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Miscellaneous - 466 SALEM STREET 4/30/2018 (2)
y �- - - 468 SALEM STREET S fi !I/ 210/038.0-0253-0000.0 y' i i North Andover Board of Assessors Public Access Page 1 of 1 HART„ North Andover Board of Assessors l9 9SswCHU roperty Record Card Click Seal To Retum Parcel ID :210/038.0-0253-0000.0 FY:2011 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales Summary Residence Detached Structure Condo 466 SALEM STREET Commercial Location: 466 SALEM STREET DEYERMOND,WILLIAM M Owner Name: ROSEMARY DEYERMOND Owner Address: 466 SALEM STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 0.90 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2236 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 438,800 455,400 Building Value: 243,000 259,600 Land Value: 195,800 195,800 Market and Value: 195,800 Chapter Land Value: LATEST SALE Sale Price: 266,000 Sale Date: 06/29/1993 Arms Length Sale Code: Y-YES-VALID Grantor: DRIVAS,JOHN Cert Doc: Book: 03770 Page: 0196 http://csc-ma.us/PROPAPP/display.do?linkld=1702352&town=NandoverPubAcc 5/18/2011 Residential Property Record Card PARCEL_ID:210/038.0-0253-0000.0 MAP:038.0 BLOCK:0253 LOT:0000.0 PARCEL ADDRESS:466 SALEM STREET FY:2011 PARCEL INFORMATION U /2005 se Code: 101 Sale Price: 266,000 Book: 03770 Road Type_ T Inspect Date: 08/17 Tax Class: T Sale Date: 06/29/93 Pa e: 0196 Rd Condition: P Meas Date. 08/17/2005 Owner: .. -- - -g - - _ -_ _ - Tot Fin Area 2236 Sale Type P _Cert/Doc: Traffic: M Entrance: - X DEYERMOND,WILLIAM M Tot Land Area-0.90 Sale Valid. Y - Water: -' Collect Id: SGC - ROSEMARY DEYERMOND ----- ------ --- _ e __ -- , -- -- 0 -- _�... .� _. .- - - Grantor: DRIVAS,JOHN Sewer:� - � I'nspect Reas: M Address: -- ---- ---�. __-- - - --------- — - __ 466 SALEM STREET Exempt-B/L-/o / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION NBHD CODE: 5 NBHD CLASS: 5 ZONE: R3 Style: __ CL Tot Rooms: 8 Main Fn Area: 1274 Attic: � . Y 4___..__-__._.. - - - - -- Seg Type- Code_--Mef_hod_ Sq-Ft ®Acres Influ-YIN Value Class Story Heights 2.50 Bedrooms: 3 Up Fn Areal _962 Bsmt Areal 962 _ 1 P 101 -S 39000 0.900 4 195,750 --• Roof: G`- Full�Baths: --2 Add Fn Area_: Fn Bsmt Area Ext Wall`. FB- Half Baths:' -1 Unfin Area- 370 Bsmt Grade VALUATION INFORMATION Masonry Trim: Ext Bath Fiz_ 0 -Tot Fin Area_ 2236 _ Current Total: 438,800 Bldg: 243,000 Land: 195,800 MktLnd: 195,800 Foundation: CN Bath Qua-l:'—_ T RCNLD: 243014 Prior Total: 455,400 Bldg: 259,600 Land: 195,800 MktLnd: 195,800 Ktch Qual: 'T Eff Yr Built: 1987 Mkt Adj _ Heat Type: HW Ext Kitc_h: - Year Built: 1987 Sound Value: Fuel Type: O _Grade. - G Cost Bldg: 243,000' Fireplace: 2 Bsmt Gar Ca _Condition: A—-Att-StrVal1 - -- --. __.... 7 Centpral AC: -N •Bsmt G'ar SF_p_ Pct Complete: ---1100/100/88- Porch _Att Str Val2. Att Gar SF' %Good P/F/E%R: •- /100/100/88 Porch Upe Porch Area Porch Grade Factor S 168 W 272 SKETCH PHOTO 14 4 S 272 Sq.Ft 12 168 Sq. 2?A 717 14 .r FM 'S t _ tl::��• e 312 Sq. ;0 1274 S §a:ft 20 24 ?2g 26 . w _ 466 SALEM STREET '? t a Parcel ID:210/038.0-0253-0000.0 as of 5/18/11 Page 1 Of 1 ofM�eT.1� 5437 F s Town of North Andover HEALTH DEPARTMENT CHU CHECK#: DAT LOCATION: 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 In WI) $ ❑ Titl 5lnspector $ Title 5 Report $� ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer NORTH : 5467 • Town of North Andover ` '• HEALTH DEPARTMENT �SSIGH�stt .. CHECK#: AT LOCATION: TGA H/O NAME: Ile 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) $ ❑ Tit 5lnspector $__f�J Title 5 Report $. F ❑ Other:(Indicate) $ Health Agent Initials' White-Applicant Yellow-Health Pink-Treasurer ,,z Commonwealth of Massaci usetts W Title 5 Official Inspection Formi Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �U `IC V� u 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When A. General Information filling out forms RECEIVED on the computer, use only the tab 1. Inspector: 2011 key to move your i AY 18 2 Q 1 j cursor-do not F. Paul Cardone use the return Name of Inspector OWN OF NORTH ANDOVER key. Septic Compliance, Inc. HEALTH DEPARTMENT !Q Company Name 447 Boston Street Company Address Topsfield Ma. 01983 City/Town State Zip Code 978-407-1808 978-681-0726 3294 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the ocal Approving Authority p or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) wiMin 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. o { D 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 466 salem st No.Andover,Ma Deyermond 5-8-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover _ Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C Further Evaluation is R it rtRequired by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is North Andover Ma. 01845 5-8-2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" o:"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure ® ❑ criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 466 salem st No.Andover,Ma Deyermond 5-8-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street M Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes 