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Miscellaneous - 464 BOSTON STREET 4/30/2018 (3)
�' r i i I i I I 111 I I /�/ Map/Parcel Lot & Street " (O CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Approved by: Plan Approval: Date: Plan Date: Designer: Conditions: Water Supply: Town Well Driller: Well Permit: Well Tests: Chemical Date Approved Date Approved Bacteria II Bacteria I Date Approved Wiring Sign-off: Plumbing Sign-Off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: YES NO All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO F Other? YES NO Any Variance Needed? FINAL BOARD OF HEALTH APPROVAL: F DATE: APPROVED BY: Q .ti SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit# Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: i Town of North Andover *µORTP�1 4 Office of the Health Department Community Development and Services Division 3111 27 Charles Street North Andover,Massachusetts 01845 �SSAc►+uSEt Heidi Griffin Telephone(978)688-9540 e;i„ Duhlic ffer1rh P rrrtr:r- Fax (978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE October 15, 2003 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by John Soucy at 464 Boston 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. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Jonath arkey Chaimlan,North Andover Board of Health BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC September 27, 2003 North Andover Health Department Town Hall Annex TC ,' J ;, ;'°, a :` 27 Charles Street North Andover, MA 01845 2,6 2003 Re: 464 Boston Street,North Andover, Septic system design j m 1 Dear Sir or Madam: Enclosed are three copies of the as built septic system plan and the certification document for the above referenced property. The certification still needs to be signed by John Soucy as the installer. If you have any comments or questions please do not hesitate to contact this office. Sincerely, C J Benjamin C. Osgoo r., EIT President 60 BEECHWOOD DRIVE-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; W repaired; by c7oHt,3 �a�vccA located at 13o s 7-o,4 -S i was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# ,plan dated , with a design flow of 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 Health. Bed inspection date: Z 3 v 3 S Engineer Representative Final inspection date: 41lu " C Engineer Representative Installer: Lic.#: Date: 10 Engineer: Date: 03 i RIG�'lARO a , TANWO y 13021 C Ss� -04 I Page I of 2 Pamela DelleChiaie From: "Dan Often heimer"<info@millriverconsufti ng.com> To: "'Pamela DelleChiaie"' <pdellechiaie@townofnorthandover.com> Cc: "'Heidi Griffin"'<hgriffin@townofnorthandover.com>; "'Brian LaGrasse"' <blag rasse@town ofnorth andover.com> Sent: Tuesday, September 23,2003 12:30 PM Subject: RE: 464 Boston Street-Final Inspection Heidi,Brian and Pam, We're all set for tomorrow(9/24)at 8:00 a.m. I am also likely going to be inspecting 227 Granville Lane tomorrow morning too. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester,MA 01930-2259 978-282-0014 or 1-800-377-3044 info@millriverconsulting.com -----Original Message----- From: Pamela DelleChiaie [mailto:pdellechiaie@townofnorthandover.com] Sent:Tuesday, September 23, 2003 9:33 AM To: Dan Ottenheimer Cc: Heidi Griffin; Brian LaGrasse Subject: Fw: 464 Boston Street- Final Inspection Hi Dan, John Soucy called. He would like to setup a Final Inspection for 464 Boston Street. John can be reached on his cell at 603.216.7175. Thanks, Pam --Original Message — From: Dan Ottenheimer To: 'Pamela DelleChiaie' Cc: 'Brian LaGrasse' ; 'Heidi Griffin' Sent:Wednesday, September 17,2003 9:40 AM Subject: RE: 464 Boston Street-Bottom of Bed Inspection We are all set for today at 12:00. Dan Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@milliiverconsulting.com 9/23/2003 - Page 1 of 1 Pamela DelleChiaie From: "Dan Ottenheimer"<info@millriverconsulting.com> To: "Heidi Griffin"<hgdffin@townofnorthandover.com>; <blagrasse@townofiorthandover.com>; <pdellechiaie@townofnorthandover.com> Sent: Thursday, September 18,2003 8:48 AM Attach: Construction Inspection Form Boston Street#464.doc Subject: Boston Street#464 Heidi, Brian and Pam, Attached please find the inspection report for the bottom of bed inspection at #464 Boston Street. Construction was fine, and Mr. Soucy is now our best friend because we were able to accommodate his construction schedule very nicely. A question arose regarding the private well on the property. The Town's setback distance table indicates that wells must be 100' from soil absorption systems. Do you know if that applies to wells which are plumbed to an outside sillcock for irrigation purposes too? Title 5 provides a different setback distance from potable and irrigation wells, and i am not sure what the intent was and how to interpret the North Andover Regulation. Thanks for any help you can provide. Dan I Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 info@millriverconsulting.com 4/18/2003 Commonwealth of Massachusetts Map-Block-Lot 107.D-0076- ---- Board Of Health Permit No North Andover -BHP-2003-0333------------ ------ ---- P.I. FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted John-Soucy---------------------------------------------------_ ------------------------------------- to(Repair)an Individual Sewage Disposal System. at No464 BOSTON STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2003-033 Dated September_08,2003 ---------------------Board ---- - --- Issued On: Sep-08-2003 Board Of Health fi ..........................................................................................................................................................• ............. Commonwealth of Massachusetts Map-Block-Lot 107.D-0076- Board Of Health ----------------------- North Andover Certificate of pliance THIS IS TO CERTIFT,That ividual Sewage Disposal System (Repair) by ....Johncy Sou ----------------- ------- ------- -------------------------------------------------------------------------------------------------------------- Installer at No 464 BOSTON ET ---------------------- -------------------------------------------------------------------------------------------------------------------------------- has been install ,n accordance with the provisions of TITLE 5 of the State Environmental Code as described in the applicati or Disposal Works Construction Permit No. BHP-2003-033 Dated September 08Z 2003 ----------------------------------------------------------------- Printed 0n: Oct-22-2003 Board Of Health TOWN OF NORTH ANDOVER BOARD OF HEALTH /0/1 Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction$ 5 " Soil Testing / /G Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ offal/Trash Hauler $ Other $ 70. 