is the incorrect Local Upgrade Approval request form. Please use form 9A for the Local Upgrade Approval requests. 8. Please indicate the distances on the site plan from the system components to the existing V�✓ dwelling,propert"lines and wetland resiource area(NA 3.2). 9/Proposed finish grades are missing from the design plan (3 10 CMR 15.220(4)(g)). These will be needed to ensure proper cover material over the leach field and the breakout elevation is met. Page 1 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i 10. It appears the sill elevation 102.30' is being used as the benchmark. If so, please clearly note this on the design and the location of benchmark so the installer is aware during construction. - '7 1 Please indicate thmodel/brands of the septic tank and distribution box that are proposed (NA 3.2). ._ X1,2-Please provide a note about the abandonment of the existing system (3 10 CMR � 15.354)(NA 3.2). }� 5 11-3�Please indicate the building sewer line shall have watertight joints and be laid on a X1 compact firm based(3 10 CMR 15.222(3-5)). �4 1Please indicate a 6" stone base is proposed beneath the septic tank and distribution box (310 CMR 15.221(2)). 1�!Since the bottom of the septic tank is below the ESHWT buoyancy calculations are required(3 10 CMR 15.221(8)). M60'Please provide a note that the septic tank and distribution box shall be watertight(3 10 CMR 15.221(1)). �•---- ,dnder the DESIGN DATA section, the SF of the chambers are incorrect (� 806 SF). 18. Under the DESIGN DATA section,there is conflicting information aboSAhe,-proposed number of chambers. Both 15 and 16 chambers are noted. 9.�Under the DESIGN ELEVATIONS section the D-Bo,x outlet elevation is incorrect. 20. Under the DESIGN ELEVATIONS section, the To of Chamber elevation 100.90 Top ( ) appears to be incorrect. According to the DEP approval letter the height of the Field Drain Contactor C4 chamber is 8.5". This would result in a top of chamber elevation of L.,1100.19. This will also change the breakout elevation on the design plan. Please modify this accordingly throughout the design plan. t2 `Please indicate the location of the proposed inspection port on the site plan view. '`�22. Under the PLAN &PROFILE section,the length and slope of the building sewer line and the line between the septic tank and distribution box are labeled incorrectly. 23 'Under the PLAN & PROFILE section, an inverted U-shaped pipe is required for the 2- compartment tank(3 10 CMR 15.224(4)). X24. Under the PLAN &PROFI " LE section, 6 minimum cover is proposed over the Cultec chambers. If allowed,please demonstrate how section 310 CMR 15.240(9) does not apply. 25!The size of leach field on the site plan is depicted incorrectly. Please modify accordingly to demonstrate the correct size and the associated finish grades. 26. Please indicatte ho),delineated the wetlands depicted on the southwestern portion of the property. 27. Since the Cultec Chambers system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use"will apply. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clear) indicate an area or y f the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; I i Page 2 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r 1 • � I Section II(18): a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 5 IIA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comely with all terms and conditions; 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Although not a reason for disapproval, you may wish to consider installing the proposed tank in a similar location as the existing tank to avoid another building sewer pipe in the foundation wall and to reduce the piping from the tank to the distribution box. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, san Y. Sa r, /RS 1Public Health Director cc: Gary Grant Page 3 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Of NORiq, 6757 � 9 Town of North Andover �`+�'• '� HEALTH DEPARTMENT CHU CHECK#: ATE: LOCATION: H/O NAME: fz�iulf, CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ VU Septic-Design Approval $� ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ t j Health Agent Initials T vhite-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,REH5/RS 978.688.9540—Phone978.688.8476—FAX Public Health Director E-MAIL:healthdept d)townofnorthandover.com WEBSITE:hitn://viww.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: l/�- /a-0 IRECE�!!ED Site Location: S BDSTp n S•r MAY 12 2u 14 • 1 "S?W�I(W NORI'r,iii L-VER Engineer: m mo �eA1.TH DEPARTMENT New Plans? Yes /$225/Plan Check# (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes V No Telephone#: "7? Y 6 4 —�4 y (2_Fax#: E-mail:]j Uk4On-tev U S ( $4H00 . G�'►�� Homeowner /' L Name: G a r y (��`�/� OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database I � I � c IT1 1-7'. j1P G✓ I _� < < I i f j i II Blackburn, Lisa From: Blackburn, Lisa Sent: Monday, March 31, 2014 8:24 AM To: Dan Ottenheimer;Isaac Rowe; Pam Lally Cc: Sawyer, Susan Subject: 437 Summer St. and 450 Boston Street Attachments: 437 Summer St..pdf,450 Boston St..pdf Good Morning, Attached are applications for soil testing at 437 Summer Street and 450 Boston Street. Please contact the engineers, Bill Dufresne for 437 Summer Street and James Morin for 450 Boston Street to set up a date.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 Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com -,P ^w i I 01)"?716391 Oaio 11�ow Commonwealth of Massachusetts orm 4RECETyra,Recor Massachusetts System Pumping Record JUL 0 5 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT System Owner System Location Grant r'.iry i Ou t ot-n St , Ct1) 1(r7..1,)V,-r �,A, i,j ^If, � �,J(^f Y r, Hr. r � iI.H." Type: Emergency Routine Cesspool: No Yes Septic Tank: No YesFZ Date of Pumping: S Quantity Pumped: ZOZ?a Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: ' /• P !X Date: Pumper Signature: �v Condition of System/Other Comments Dep Approved Form-12/07/95 107 Forest St. N FOMI 4" SYSTEA•1 PUMPP\'G RD Middleton,MA 01949 QIP , <_ (508)774-2772 S�Q 5 w GE" y C Commonwealth of Massachusetts s Masachusetts se m Pu. m�zn record ystem «rter y%em oeapon & ltFf s��C le- Ono e-,-- t/SU 2�S�u✓1 S} /tr �j ANI �c►Z (�2—Z3cw ;. Date of Pumping: Q 259 0 .. * Qtlwltity•Pumped:_-,._gallons Cesspool: No El Yes ❑. .,Septic,.Tan1;; ,.No Yes S}'stem Pumped bN: Ct cK r:, Contents transferred to: License #; w Date Inspector 0� 4..' to 1r '�•� , ' .. - .... - • THE PROFESSIONAL EXPERTS 1N THE SEPTIC AND DRAIN INDUSTRY.,• C' ..fie .. .d•` , .. .. .t Address b 13 6 s-ro,Y Sr- Title of File page of T Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/_ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department TO: NORTH ANDOVER, MASS �Q—Lr" Y 197.6 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at, o 7- 7 3 c),5 7-o /(J S7— North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 192- 7 2- 7 01 jN OF eg.Pro . gine eg. rian BARBAGALLO N No. 464 = k 01—STE�t<<�� f � J '/C0 Co W05T• C.O. - - . w 7t " ,T 'ec/siz, 1111M.40 N ' 7 6�l GAZ 00, IV �e� 1 i All- lotAf � • � � � Jlo�' Y / do- - ISO ' MAIL IkI -61 rAm TSS 12���-�o ter, co co Joseph j. barbagallo, r.s. I westward circle no. reading,mass. e: t ' d XOQ 'q -IV15 Owl • F `71�1�M ON 'n i l 1- tt b''�►Z� Jw rwd5 h-ZL ws 10 sjv2lnl� SL•61•-! H-t)rn/rri W L -- :? O►� ON m `�lCt42�l�tS`1q'9 CYJO� � � a o 4cc, Tl )09 O nom a v � J5p