0 No Last date of occupancy: CurrentlyOccupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): -- — 466 salem st No.Andover,Ma Deyermond 5-8-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is North Andover Ma. 01845 5-8-2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner told me tank was pumped 4-2011 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: last time pumped 1500 gallon tank 2000 gallons were pumped out field is saturated. How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Nothing on record,owner told me approximately25-30 years of age Were sewage odors detected when arriving at the site? ❑ Yes ® No 466 Salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface,Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): PVC to cast leaving the house. Septic Tank(locate on site plan): Depth below grade: 16" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------- ---------------------------------------------- Dimensions: 10'long 6' wide 610" high Sludge depth: 2-3 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Septic Dip-Stick and Tape 466 salem st No.Andover;Ma Deyermond 5-8-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is North Andover Ma. 01845 5-8-2011 required for every _._ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): We recommend tank be pumped on a yearly basis,baffles were in good condition,structural integrity appeared to be good,liquid level was even with bottom of outlet pipe,no evidence of leakage. Grease Trap (locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street _ Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Pip was full Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was Ievel,couldn't run water through box to check equal flow,because of standing water in pipes,some carryover floating in box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches approx.45'long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): good none Appears to breakout certain times of the year down by the driveway soil was damp grassy front yard area. 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 466 salem st No.Andover,Ma Deyermond 5-8-2011•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 ' .� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAssessments : 1% 466 Salem Street Property Address William & Rosemary Deyermond Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 0 r=i I� ti v = /- ' "66 salem s;No.Ancove-Aa Deyermond 5-8-2011-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposai System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 466 Salem Street Property Address William & Rosemary Deyermond _ Owner Owner's Name information is required for every North Andover Ma. 01845 5-8-2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 4+Feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: N/A Date I ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Checked basement(Dry) No sump pump, dug 4' hole in d-box area Soils will need to be done for upgrade. 466 salem st No.Andover,Ma Deyermond 5-8-2011•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Septic System Information 466 SALEM STREET Printed On: Wednesday,May 18, 2011 System ID: BHS-2002-1397 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number. Design Flow Provided. Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water. Diameter. Leaching: Grinder: No .No Soil Type: Depth: Laundry. No No Haulin4/Pumping Listin Quantity Tyne System Tvve Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Septic Tank Bateson Enterprises 04/07/2005 1500 Routine Septic Tank Bateson Ent GLSD 04/27/2006 2000 Comments: tank flooded and runback Routine Septic Tank Bateson Ent GLSD 04/17/2007 2500 Comments: tank flooded and heavy runback Routine Septic Tank Bateson Ent GLSD 03/16/2009 2000 Comments: system flooded,run back SAS Routine Septic Tank Bateson Ent GLSD 03/16/2010 2000 Comments: tank flooded&runback from SAS Structures Structure Type Status Address OPEN 466 SALEM STREET Inspections: Inspected: Expires: Inspector: Status: 05/13/2011 F. Paul Cardone Fails Comments: Title 5 Inspection GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 SygHTFi C, veo pSSACMUSEj ��k9� � � �i 4110 PUBLIC HEALTH DEPARTMENT TOWN OF NORTH ANDOVER Community Development Division HEALTH C9ERARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;a)repaired; By: Jim Kellett , Kellett Excavating LLC (Print Name) Located at: 466 Salem Street (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 9/8/11 and last revised on 10/11/11 ,with a design flow of 330 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 10/15/12 /✓l. FntM Engineer Representative(Signature) John M. Morin, PE And–Print Name Final Construction Inspection Date: 11/6/12 Engineer Representative(Signature) John M. Morin, PE And–Print Name Installer: (Signature) Date:—///2/1 Jim Kellett, Kellett Excavating LLC And–>Print Name Enginer:�J�,. e'Vi.