55 - " Health Agent White - Applicant Yellow - Dept. Pink - Treasurer APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: SoHo � CURRENT INSTALLER'S LICENSE# LOCATION: 63-41h s-f' ,i,'-- S044 ,/-fin i•�,P� LICENSED INSTAL R: �A LA SIGNATURE: TELEPHONE# 3-5-70 CHECK 'ONE:: REPAIR:V NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only �v $ .00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North.Andover licensed installer for the construction of the septic system for the property at L (o`� l�oS-fin _ relative to the application ofk, U4 dated — U for plans by Al � F_: (�.t,rr. and dated —a 3 with revisions dated L —U I understand the ollowing obligations for management o this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. 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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer request the inspection but does not have to be present. b) Final inspection Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work 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 in the Town of North .Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. 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 Septi Installer Date: C?nr;—O Disposal rks Constru ion Pit 4 Town of North Andover, Massachusetts Form No. 1 • NORTH BOARD OF HEALTH p APPLICATION FOR SITE TESTING/INSPECTION SACHUs �y Applicant -11-vwe� 40zzl. NAWE / ADDRESS TELEPHONE Site Location Wa �r � Engineer l.//. ( ` NAME DRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee . G Test No. iy o� S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. a ` Form No. 1 Town of North Andover, Massachusetts NORrM BOARD OF HEALTH zy- e' Q��T LEO ib q�0 APPLICATION FOR SITE TESTING/INSPECTION ��SSACHU$���y Applicant & NAME,Z/ ADDRESS TELEPHONE Site Location_ /� LX�0�d� '4�, Engineer NAME ^DRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Test N o Feeee �� . S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS FEB 9 2003 DATE: 'Z-I )% 103 MAP&PARCEL: /079 7G LOCATION OF SOIL TESTS: Y L30S i ON '! `sem• OWNER: 0(i a-*)- w qL-c 'z}1�1� TEL.NO.: ADDRESS: -,/6 q 0VS-7Z)/% ST P O 4-17( tiN e o,)Q,- A4 ENGINEER: OF.- F"Ci i.'eee d.; TEL.NO.: ,7?9 — 6 S 6 -/7(, � CERTIFIED SOIL EVALUATOR: R C+1/4171P �` I G�KG cl�, �� A Qs 0� 1 Z Intended use of land: Residential Subdivision Single Family Hom Commercial Is This: Repair testing _ Undeveloped lot testing In the Lake Cochichewick Watershed? Yes No 1 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. 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$200.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Ch y U lb wkq r. .cab 19 - a- `7;r 1/� n 16 + 7 z l.. i Le �� ' Page 1 of 5 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non-conforming system with a design flow of<10,000 gpd, where full compliance, as defined in 310•CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non-conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(l), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: C Jq 20 I w w j_c 2 q K Address: a M q(t2 (214 OP S R0 G-u s 4 R Phone#: Address of facility: c _ _ �t6 �'Zs`r�x� S iYLt r i ,vv .2 j?{ A,,xpwc & , 1 Iq 2) Applicant (if different from above) Name: s/-44 Address: Phone#: 3) Type of Facility: _Residential Commercial School Institutional (Specify) 5 j,L L� iu►j Ly n, L_L_j A/ �- Page 2 of 5 4) Type of Existing System: _privy cesspool(s) conventional system other(describe) ` Type of soil absorption system(trenches, chambers, pits, etc.) Cao 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system gpd Approved: _yes Approval date: i q'1 `! no Why: b) Design flow of proposed upgraded system t,o d Why i3 R c) Design flow of facility No gpd 6) Proposed upgrade of existing system is: a) 4—Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CN1R 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? vr Reduction of setback(s)(list setbacks to be reduced with proposed setback distances) 545 Tr, rvia. f 2-AA vZtd jZ ttZei7 TO iO t Percolation rate of 30-60 minutes per inch(state actual perc rate) Up to 25% reduction in subsurface disposal area design requirements (state required& proposed size) f Relocation of water supply well (identify well, describe relocation) R E%-t- N L3,&- &13 6AJ i> 1 a►-� �-4 i G k/L S PC .?Lc'n5 Reduction of required separation between bottom of SAS & high groundwater(specify proposed reduction& perc rate) Page 3 of 5 : Other requirements of 310 CMR 15.000 that cannot be met(specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) 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 ground water elevation pursuant to 310 CMR 15.405(1)(n(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater feet As determined by: Evaluator's name: Evaluator's Signature: Date of evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. 1 l Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. c) A shared system is not feasible. /1/-j d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications,site evaluation forms), must accompany this application. Is the DSCP application attached? i� yes no Page 5 of 5 11) 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 knowing violations." Facility Owner's ' ature Date Print Name &A 4 V%-.,v, C DS Name of Preparer Date `173 - b0 6 - 17C 60 3 ������� -OP- A Telephone No. &Address of Preparer NOTE: Title 5, 310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. Town of North Andover, Massachusetts Form No.r _ NORTs, BOARD OF HEALTH ow o s " �� !t.•''" DESIGN APPROVAL FOR 'ss,C""5``� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant ` Test No. ��� / Site Location Reference Plans and Specs._ � � � C� Ali ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. : CHAIRMAN,BOARD OF HEALTH Fee � 5 Site System Permit No. �o��� r ^ TOWN OF NORTH ANDOVER a?,.;` . HEALTH DEPARTMENT I. � p 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �qs°�_•�^ �� SACHUS Sandra Starr,R.S., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 FAX Benjamin C.Osgood,Jr.,EIT From: Pamela for Sandra Starr TO: NEW ENGLAND ENGINEERING SERVICES,INC. 60 Beechwood Drive North Andover,MA 01845 978-685-1099 Pasco 2 Fac 978-686-1768 Date: -fl98~/ Phones /�o.41 d r�%9 Septic Plan Response CC: Sandra Starr,R.S.,C.H.O. Re: Health Director ❑Urgent x For Review ❑Please Comment ❑Please Reply ❑Please Recycle •Comments: Attached is the response from Sandra Starr regarding Septic Plans for the following property: �W lllZez S� ` A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any qL Xc: Address File Chrono File y Town of North Andover, Massachusetts Form No.2 • *0R'r#j h BOARD OF HEALTH ..�^ • -.� 3? •'�. - .�. ��c � OJT DESIGN APPROVAL FOR CHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ,,-...�,�%/ p Test No. Site Location �C?.S'""'G✓.��� Reference Plans and Specs._ ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD�OF HEALTH OLD Fee �' �/ Site System Permit No. 7 4-A i f NORTH TOWN OF NORTH ANDOVER HEALTH DEPARTMENT J6- 27 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 9Ss"„«„st`y Sandra Starr,R.S.,C.H.O. (978)688-9540-Telephone Public Health Director (978)688-9542-Fax I Ta 4�91 From: A Fax: Pages: Phone: Date: Re: `y(r, ,� CC: ❑Urgent ❑ For Review ❑Please Comment ❑Please Reply ❑Please Recycle I A Please call 978-688-9540 for assistance with any questions. Thank you. xc: Address File Chrono File .Towil of'.North Andover; Nfassachusetts Form No.z • �.NORTIy. - cBOARD`':OF H`E.ALT'H DESIGN APPROVAL ss"`N"Stt SOI:L-ABSORPTIO,N SEWAGE. DISPOSAL SYSTEM Applicant---C-1 f Test No. ZWL5 Site Location Reference'Plans and Specs. e��', zi"e -- --`/ ENGINEER DE'S.fGN: DATE Permission is granted for an individual soilabsorption sewage disposal system to be installed in accordance with:,regu:Iations of Board of Health. CHAIRMAN, BOARD O'F H'EALTH . Fee Siae System.Permit No. /p(. d II ZIKd`'' TOWN OF NORTH ANDOVE BOARD OF HEALTH Location ✓✓ Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ ` �V Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 6838 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer TOWN OF NORTH ANDOVEJ3 BOARD OF HEALTH Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit i ' , $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 603 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer SEPTIC PLAN SUBMITTALS PLOCATION: Map &Parcel f4 70 �7(� NEW PLANS: YES $225.00/Plan r Check#: y i REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: S NO LOCAL UPGRADE FORM INCLUDED: S NO i DATE: a 3 DATE TO CONSULTANT: DESIGN ENGINEER: ^w - `/n "' Telephone#: 6,96/76 9 When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. ., Apr 01 03 02: 14p NORTH ANDOVER 9786889542 p.5 r P - 6 _ 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-'_31(6) Capacity of pumps)- gpm Q ' 'TDB-220(4)(r) Pump can pass 1 1/4"solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-23)(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) pump performance curves included-220(4)(r) Manua!operating switch-NA 12.01 _ Check valve,bleeder hole-IIIA 12.01 I childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4- "stone beneath chmbr.specified-221(2)&128(1), Buoyancy calculations if chamber is at or below water table-221(8)0 9"of cover over chamber(minimum)-228(1) ' H- 10 loading(min..)-B-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete for all designs) OK Problem NIA _✓ 50°o larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle or imperv. area above It unless unavoid ble-240(7);NA 13.02 —;� Vented H under impervious cover-241 (1) Vented through same pipes as distribution system-:'41 (l)(a) Vent protected from precipitation/animal entry-241 (1)(b) V — vent is placed beyond traffic or impervious area-2i 1 (1)(c) All lines connected to vent if bed or trenches-241(i)(d) 9"cover over peastone-240(9) Reserve area provided(new construction)-2480) -- ✓ Reserve 4'from primary leach area-NA 9.04 V 4'(S'if Pere rate<=2 MPI)separation to g.w.-212(x)&(b) 4'(down to T with variance or I/A-upgrades only)of natural soil under l.f. G'VV separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-25l(9) �- Require 5'removal and replacement if in fill-255(:;) Top of leach facility<=36"below grade-221(7) Final grade over 11 minimum 0.02 ft/ft-2400 0) ` Surface&subsurface drainage away from i.f.-240(1 1)&245(5) _ Minimum design flow 440 gpd without deed restriction-NA 13.01 �- 3:l slope where grading required-255(2) Toe of fill slope stops 5'from property line or swap;installed 255(2} b Impermeable barrier if<3:1 slope or<15 feet to-3:Islope-255(2) JV, Impermeable barrier/retaining wall poured concret,:-NA 9.02 t/ Retaining wall stamped by P.E.-255(2)(b) JTop of retaining wall>=top of peastone elevation-255( 2)(}) 10'offset from edge of leach facility to edge of ret, wall-255(2)(g) Pere test(s)done in most restrictive layer- 104(2) Pere test 4'below leaching elevation-NA 7.06 Design flow listed and required/provided leach are:z given-220(4)(f1 _ Leach pipes SCH40 PVC-NA 10.01 -AZ Leach pipes minimum 4"diameter except for dosed system-NA 14.04 1�fiu14 it LII r,�� A tr 2) (307", %GG y ,0 0 f �,,� w Apr 01 03 02: 11p NORTH ANDOVER 9786889542 p. 1 \, w . 27 Charles Street Nodh Andover,MA 09845North Andover Telephone#(978)688-954a Faf#(978)688-9542 Board • f Health ftx From: r7'v- To.' a / Fa)c �/d J�� J�_`J J Pages: Phone: �� / —/lo� ®ate: , P, Re: CC, ❑ Urgent RIKr Reviww ❑ Please Comment ❑ Please RePly © Please Recycle a Comments! Apr �01 03 02: I1p NORTH ANDOVER 9785889542 p. 2 CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job .¢41¢ AIS /1 ST® The following is a checklist that incorporates all Title.5 and local regulations for septic plans. Name of Applicant: a. 'L Name of Designer: AICG�e�-V444A)p &AL7' Plan Date: - 2 -c3 Revision Date: Date of Review: Property Address: _ QHS%oN ,Fn Map: 40 D Lot:—26—, BOH Reviewer: Type of.