� (Signature) Date: I//-7 2 John M. Morin, PE, The Neve–Morin Group, Inc. And–Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com FINAL GRADE INSPECTION Date: 1 Address: qbb �.. iLOAMED? ❑ SEEDED? ❑ 'OVER PER PLAN? r Othe'T ,— 6,�� 1�j j) Commonwealth of Massachusetts RECEIVED City/Town of " !aAR 3 01011 a System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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. A. Facility Information 1. System Location: Left front of house, right front of house, left side of hou , righ side of house>Left rear of house, right rear of house, left side of building, right rear of building, under deck. City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State. �+` / Zi ode Telephone Number l B. Pumping Record 1. Date of Pumping —'�2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) 2-`S`eptic Tank ❑ Tight Tank ❑ Other'(describe): 4. Effluent Tee Filter present? ❑ Yes Q_N_0� If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Sys em: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: S.D. LAell W to r Signatu ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECF-lused, but City/Town of System Pumping Record V'JN Form 4SOWN OF NHEALTH DEP has provided this formfor use by local Boards of Health. Other f may be 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. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left/ t side of hous Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under e Address L40 r Citylrown State J Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 1-7 Date 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. Conditio of S stem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locat contents were disposed: G.L S.Q Lowell Waste Water r� Sign t e Haule —Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 r. • 5�,'S �16ga • • n , ��RXTBD.F�`ti North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 466 Salem Street PARCEL: 253 MAP: 38 LOT: 2 INSTALLER: Jim Kellet DESIGNER: Neve — Morin Group PLAN DATE: 10-11-2011 BOH APPROVAL DATE ON PLAN: 10-17-2011 INSPECTIONS TANK INSPECTION: 10-3-2012 DATE OF BED BOTTOM INSPECTION: 10-12-12 DATE OF FINAL CONSTRUCTION INSPECTION: 11-1-12 DATE OF FINAL GRADE INSPECTION:11-6-12 SITE CONDITIONS n/a Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base n/a Cleanouts per plan X Bottom of tank hole has 6" stone base Weep hole plugged 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 f ® Outlet tee installed, centered under access port (effluent filter) ® 24 inch cover to final grade installed over one outlet Neoprene boots used inlet/outlet Comments: Old Tank was crushed. Please see pictures in the file. Pipe from tank to tank was not bedded properly PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged X 1500 gallon Pump Chamber installed X H-10 loading X Monolithic tank construction ® Inlet tee installed, centered under accessp ort ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24 inch cover at final grade installed over outlet ® Water tightness of tank has been achieved by visual testing Neoprene boots used inlet/outlet Comments: Tank to Tank 21'2" Tank to House 13' CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution n/a Speed levelers provided (not required) Comments: t SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan — See Notes ® Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan n/a Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Remove larger rocks. Scrape the sides of the hole. Depth of hole was not deep enough Dig down approx. 6 to 8 inches in side, closest to the tanks 38'x 26'3" Hole was staked out only with overdig. I called Jim Kellet and told him how to stake out the hole. FINAL GRADE ® Loamed? ❑ Seeded? ❑ Cover per plan? Comments: The homeowner wrote a letter. She will be responsible for seeding. DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan 14 BM = 103.74 HR = 1.70 HI = 105.44 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 698 98.11 98.1 +/- Septic 8.1 +/- Se tic Tank IN 704 98.05 97.87 Septic Tank OUT 725 97.84 97.62 Pump Chamber IN 775 97.34 97.47 2" Pump Chamber OUT 797 97.30 97.22 4" Distribution Box IN 282 102.27 102.28 Distribution Box OUT 295 102.14 102.11 Lateral 1 TOP 303/316 1 Lateral 1 INVERT 102.06/101.93 102.03/101.90 Lateral 2 TOP 302/317 Lateral INVERT 102.07/101.92 102.03/101.90 Lateral 3 TOP 303/319 Lateral 3 INVERT 102.06/101.90 102.03/101.90 Lateral 4 TOP 306/317 Lateral 4 INVERT 102.03/101.92 102.03/101.90 Bottom of Bed 405 101.40 101.40 SKETCH PLAN 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 ' 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 • SF,'STL'ED'36ys,' • • oos �`M �A�RA7 ED 1XV l PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF. COMPLIANCE As of: 11/26/12 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System BY Kellett Excavating At: 466 Salem Street Map 38 Lot 253 North Andover, MA 01845 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Susan Sawyer Public Health Agent ELE COPY 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I Blackburn, Lisa From: Sawyer, Susan Sent: Monday, November 05, 2012 3:01 PM To: Deyermond, Rosemary Cc: Blackburn, Lisa; Grant, Michele Subject: RE: 466 Salem Street-Septic System Rosemary, I have received your email that states that you are assuming responsibility for the system after the loaming is complete, and that the installer nor the town will be responsible for ensuring that seeding of the system area is completed. After the Health Department does the final grade inspection and the installation form is properly signed by both engineer and installer, and a final "As-built" of the system is submitted;the HD will send you a Certificate of Compliance. A copy of this should go with all your other information to prove you repaired in line with the regulations.The actual IRS forms we don't provide. Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg.20,Unit 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com From: Deyermond, Rosemary Sent: Monday, November 05, 2012 12:29 PM To: Sawyer, Susan Subject: 466 Salem Street - Septic System Hi Susan We have come to an agreement with Mr. Kellett regarding the final phase of the septic installment. Mr. Kellett 9 9 9 P P will be finished laying the loam this afternoon. We have decided to replace the sprinkler system before the hydroseeding is done. So, as far as we are concerned Mr. Kellett will be finished this afternoon. Is there anything the town needs for final approval or are we all set. Also, do you give me the form for our tax rebate? Thanks again for all you help, it is really appreciated. Rosemary i 60b3 9 Town of North Andover HEALTH DEPARTMENT '7ACHU C' CK#:'6� DATE: r, LOCATION: C�/ H/O NAME:. CONTRACTOR NAME- Type AME•T e of Permit or Lice (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 $ ❑ Sep�ti -Design Approval $ ®/septic Disposal Works Construction(DWC) $ yv ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-.Health Pink-Treasurer Commonwealth of Massachusetts Official Use Only Permit No. P De artm en t of Fire Services � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT I7V INK OR TYPE ALL INFORMATION) Date: September 25, 2012 City or Town of North Andover To the Inspector of Wires: By this application the undersigned-gives notice of Insorher intention to perform the electrical work described below. Location(Street&Number) Salem Street,,--J- Owner treet,-J-Owner or Tenant William&Rosemary Devermond Telephone No. Owner's Address 466 Salem.Street Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Dwelling Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Wire septic pump,float sw►tch'es andhigh wal .panel. ater arm' , ;table may be waived by the Inspector of Wires. Date [(r�_ �• �. No.of C Total swt:: ,,.r�----'�/�T--Y..�.,_..v...�AA ' TOWN OF NORTH � r I PERMIT FOR WI i C cones Y i This c . . . %f . . . . f, fi! ll has permission to perform . . . :`. . � 7 F j Other wine in the building �f �r j- at . . .l b, , , -? /�'6-r .�. - . . . . . . 7 . . . � � alent t ,North r� F[e ©' Lie. No �l�`f / , 'y. �V�/ 5 �g1 G alent ,� . . �� _- 1 ELECTRICAL INSf r alent Check# // / d `2-4 / _ �M desired, or as required by the Inspector of Wires. q pipal policy.) IEC Rule 10,and upon completion. `11•j sv , -mance of electrical work may issue unless the licensee provides proof of liability insurance including"comp e`tea opera' atioI coverage or its substantial equivalent. The undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: David W Meehan LIC.NO.: 81296A Licensee: David W Meehan Signature` 54-Il 11 r. LIC.NO,: 8126A (If applicable, enter "exempt"in the license number line) V Bus.Tel.No.: 978-587-7518 j Address: 4 Mulberry Drive Peabody,MA.01960 Alt.Tel.No.: 978-535-4022 *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re- quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ , Signature Telephone.No. >10 I Gloucester,IMA 01930-2719 Phone:(978)282-0014 Fax:(978)282-1318 irowe .millriverconsulting.com www.millriverconsulting.com From: Sawyer, Susan [ma iIto:ssawyer@townofnorthandover.com] Sent: Wednesday, October 31, 2012 4:15 PM To: 'Dan Ottenheimer'; Grant, Michele Cc: 'Isaac Rowe'; 'Pam Lally'; Blackburn, Lisa Subject: 466 Salem Street The Health Department received a call today from John Morin of Neve-Morin Group. 466 Salem is ok'd for final inspection. Please contact Jim Kellett to set up the final inspection with him. Thank you, Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg.20,Unit 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com From: Dan Ottenheimer [mailto:info(&mill riverconsulting.com] Sent: Wednesday, October 24, 2012 8:34 PM To: Sawyer, Susan; Grant, Michele; Blackburn, Lisa Cc: 'Isaac Rowe'; 'Pam Lally' Subject: 85 Boston Street Construction Inspection Form is completed and attached. I would encourage you to confirm they got DEP approval for the 2'ground water separation,and also have a deed notice recorded before issuing the C of C. These are part of the Enviroseptic DEP approval, and were part of the designer's initial application in a draft form. Any questions, let me know. Dan 2 .........................--------..........-----•......--• ------------••-•-•-•---------•. ............ ................ Reference No: BHF-2004-000139 ................................... Permit No: Department: ................................... North Andover BOARD OF HEALTH ......................................................................................... Fee Type: Account No: ................................... DWC-Full Repair PERMIT Receipt No: REC-2013-000406 ......................................................................................... ................................ Paid By: Paid in Full On: Wed Oct 24,2012 James Kellett .................................... ......................................................................................... Check No: 1061 Received By: .................................... Lisa Blackburn ......................................................................................... TREASURER'S COPY Amount: $250.00 ........................................................................................................................................................................... ...................—............. ........................ ........................ ..........—.........*...................*'*'*'*'*...........*............. Reference No: BHF-2004-000139 ................................... Permit No: Department: ................................... North Andover BOARD OF HEALTH ... ..................................................................................... Account No: FeeType: .................................... DWC-Full Repair PERMIT Receipt No: REC-2013-000406 ......................................................................................... .................................... Paid By: Paid in Full On: Wed Oct 24,2012 James Kellett .................................... ......................................................................................... Check No: 1061 Received By: .................................... Lisa Blackburn ......................................................................................... DEPARTMENT'S COPY Amount: $250.00 ....................................................................................................................................... ......... a �KLtnr Commonwealth of Massachusetts Map-Block-Lot s • 038.00253 ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2012-0560 P.I. FEE F.I. $250.00 DISPOSAL WORKS CONST UCTI N P RMIT Permission is hereby granted James_Kel to(Repair)an Individual Sewage Disposa System. at No 466 SALEM STREET ------------------------------------------------- -------- ---------------------------------- --- -------------------------------------------------------- as shown on the application for Disposal Wo s Co struction Permit No. BH 2 12-056 Dated May O1,2012 --------- ------------------------------------------------------- I ssued On:May-01-2012 BOARD OF HEALTH � g� jj�dra , mmon alth of usetts Map-Block-Lot - - } • 038.00253 BOA D OF HEALTH '} N rth Andover r CERTIFICA OF COMPLIANCE THIS IS TO CERTIFY,That the In vidual Sewage Disposal System (Repair) by James Kellett Installer at No -46-6-SALEM STREET ---- - -------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2012-056 Dated _May_01,-20.12 ----------------------------------------------------------------- Printed On:May-03-2012 BOARD OF HEALTH 1 A. North Andover Health Department Community Development Division October 23, 2012 Jim Kellett Kellett Construction 400 Salem Street Lynnfield, MA 01940 Re: 466 Salem Street—DWC permit Dear Mr. Kellett, This letter is in regards to the subsurface waste water treatment system being installed by you at the address noted above. On October 23, 2012, an onsite inspection was conducted at the property in response to a complaint received at the Health Office. The complaint noted that the installer was not present at the site during installation as per the requirements in town. Michele Grant, the N. Andover Health Inspector, found that the complaint was valid as there were clearly important parts of the installation going on,without the licensed installer present. She immediately told your employee to stop construction until this issue was resolved. You have been verbally warned on previous occasions for items related to system installation and N. Andover's protocol and procedures. (i.e. stone depth, insp. readiness,pump specifications)This letter is to inform you that violating the protocol on the"septic system installer project management obligations"form (see attached)has resulted in the following action. The current DWC permit for 466 Salem Street issued to you has been rendered null and void. To continue work on this site,you will have to reapply to the Health Department. To receive your new permit you must submit the appropriate fee of$250 and paperwork. Be advised that additional infractions could influence approvals of future applications to work within the Town of North Andover. Sincerely, an Y. S^ er, RS Public Health Director CC: Homeowner Neve—Morin Group Curt Bellavance, Com. Dev. Dir. 1600 Osgood Street,Bldg 20 Unit 2035,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com y rt � x i r4 � i _ & aci 3�'i. `� � •L��`�l''���� ���s a ��af 1y.