-Plan (new or upgrade): t�AZ6f Z)4' Number of Bedrooms: + C44-0 gpd) Garbage Disposal Allowed: NO General Information: N.A. =North Andover Septic Regulations Other numbers refer to Title 5 OK Problem NIA Street number and map/lot-220(4)(u) Maximum scale of l "=40' for plot plan - 220(4) -� Maximum scale of l "=20'for profile and component details-220(4) �- Legal boundaries of the facility being served-220(4)(a) Names of abutters from,recent tax map- NA 8.02j _L/ Number of bedrooms,design calcs.,-NA 8.02i ✓ Name&address of record owner&applicant- NA 8.021, V Name&address of designer-NA 8.021 ✓ Holder and location of all easements-220(4)(b) Date pian drawn&any revision date- N.A 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) VT All distances on site plan-NA 8.03a-c Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) V Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(.-) �- Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) `/ Locations and logs of percolation tests-220(4)(i) ,IT _ Date(s)of soil testing-220(4)(h)&(i) v/ Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests-N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) -V Name of soil evaluator-220(4)0) Soil logs and pere test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system -220(4)(n) �- Complete profile of the system to scale-220(4)(o),NA 8.02c Cross section of leaching facility-NA 8.02w (Not to scale) f Location ofbenchmark(s)within 50-75 feet of facility-220(4)(q) Apr 01 03 03: 45p NORTH ANDOVER 9786889542 p. 3 a• 7 Leach lines capped,vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(0), Pressure dosing required over 2,/000 gpd or with VA remedial use-231(1) Leaching Trenches(Check here if not present: V ) OK Problem N/A _ Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) 1n fill or reserve between.trenches, 10'min.-NA 14.01& 14.03 Available leach area given(Min. 500 s-f.)-NA 9.01(2) _ Bottom =L x W x 9 = s.£ _ Sidewall=L xD x# x2= s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR = 9-day Effective area is>-design flow of facility being served 2"of 118"- 1/2"2x washed peastone.-247(2) Trench depth of 3/4"to 1 I/2"double washed stone 247(1) Leaching Pits(Check here if not present:�) OK Problem N/A #of pits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D Depth of pits(max eff.2'): -253(1)(a) Available leach area given Bottom=L x W x 4 of systems= s.f. Sidewall=L+W v x D x 2 x#of systems= S.C. _ Total area=bottom +sidewalI �J Effective leach area given Loading factor: Effective area=total area s.f.x LTAR Effective area is>=design flow of facility being served _. Minimum oft pits at least 13'X[6'-NA 9.01(3) Distribution for galleries/chmbrs. in trench config.-pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed con$g.-ea pipe serves<=40 s.£-253(6) Spacing-2 times the effective width or depth(the greater)-253(l)(c) 2"of 1/8"- 1 /2"2x washed peastone.-247(2) 3/4"to 1 112"double washed stone-247(1) Each pit has at least one 20" access cover.24"C1 to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary, extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: 01� Problem N/A cJ Number of fields: (need dosing chamber if> 1,231 (1)) 7 Apr 01 03 03: 45p NORTH RNDOVER 978GS89542 p. 4 8 Length(100'max.): -252(2)(b) Width: /�'- I _ Total area: L _x W � s. f. Minimum 900 square feet-NA 9.01(1) _ Distribution lines connected with solid pipe—NA I5.01 Effective leach area given Loading factor:_Q,-60 Effective area=t r = oral a.ea s � _ .it x LTAR g day Effective area;s>=desi�«n flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) 4`maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(t') Between 6"and 12" of 3/4- 1 lit"stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feetifoot—240(10) V- Grading shall divert drainage away from leach area—240(l 1) Grading slopes away from dwelling 5!24/01 8 Y�Apr 01 03 03: 44p NORTH ANDOVER 9786889542 p. l 3 perc rate `l.= loading rate (yes or no) septic tank below g.w.table (yes or no) pump tank below g.w.table -2550) l.fin fill Setback Distances(Gi-ven in feet) 15.2: 1 YES NO is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK problem NIAoptic Taak Leach Facility - property line 10 10 20 Cellar wall 10 inground pool 10 20 Slab foundation 10 10 5 10 1/ Deck,on footings,etc. — 10 l0 Vv aterline 100 private drinking well �� 75 100 Irrigation well Wetlands 75 100 Public well 400 400 �L— 150 Wetlands bordering surface 150 water supply or trib. (in Watershed) Trib.To Surface Water supply 325 325 Reservoirs 400 400 Jz_ Tributaries to reservoirs 200 200 / Drains(wat. supplyRrib.) 50 100 ' V/ Drains(intercept g.w_) 25 50 yl Foundation drains 10 20 ✓ 10 Drains(Other) 5 ' _✓ Drywells 20 25 — 15'to 3:1 slope Downhill slope 3 Rpr 01 03 03: 44p NORTH ANDOVER 9786889542 p. 2 5 ' Tight Tank(Check here if not present: V OK Problem N/A _ 500%of design flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified(if soil non-native)—221(2) _ 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) _ Tank is watertight—221(1) 9"of cover over tank specified(minimum)—228(1) _ H-10 loading(min.)—H-20 if traffic—226(3) _ Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 _ AN alarm set at 315 tank capacity—260(2)(c) _ Min. 1-24"frame wlcover at finished¢rade—228(2)(f) Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: ) OIC. Problem N/A U inlet elevation: g� Outlet elevation: c _ 0.17' drop from inlet to outlet(minimum)-232(3)(b) y7 6"sump(minimum)-232(3)(e) ✓ All outlets at same elevation -232(3)(b) t/ Outlet pipes laid level for first 2 ft.-232(3)(c) z/ Pipe Sch 40-NA 10.01 3 j/ Number of outlets: Number oflaterals: Size of outlets: 4 u Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6"of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36"below grade-22 l(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present: OK Problem IvlA Volume specified: Z�0(4xr) _ Pump on elevation- 220(4)(r) _ Pump off elevation: 220(4)(r) _ Alarm on elevation: 220(4)(r) _ Number of cycles per day-220(4)(r)(also 254(l)(d)if gravity from d-box) Minimum 2"delivery line to d-box if gravity-254(1)(c) Pressure dosed l.f. if flow>=2,000 gpd-254(1)(a)&254(2)(a) _ Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 5 Fl pr 01 03 02: 13p NORTH ANDOVER 9786889542 p. 3 i 4 wio barrier BuildinglSewer OK Problem N/A Grease trap required for certain uses(check 230 for details) t/ Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC–NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) l� Pipe laid on continuous grade in straight line-222(',)@ Cleanouts precede all changes in alignment and grade-222(8) !� Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change-222(8) _ Invert elevation at building: /00 Invert elevation at septic tank: r – Length of run: /D r Slope: o DZ (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private weil or suction line-222(2) Septic'Tank OK Problem Nl k Tank is accessible-228(3) ✓ No structures above tank–(228(3) ✓ Tank can accommodate both primary&reserve–NA 9.04 200%of flow(required&provided given. 1500 min,)-220(4)(0&223)(1)(a) 2-3"drop from.inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) _. 3"air space above tees/baffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) L Tees extend 6"above flow line-227(1) ✓ T Inlet tee extends 10" below flow line(minimum)-227(6) ✓ Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 cornpart) 228(2) t/ 3-20"manholes-228(2) _� ✓ i childproof;24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) —S� V Soil compaction below tank specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath tank specified-22 1(2)&22 8(1) V If> 1,000 gpd AND not a single fam.dwell.must be 2 tF s or 2 comp.-223(l)(b) If plan specifies disposal must be 2 tanks in series or 2 compact,tank-223(1)(c) �G Buoyancy calcs.required if tank at or below water table-2.n 1(8) Tank is watertight-221 (1) 1/ 9"of cover over tank(minimum)-228(l) H- 10 loading(min.)-H-20 if traffic-226(3) ✓ Top of tank<=36"below grade-221(7) t/ All pumping to tank(if applies) in accordance with-229 Tank is set to keep old system in service during install if possible II 4 I f MORtk l,% 4 � QcG C % - t�AR AN SRO ' a •1 yo //// D©�HEAL' I t • �/ ccs/ -MAY I p a '• e BOARD OF HEALTH �ss"c"usE� NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT f Permit # Date / A permit is requested to: drill a well ✓ install a pump LOCATION: Z` `�7'I �� ? �J Lot # Owner �Z ///Address �G y.�as1 FS/ Tel well Contrctr ;�G� ct/� Add. X0--97`-2 . `i/ Tel PGa-/�"! Pump Contrctr S,A(i'U(, `p Add. A'ZAl-J Tel WELLS (To be completed at time of pump test. ) Type of well Use P :C Diameter of well Size of casing Depth of bed rock Depth casing into bedrock � Seal been tested? Yes ( No (_) Date of test Depth of well p Water-bearing rock Y'e.S i Depth to water Delivers GPM for OVI_ -74- (how long?) Drawdown �� feet after pumping y hour at GP Date of completion_ Signature of wel&7contractor PUMPS (To be filled in before installation. ) Name & size of pump_ �J� _ Type Size of tank Z 4A-zPump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastics Sleeve used to protect pipe? Yes ( No (_) T well seal �4 Date gnature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health MA DEP Resource Protection - Septic Systems/Title 5: Your Septic System: A Reference Guide ... Page 1 of 4 "77,77, Mass, Ov'5 kw 00* W -tW ' ° t ch site zap 3 r " F , iy}Y title 5 —--------_---"I'll R 1) 1 c vs t e septic systems/title 5 topics ? DEP general topics __._........___� .w _.. _ 21, Your Septic System: A Reference Guide for Homeowners Caring for Your Septic System The accumulated solids in the bottom of the septic tank should be pumped out every three to five years to prolong the life of your system. Septic systems must be maintained regularly to stay working. Neglect or abuse of your septic system can cause it to fail. Failing septic systems can . cause a serious health threat to your family and neighbors, . degrade the environment, especially lakes, streams and groundwater, . reduce the value of your property, . be very expensive to repair, . and, put thousand of water supply users at risk if you live in a public water supply watershed and fail to maintain your system. Be alert to these warning signs of a failing system: . sewage surfacing over the drainfield (especially after storms), . sewage back-ups in the house, . lush, green growth over the drainfield, . slow draining toilets or drains, . sewage odors. o POLIOVIRUS VACCINE INACTIVATED t, 7I I k lo`�c 36o /tom V e'r'_ MKT4657-1 file:HC:\My%20Documents\Brochures\MA%20DEP%2OResource%2 PPrctection%20-%2OSeptic%... 4/2/2003 MA DEP Resource Protection- Septic Systems/Title 5: Your Septic System: A Reference Guide ... Page 2 of 4 yy /{ t ..a •. .a A• nl s4i {•f•..•}{••x ••L lrie on(dump out)ports 'ir-.f.. r.•fa'aR. .ir p riiM �'•• T081 Inlet: =Mph -; u �� Outlets treated eater$�a�p house S► tewater pas to dest6bution box and drain field UVaatetivdte� tud Tips to Avoid Trouble DO have your tank pumped out and system inspected every 3 to 5 years by a licensed septic contractor (listed in the yellow pages). DO keep a record of pumping, inspections, and other maintenance. Use the back page of this brochure to record maintenance dates. DO practice water conservation. Repair dripping faucets and leaking toilets, run washing machines and dishwashers only when full, avoid long showers, and use water-saving features in faucets, shower heads and toilets. DO learn the location of your septic system and drainfield. Keep a sketch of it handy for service visits. If your system has a flow diversion valve, learn its location, and turn it once a year. Flow diverters can add many years to the life of your system. DO divert roof drains and surface water from driveways and hillsides away from the septic system. Keep sump pumps and house footing drains away from the septic system as well. DO take leftover hazardous household chemicals to your approved hazardous waste collection center for disposal. Use bleach, disinfectants, and drain and toilet bowl cleaners sparingly and in accordance with product labels. DON'T allow anyone to drive or park over any part of the system. The area over the drainfield should be left undisturbed with only a mowed grass cover. Roots from nearby trees or shrubs may clog and damage your drain lines. DON'T make or allow repairs to your septic system without obtaining the required health department permit. Use professional licensed septic contractors when needed. DON'T use commercial septic tank additives. These products usually do not help and some may hurt your system in the long run. file:HC:\1\4y%20Documents\Brochures\MA%20DEP%2OResource%2OProtection%20-%2OSeptic%... 