�H��� L � � ��s ar+� z•c � �� LW a. 41 3= I ' 05 r5o '44±1 41 Ik y� a� r � a El , FRI �i y rp d /;. �#�I A fi #. f�� I , b/� ���. � •1[�iS. d r i�..T'm. t#:�"*C� ..E.'p�tY..fp y� _ ,. '. at fgt �� � tF'..ni', 1.."* ♦� � a'a�r a y1 . R s. L a q . z m , w s 1 , ter•. . ' y r Application for Septic Disposal Systeme TODAY'S DATE o m pConstruction Permit — TOWN OF 250.00—Full Re ORTH ANDOVER, MA 01845 25.00 -Component 9SSACHUS�t Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use XRepair 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 key. A. Facility Information , or SA Lem -54 ' Address or Lot# �. . City/Town TOWN OF NOF2Th!AtVi<1QVER .HEALTH DEPARTMENT 2.- *TYPE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** JR 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 1411 G/1/Aiyi f f�c>v@�'►w►at-"/ �tt.y�r/ylQe�E'� Name cwt p� W��. Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information 00, 6 c L Name t Name of Company 4`0:5 Address /? City/To n State d 95 Zip C71 Telephone Number(CelliPhone#if possible please) 4. Designer Information Name q Y }, A , Name of Company Address CitylTown State Zip Code F?fir—4�4_71-'- 9.s'�6 Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 ,°T#q Application for Septic Disposal System et` � TODAY'S DATE TODAY'S Permit - TOWN OJC' ORTH ANDOVER MA 01845 $ 2so.00-Full Repair �► °•_.° $125.00 -Component 9sS�C US PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: [ esidential 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 Nodover, and not to place the system in operation until a Certificate of Compliance has be n is ued bythis 'oard 7e�n>�_ ' ame Date Applica of n'Approved By: , oard of Health Representative) , Na' r 4Date /Application Dis proved or the following reasons: 4C 10-1---5-�0" 0 D For Office Use Only: L Fee Attached? Yeses No 2. Project Manager Obligation Form Attached? Yes:�l No 3. Pump S sy tem? If so,Attach copy ofElectrical Permit Yes v No 4. Foundation As-Built?(new construction ronly): Y No (Same scale as approved plan) 5. Floor Plans?(new construction only): s No Application for Disposal System Construction Permit•Page 2 of 2 r w ` SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by (Engineer) Relative to the application of C��l.S / /GGI� ® (Installer's name) And dated 1 !Js (Originalate Dated o ay s ate With revisions dated (Last revis d 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 prior to performing any work on a site. I must have the approved dans 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, ignificant 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 abpr�plans No instructions by the homeowner.general contractor or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: �`�1 `��� (Today's Date) �'! ame—Print) e—Signed) ter- SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by Relative to the application of 1-J (Engineer) (Installer's name) And dated L�. Z14CM/ (Original ate Dated ( Z,— (I , -- � o ay s ate / f With revisions dated 4 (Last revis d 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 prior 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 M3:company. a. Bottom of Bed—Generally,this is the first(V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built of verbal OK (or e-mail to:healthdeptQtownofnorthandover.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: „� t �-/'�~ (Today's Date) Al xe Qz_,r_� Ace' (Name—Print) e—Signed) ���+~si. � �•. � s �ti�, �� '!� �r,�,�!3'y a� ,. �y w��' �+ �1 y,}}�� �',�J♦�yY I-V+Vr� ,..Y`rW; s i t r10,-1 91 17 ifs a n r ♦ bt Y ` y 4�5 § CCfpr+, .s, ,.• f. t,� �c 1. "5 r 1 -.r• n. t a i�� "'" P; ,'Ak - "h -4'V -<%-�tS 4......,.. • f n ,. ,g' ��'�` :�;" � a �� AAA Ip � - ��, tYS`�. `�1v.- � �•� .ti:Y� �'sx°t.�'L Qi +�"�i.� jtY� ':j�1` ;j .�`:.e� � sii - t a i.• _ c A ' IN °t. �Si jt t4a ...y��,� �� �'� a� � i � r! � � N�5� .� � �• '� �T��,�� �r�#��� 'fir * irKms.'' r �'7 •:s, ?� ��•,. S t " - 4.)V lot Ah rk `. t t� 1 �� t'� �r� �* t .� ` •pct +»"`�3; iSS3, _ � •-t' �R,'°1.,9'k d '� �lY �,. 9' €' 'gam ' ,°�'a a r _� 'i _ w {$ 4yyt_!�� a',3 k^a i�i � T Y�'/��"• � R d�g� k+ �:, �#.t �'Y� �♦ 3. a� r l`� 0.� «'`S,. x<_. « ' Ac rol V. c �t� e it 44 ? V,, $t Wit' � 4 to1 A i e �t nye 0 North Andover Health Department Community Development Division October 18, 2011 Rosemary and William Deyermond 466 Salem Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 466 Salem Street, Map 38, lot 253,North Andover, Massachusetts Dear Mr. and Mrs. Deyermond, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by the Neve—Morin Group dated September 8, 2011, last revised October 11, 2011. The design has been approved for use in the construction of a replacement, three bedroom, onsite septic system. This plan is generally good for 3-years from the date of approval however since this property received a Title V failure,the system must be installed within 2 years from the date of the failed inspection. This date was May 8, 2011. 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, The following local upgrades have been approved. 