4/2/2003 MA DEP Resource Protection - Septic Systems/Title 5: Your Septic System: A.Reference Guide ... Page 3 of 4 DON'T use your toilet as a trash can by dumping nondegradables down your toilet or drains. Also, don't poison your septic system and the groundwater by pouring harmful chemicals down the drain. They can kill the beneficial bacteria that treat your wastewater. Keep the following materials out of your septic system: NONDEGRADABLES: grease, disposable diapers, plastics, etc. POISONS: gasoline, oil, paint, paint thinner, pesticides, antifreeze, etc. Septic System Explained Septic systems are individual wastewater treatment systems that use the soil to treat small wastewater flows, usually from individual homes. They are typically used in rural or large lot settings where centralized wastewater treatment is impractical. There are many types of septic systems in use today. While all septic systems are individually designed for each site, most septic systems are based on the same principles. A Conventional sopft 4aw A Conventional Septic System A septic system consists of a septic tank, a distribution box and a drainfield, all connected by pipes, called conveyance lines. Your septic system treats your household wastewater by temporarily holding it in the septic tank where heavy solids and lighter scum are allowed to separate from the wastewater. This separation process is known as primary treatment. The solids stored in the tank are decomposed by bacteria and later removed, along with the lighter scum, by a professional septic tank pumper. file://C:\My%20Documents\Brochures\MA%20DEP%20Resource%20Protection%20-%20Septic%... 4/2/2003 MA DEP Resource Protection - Septic Systems/Title 5: Your Septic System: A Reference Guide ... Page 4 of 4 1 After partially treated wastewater leaves the tank, it flows into a distribution box, which separates this flow evenly into a network of drainfield trenches. Drainage holes at the bottom of each line allow the wastewater to drain into gravel trenches for temporary storage. This effluent then slowly seeps into the subsurface soil where it is further treated and purified (secondary treatment). A properly functioning septic system does not pollute the groundwater. For More Information A videotape version of this brochure, also entitled "Your Septic System: A Guide for Homeowners," is available through the EPA Small Flows Clearinghouse. Call 1-800-624-8301. For more information about maintenance or inspection of your septic system, contact your local board of health or the Department of Environmental Protection: Central Regional Office (508) 792-7650 Northeast Regional Office (978) 6617677 Southeast Regional Office (508) 946-2700 Western Regional Office (413) 784-1100 Boston Office (617) 292-5673 deg home•calendar• new additions•search •site map•privacypolicy mailto douglas.roth_@state.ma.us file:HC:\N4y%20Documents\Brochures\MA%20DEP%20Resource%20Protection%20-%20Septic%... 4/2/2003 s 03/26/2003 15:19 17813340115 TANGARDR PAGE 03 FORM 11 - SOIL YVALLATOR FORM Pagexof3 Locsiion Address or Lot IJc. - On-site Retrew r 'mac T � Deep Mole Number Date;-5h ' Time-. �; Weathers Location iidentif/L-ry an site plan? !t(7 Land Use 19-- ,t� Slope i%? Surface Stories Vegetation !d/ A.j Landform ��GQ Position on landscape (sketch on the batik) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOO` Perth from Soil Horizon Soil?exturc Soil Color Soil Other Swfaee Onches) (USDA) (Munsell) Mottling istructure,Stories,e9ulders, :.onsis'ency, k Gravel) ' U IDLE i5 -r PArent Mate'ial (geologic) t)gXhtoLledrock: Dcoth to Grcundweter_: Standing Water in the Hole: Weeping from P!Face: r stim.atcd Seasonal High Ground Water – r — V --- DEP APIIRDVBA F()KM•1210"1'9$ 03/26/2003 15:19 17813340115 TANGARDIR PAGE 04 FORIM 11 solL EVALUATOR FORM Page 2 of 01 1�o. , Location Address or I (Ott-site R K—evLew Deep Hole Number " Date Weather Time7 Location ;identity on site plan) Land Use slope 7 Surface Stones Vegetation Landform Position on landscape {sketch on the b3ck) Distances frorn'. open Water Body feel Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLEILOG" 01har SLjrfare Soil HarizM75oil Textvre Soil Color Soil OA (USDA) imumsell; Mottling (Smcimrs, Stones, ulcers, Gravel) Z. ley 'Y Z� 17— !=MV5 ffTMFqY PR Parent mater* igeologid Oapthtotladrock: Dr Wooping from Pit Face:,ptt,t)Groundwater. stanoingWatermth Hole: Estimated Seasonal High G-oL:md Water-.----- DFT APPROWD F0101• 12107195 03/26/2003 15:19 178133412115 TA14GARDR PAGE 05 • FORM 11 • SOIL EVALUATOR FORM Page 2 of 3 J" Location Address or Lot iqo 0 n-suLt e—Review .-- Af Weather Deep Hole IN14irnt)erDate, Time: Location (identify on site plan) Land Use /1111 Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: open Water Body feel Drainage way feet Possible Wet Area feet Property Line fee*, Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG Death frorr. Sail Horizon Soil Texture Soil color Soil Other Su,face UnchcG) (USDA; (Munseill Mottling (Struettife,Stones, Boulders, Concis-,encs, [3rayel) 0,1ffr. '7 D71509Z XFLA Parent Material igeologic) Depthtogedrock: Deu-.h to Groundwater: Standing Water in the.Hole Weeping from Pit Face; Estimated SaqSonal Hhgh Giound Water:_ 3; DEP A'PFROVED FO Khl- 12107193 NEW ENGLAND ENGINEERING SERVICES INC April 2, 2003 Sandra Starr, Administrator ;_i OF�-¢ North Andover Health Department _. Town Hall Annex 29 Charles Street FAPR - 3 @0 North Andover, MA 01845 { Re: 464 Boston Street,North Andover, Septic system design . Dear Sandra: Enclosed are the following documents for the above referenced property. 1. 5 copies of septic system design plans, one with an original stamp. 2. Copy of soil evaluator sheets. 3. Application for approval. 4. Check to cover the approval fee. 5. Local upgrade approval request form. This plan is being submitted for approval. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, Benjamin C. Osg d, Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 oao D�� (seri .. 3 64 $ >, ocw000 0000c,�oc000000cGoar+000a000000ac:. o oo� owocv00000cisaogaooca 4 o.� `s4� Go � � ,.;� �_ •' �5 O.00� z ` �� O.�?4.�, .P„rypO.000Q OO OODOOR"'vgoO�CQ TLANps CO) til S?2, P L 2c vli- ���N � ��.� � � ctF• .OHO / �. N fl p � elf 29 s .03 tE— � W r k-7-7.72- __ W` CNST1 I W' A .Iqozou1 VD R—A -i�.. t°y 'a• "'f a '� �rt� '^f." 'i "'��w` r", _ ro r is..... ..�:.- •. '_. L ,r �sy_.., � ,i� • 401 �• d :i t ,r- � •/YID ��� LP LP GAZ, 24 s - k � c0 ' 00;"COAL 71 Tc►►.�1L ` ; I 6t7=gppt� �t2`1 om.��omoeamaso�ca✓uco coca 't�`16.1 .Ash �C04:040 4204M IQ fizz'a e pj•M. T 100.0 t .� •oseph •. barbagalio,r.s. 1 westward irc E no.°Nesdin g,mass. -=--� t MORTIr F�Q N�°ur�so o ... ,,�tiooL ap©F HEAVE . -NAY r 1 •'''`� BOARD OF HEALTH ,SSA JN4U E< NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT `c� Permit # Date 4/ A�//� A permit is requested to: drill a well ✓ install a pump v LOCATION: 2` `�7' ��5 ? cJ Lot # Owner ` Address �G �/ a5/� tJY Tel Well Contrctr ��� AddTel Peb7�n 7�7 Pump Contrctr SlaatL `P Add. 636:-7 Tel WELLS (To be completed at time of pump test. ) Type of well . Use :21-11P Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been .tested? Yes ( No (_) Date of test f g� Depth of well p Water-bearing rock Ye S i Depth to water /07 Delivers_. GPM for (how long?) Drawdown g� feet after pumping y hour at GP Date of completion_ Signature of wel contractor PUMPS (To be filled in before installation. ) Name & size of pump 6�/axs Type Size of tank Z �P�Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastics Sleeve used to protect pipe? Yes ( No (_) T3 l seal_ Date gnature of pump installer ************************************************* ******************** Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health v y POLICY Artesian Wells WELL & PUMP Gravel Wells Booster Pumps Route 28 P.O. Box 900 Jet Pumps WINDHAM, NEW HAMPSHIRE 03087 (603)898.4232 • 1-800-992-PUMP Submergible Pumps Sump Pumps Pump Parts Carol Walczak Number 5907 464 Boston Street Motor Controls North Andover► MA 01845 508-685-1946 Water Tanks Date 05/03/95 Sewage Pumps ------- ----------------------------------- Alarm Systems Water Analysis Results ------------ Maximum Contaminant Level __________ _____ Alternating Panels pH ------------------ 8.0 - ( 6.5 - 8.5 EPA-See Std.) Pipe& Fittings Hardness ------------ 70 ( 100 PPM . EPA Sec Std) Copper Chlorides ----------- 6 ( 250 PPM EPA Sec Std) GaIv. Nitrates ------------ <.5 ( 10 PPM EPA Pri. Std) Plastic Sodium -------------- 5.1 ( 250 PPM EPA Sec Std) Iron ---------------- -84 * * ( .'30 PPM EPA Sec Std) PVC Manganese ------ ----- -18 * * ( .65 PPM EPA See* Std) Water Conditioners Coliform Bacteria --- Absent ( 0 EPA Pri Std.) Cartridge hitters -----=----------- ------------- ----------- -------- ------------------------------ -------- ------------------ Chemical Feeders Tested by Certified Laboratory Nuiber 1015 Test Results Entered $y Neutralizers hip Denotes over iieit of Standards (either Secondary or Pridary). Reverse Osmosis -------------------------------------------------------------------------- Softener Salt This sample meets EPA primary standards for safe drinking water based upon Softener Cleaner the sample we received and the items which were tested. Other standards (Ex: FNA, VA, State & localities) may differ from EPA standards and these PoaAsh. may need to be considered. Soda Ash Well Sanitizer Bacteria was tested using the EPA approved Presence/Absence method. .SIr7d l alt' �•,ti 24 Honr Emergency Service Residential Commercial Water Testing. - Pump Hoist Portable Puller Backhoe BRA NUS' Aquatron Campbell G&L Goulds Pulsa Feeder S.J. Electro Wellmate Providing Profemiorwl 14'ater Service Since 1966 i tir Department of Environmental Management/Division of Water Resources a i . t WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address N S E W of (feet) (circle) City/Town./� / • / (road) Well owner t �C�� `�► C Z��� Add ess q(G� (�sfe'i S-• N S E W of cc, in tenths) (circle) Board of Health permit obtained: yes no❑ uitersecf. w/ (road) WELL USE WELL DATA Domestic dpublic❑ Industrial ❑ Total well depth . ft. Monitoring❑ Other Depth to bedrock ft. Water-bearing rock/t nconsolidated material- Method drilled f q Description ''� Date drilled S � Water-bearing zones: CASING 1) From—P-A0—To add Type 7 J feel 2) From To Length-626--ft. Dia(.I.D.) in. 3) From To Length into bedrock—ft. Gravel pack well: dia. Protective well seal: r�VC S� Screen: dia. Grout-El Other e Slot t length from_to STATIC WATER LEVEL(all wells) �/ Static water level below land surface ft. Date �5 Z-2J WELL TEST(production wells) Cf /1 Drawdown�ft. after pumping ( hr. min.at40gpm How measured-412411 � Recovery_ —ft. after_hr. mIn. 0 LOG of FORMATIONS COMMENTS 0 >a Materials From To O DrillerIrc? I 80 () Firm t e ( + Pty Address Alb" City/Town Nb/ // i Su ervisin Driller Re # i/ Si naro of sneer wing registered well driller PlessePrint firmlie BOARD OF HEALTH COPY • J i TO: NORTH ANDOVER, MASS A/° �!�-19 TSJ 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 LoS SON 57--North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 4/a V• 1 —19= _ 4eg- PyVjnee,r/Re unitarian r s nr G� 0Uti8 PLSaU 4i r 401 I C CG ra 1p + + II I' AI r � C 370 LA N 4- C'�R} 4S' 1 :� 10ao 6Al kl 7' AC,& r 5too� - Z5 -— — 351 ,/ t 1I t 0�0690O0O Qf G►6apd�yd m O C=AOCOi7 CDCOp , aai C.iY � IJi M. 0 ► � � � I IL X11 , ► �' , Joseph j. berbagallo, r.s. 1 westward circW no. reading mass. _LTro bJlTI� HJT , . LOQ � U /S.cp_sa w _ I 1` X44 109 LP / 4!N? zti �'�.z 37 z 1 i toao fit,. 21 2S1 i �xr�-c.�� v�►v� - ,� f b,► vua - - - too A / CS i 1 ft '.!AIL !A a 7k.L-P _ �i M&100-GAO vt)0 S-T C) N ST. Q1 6k4c6q( � . �o Joseph j. barbagallo, r.s. I westward circle no. reading,mass. • Oft* i-IC)I-'E • 03-0=TAT -MS T M-M — (Da11 MIIJ.Top sc►►. co.►EtZ �'°.y 5}11 WAS"Go Mr"Tw RAlli4 OR�baiCw. Tc UO-OL POgroWAWI§b c klr fl�►o situs •�'►� 'joy t%J%a%Prwi AUA 1�jti'SANOY 1 MILL WATL=r- gj Q%-o b �ATUI�ATI�! 1'S/nnJ, 131AIN, vi 60AN 50 N C7 = cx� P�A�'E ' tDiii�+v/INGM 4/i ti7�j t'yf7Y 4' o =�TA4.)K_ wl'-�P` 'Iy�•J I�Gt� ��lh 5EG"�1�.! MAW lcl- DuST 00.0 t1 -��►L.�.niJ �' t~ b0� 1-11► �o"J '• " a v C-7 �$ �c-.5w"IG. TA#AK. a a�✓J d v 0 AT �► 44 5 �,._..... _ ,�.......�.,. ..