1. The vertical offset from SAS to the estimated water table from 4 feet to 3 feet 2. Vertical offset from inlet and out let tees of the septic tank to estimated water table from 12 inches to 8 inches. 3. Vertical offset from inlet and out let tees of the pump tank to estimated water table from 12 inches to 7 inches Page 1 of 2 North Andover Health.Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Y ' 466 Salem Street October 17, 2011 This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector, The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements, Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincere Susan Y. Sawyer, REHS/R Public Health Director cc: Greg Hochmuth, RS file encl: Form 9b North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Pae 2 of 2 Page North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of F Local Upgrade Approval Form 913 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 William and Rosemary Deyermond key to move your Name cursor-do not 466 Salem Street use the return key. Street Address Cityrrown 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): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: gpd 5. System Designer: Greg Hochmuth (] PE x RS Name 477 Old Boston Road Topsfield MA, 01983 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 466 Salem Street t5form9b.doc•rev.7/06 Local Upgrade Approval, Page 1 of 2 Commonwealth of Massachusetts City/Town of E - Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. � Percolation rate 4 min./inch Depth to groundwater 3 ft, ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer October 17, 2011 _ Print or Type Name and Title Signature Date i I 466 Salem Street t5form9b.doc-rev.7/06 Local Upgrade Approval• Page 2 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 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 William and Rosemary Deyermond key to move your Name cursor-do not 466 Salem Street use the return Street Address key. North Andover MA 01845 r Cityrrown State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 gpd 5. System Designer: Greg Hochmuth ❑ PE x RS Name 477 Old Boston Road Topsfield MA, 01983 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 466 Salem Street t5form9b.doc•rev.7/06 Local Upgrade Approval, Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 4 min./inch Depth to groundwater 3 n. ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4); List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer _ October 17, 2011 Print or Type Name and Title ignat� _ 7 Date 466 Salem Street t5form9b.doc-rev.7106 Local Upgrade Approval•Page 2 of 2 i DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, November 14, 20112:30 PM To: 'Kathy@nevemorin.com'; Deyermond, Rosemary Cc: Sawyer, Susan Subject: FW: Septic-466 Salem Street, North Andover, MA- Plan Approval Attachments: 20111114140931842.pdf Hello Kathy, Here is the plan approval for 466 Salem Street. We thought this was previously scanned and emailed,but were unable to find it,so here you are. The original is sent via regular mail. Tomorrow is our deadline for applications for septic installations. Whomever is going to do the installation needs to apply tomorrow if they want the system in this year, otherwise it will have to wait until March of 2012. Please call with any questions. Best Regards, Pamela DelleChiaie Departmental Assistant �Communit Development � Health Department Town of North Andover 1600 Osgood Street � Bldg 20 1 Suite 2-36 North Andover,MA 01845 N Office-978-688-9540 9 Fax-978-688-8476 9 Email-pdellechiaie@townofnorthandover.com ; Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous -----Original Message----- From:noreply@townofnorthandover.com Lmailto:noreply@townofnorthandover.coml Sent:Monday,November 14,20112:10 PM To:DelleChiaie,Pamela Subject:Septic-466 Salem Street,North Andover,MA-Plan Approval This E-mail was sent from"RNPOA428C" (Aficio MP C5000). Scan Date:11.14.201114:09:31 (-0500) Queries to:noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 " Commonwealth of Massachusetts City/Town of a 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 William and Rosemary Deyermond key to move your Name cursor-do not 466 Salem Street use the return Street Address kkey. City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip P Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: gpd 5. System Designer: Greg Hochmuth ❑ PE x RS Name 477 Old Boston Road Topsfield MA, 01983 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 466 Salem Street t5form9b.