� , CEPH VA12 A6ALLO ,hcv•1 (2P� - i8� NORTH ANDOVER/ OF HEALTH FORM OF NOTICE OF CASUALTY LOSS TO BUILDING. AM 2i UNDER MASS . GEN. LAWS , CH. 139 , SEC . 3B TO: BUILDING COMMISSIONER OR BOARD OF HEALTH OR INSPECTOR OF BUILDINGS BOARD OF SELECTMEN North Andover Town Hall North Andover Fire Department 120 Main Street ADDRESSES 124 Main Street North Andover, MA 01845 North Andover, MA 01845 nTTENTION: FIRE PREVENT10N RE: INSURED: WALCZAK, Carol PROPERTY ADDRESS: 464 Boston Street North Andover, MA 01845 POLICY NO. 0023118670 LOSS OF water damage in April, 1995 FILE OR CLAIM NO. ABP416 CLAIM HAS BEEN MADE INVOLVING LOSS, DAMAGE OR DESTRUCTION OF THE ABOVE CAPTIONED PROPERTY, WHICH MAY EITHER EXCEED $1,000.00 OR CAUSE MASS. GEN. LAWS CHAPTER 143, SECTION 6. TO BE APPLICABLE. IF ANY NOTICE UNDER MASS. GEN. LAWS CHAPTER 139, SECTION 3B IS APPROPRIATE, PLEASE DIRECT IT TO THE ATTENTION OF THE WRITER AND INCLUDE A REFERENCE TO THE CAPTIONED INSURED, LOCATION, POLICY NUMBER, DATE OF LOSS AND CLAIM OR FILE NUMBER. QjAvlir GNATURE John F. Murnane T. M. Seger Claim Service, Inc. 15 Depot Street - P.O. Box 2348 - Duxbury, MA 02331 Telephone (617) 934-9770 Fax No. (617) 934-9194 ON THIS DATE, I CAUSED COPIES OF THIS NOTICE TO BE SENT TO THE PERSONS NAMED ABOVE AT THE ADDRESSES INDICATED ABOVE BY FIRST CLASS MAIL. 04/20/95 NATURE & DATE net M. Ferguson, Secretary FORK 13 (6-90) VL/ VJ/ LJJ/ VV.JV JV VJ�JVV11 JIGWHf`.1/HIYJJVVCIt. r"ur- CJ4 Jvdx' ►am o ,,, st ms's SEMIC Tc smmcz Aho A n .�- $7 R r "U/ memo m 01835 978-377471 cr ia NOW'Ly RMUC POR MW or NO Aaoc�s 8 Ar�� Q /Soo 1; 1f ✓G+r ���l �3as �h �t 1600 ��n IOQp NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS /V ... ............... ---1�k This is to Ce ' .44- -77:>e-)A1,P ....................... .................... Certify that .... P ----------------------------------------------- NAME (,—�-38........ .........W..IVblfAA424��......................................................... ADDRESS IS HEREBY GRANTED A LICENSE .............. ................................................... For -------------A. K:�...... 4/"4)6 ......................e......... 5,7— .............................................................................. ......3 . ....................... ............................................................................................................................................................................ ............................................................................................................................................................................. This licenseq granJcd in conformity with the Statutes and ordinances relating thereto, and expires......./Z./"" /Y�...........................unless sooner 8U ended or revoked. ............ ............. 11 V1 ..41 5P6I . .................. ...... . .......... 29�0 4 .................... ..................... ................................. .. .......................... .................. ....................................... ............ .... ------------- .......................... ..... . FORM 433 HOBBS & WARREN. INC. V 1 MORTp , O '••••••''� BOARD OF HEALTH 1S5"""5Et NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # Date / A permit is requested to: drill a well ✓ install a pump— LOCATION: umpLOCATION: J/ . Lot # Owner /��6 12',1,,1Addre_ss �G �lYc3 '9 rS1 Tel Well Contrctr TG� � Add. bo 97`--2�' `i� Tel Pilo-ff Pump Contrctr Add. 636s2 _ Tel WELLS (To be completed at time of pump test. ) Type of well -1766,XUse P , C 1 Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hour at GP Date of completion_ �c?� Signature of welZFcontractor PUMPS (To be filled in before installation. ) / Name & size of pump. Type ,L41e CrSLI_`4 Size of tank_44/ �Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic Sleeve used to protect pipe? Yes (_ No (_) Type well seal Date Signature of pump installer ********************************************************************** Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of health Address %3 o Title of File Page of Date File Open: Date fade closed: . Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action De artment Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department ?y'•1. �i +ryS yyk 1'. f9.N A �t� -1�� l 1 )My { �Comronw�alth;of Massachusetts ED k, . fit /Town o -NORTH ANDOVER MASSA Hl `E S kSystem Pumping Record Nov 13 2006 Form 4 TOWN OF NORTH ANDOVER . DEP.has provided this form for use by local Boards of Health. T EPA TM T d must be submitted to the local Board of Health or other approving authority. k Facility Information Irwrtanc . :7_0hen filling out 1.': System Location: � forms on the /-Z/ Q , computer,use only the tab key Address to move your cursor-do not City/Town State Zip Code use the return key.::. .::. 2.' 'System,Owner Name _ Address(if different from location) City/Town. State 4�Cod Telephone Number B.• Pumping Record h) 1. Date-of Pumping - Date b �� 2. Quantity Pumped: Gallo Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es If yes, was it cleaned? KYes ❑ No 5. Condition of System. 6. Sy em Pumped By: Name Vehicle License Number Iva Company' 7' Location where contents were disposed: C>2-C) � wk Signature of Hauler Date http://www.mass.gov/dep/water/tipprovals/t5forms.htm#inspect t5form4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of MassachusettsIVt City/Town of NORTH ANDOVER MAS SACHU ETTS System Pumping Record 147M Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. The Syst be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use AlT T only the tab key Address / to move your � A e da r,.�_ 4 cursor-do not City/Town State Zip Code use the return key. 2 System Owner: 2-A f �l�U►'2,M WA-1 Nam Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDaZ—�y— 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date ,http://www.mass.gov/dep/water/approvaIs/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i WELL DATABASE ADDRESS: ... Zi- 9 c.k_4tzrl'l AGE OF IN-ELL: 3, WELL DRILLER.el I� I/U,F?�-� WELL PERIYET r: f' WELL LOCATION: U U _ G' WELL-PERMIT DATE: �'-yS DEPTH OF LL: 3 d e . TYPE OF WELL: a.. DRILLED b. DUG c. UNKNOWN TYPE.0E WATER BEARING ROCK: WATER ANALYSIS DATE ,S ' L' S HIGH MANGANESE: Y HIGH IRON: Y ( 0'IV NTAMINANI'S: Y N