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of a Local Upgrade Approval Form 9B M B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 4 min./inch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer October 17, 2011 Print or Type Name and Title Signature Date 466 Salem Street t5form9b.doc•rev.7/06 Local Upgrade Approval* Page 2 of 2 The leve -Mo- ri Group, Inc. September 23, 20i1 st ` I"N911 HANDOAR Board of Health fl ALT 0119 tITMENT 1600 Osgood Street North Andover,MA 01845 Re:` 466 Salem Street Owner/Applicant: William &Rosemary beyermond Dear Board Members: Our office was hired by the o��tiers of the above •efereiced property to assist there with the permitting required to replace their existing failed septic system. The existing 39,000 square foot lot is sui�iounded by jurisdictional Nvetland resource areas and almost the entire lot is within the 100 foot wetland buffer zone: Prior to the soil testing effort our office delineated the wetland. fesouice areas affecting 'tile property: Based oil the delineation we were able to identify a small :area in the front of the house that felloutside of the 100 foot wetland buffer zone. This is the area that we targeted foie our soil evaluation. As you can see fi•oni°the design plan the soils oil the lot are a foamy sand, Class I, with a percolation rate of 4 minutes per heli which ;is ideal, However, the estimated seasonal high:groundwater elevation is extremely high, 32 inches fioin the soil surface. Because of the high groundwater we are seeking relief from the setback distance from seasonal high groundwater to soil absorption system and relief from separation distance fioin unlet and outlet tees and high groundwater to septic tank. Please find attached a Local Upgrade. Approval application. By reducing the required setback distance from seasonal high groundwater to soil' absorption system by one -foot we are able to avoid working within the North Andover, Conservation Coininission's jurisdiction, and we are able to provide a swale on the south side of the proposed leach bei to sheet flow surface runoff away fioin the abutting property owner a d away from the leaching facility: ENGINEERS o SURVEYORS a ENVIRONMENTAL CONSULTANTS LAND USE.PLANNERS 447 Old Boston Road (U.-S. Route 1), Topsfield, MA 01983 ,978-887-8586 FAX 978-887-3480 Providing Professional Services Since '1978 www.nevernPHn.com t Board of Health Page-2 Septeinber 23, 201.1 If you should have an ttestioiis regarding this information please do not hesitate to contactour 5 any office. Sincerely, THE NEVE-MORIN GROUP,INC. Greg HoOiniutl , RS Registered Sanitarian GH,�cntxat Atfachments cc: Mr. & Mrs. William Deyermond FAKATHYMOepennond 29841NAB14 LUA UrAloc I TOWN OF NORTH ANDOVER Office of C WHIM LAITY I)EATELOPl .ENT AND SERVIC'E;ti HEALTH PEEP 4RTME T 1600 QSG,001) STREET: BL'ILDI'NG 10; WITS 2-36 N�7()RTH ANDOVER 2MASSAC.HC:SEITS 011,1 1? ��'�q«;�5��''. 9'i .(F:.`'1 0-PIiane Snsan Y. Saii-ver.REI3ti F.5 9t t,, :� f—FA Pntil c Health Ni-Wor• E4NISIL:liea1thcl? c'citt���tt��tn�ttl 3 tile_+ser.eoii: \VEBSITE: ;'X*1 N)V*Wf11oA1i+i�.i SEPTIC PLAN SUBMITTAL FORM Date of S>ibniissioii; September 23, 2011 Site Location: 466 Salem Street towN of NOAT=1 ANDOVER 1I ALTH 0922 STM tJT Engineer: The Neve-Morin Group, Inc. New Plaits? Yes M$225/Platt Check#1024(includes Is' submission and one re=review only) Revised Plans? Yes 0$75/Plan Check# Site Evaluation Forms Included? Yes 0 No E Local Upgrade Form Included? Yes M No Telephone#:978-887=8586 Fax#:978=887-3.480 E-mail:Greg_@nevetnorin.com Homeowner Name: Rosemary& William Deyermond OFFICE USE ONLY When the submission is complete(including check): y Date stamp plans and letter ➢ Complete and attach Receipt Copy File; Forward to Consultant Enter on Log Sheet and Database r':Uoann6TONVIN OF NORTH=ANDOVER_Septic Plan SuNnittal Foran,roc Vanguard°Prime WILLIAM M..DEYERMOND& Market Fund ROSEMARY;DEYERMOND 1024 Mone �' JT TEN WROS 466 SALEM ST NORTH ANDOVER MA 01845.3110 ��� DATE 62=22/311 PAYTOTHE ORDER Yr^ DOLLAR Payable Through NOT VALID FOR LESS THAN 6266.00 Wachovia Bank,National Assodiati6n Wilma gt-own,DE 19843 n' 0 300 b ` , 211I11o0 3 b 0 2 2 S1:13 509' 49 ?0 ?0 : it' " Commonwealth of Massachusetts City/Town of North Andover "i Form 9A—Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15:405, or in full, compliance with the requirements of 310 CMR 16.000, require a variance' tt'u8qtto310CMR15.410 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 Rosemary&William Deyermond _ only the fab key Name to move your 466 Salem Street _ cursor do not Street Address Use the return key: North Andover MA 01845 Cityrrovm State Zip Code 2. Owner Name and Address(If different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single_Family Home with 3 Bedrooms 5. Type of Existing System: Privy ❑ Cesspool(s) Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field,pits, etc): Septic Tank, D-Box and 2 Trenches LocalUpgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval•Rage 1 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A—Application for Local Upgrade Approval DEP has provided this form for use:by local Boards of Health. Other forms may be used, but the information must be substantially the same as that,provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 330 .9Pd Design flow of proposed upgraded system 330_ 9Pd Design flow of facility: 330 pd - B. Proposed Upgrade of System 1. Proposed:upgrade is(check one): E Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301. 5/8/2011 date of inspection 2. Describe the proposed upgrade to the system: The proposed upgrade will be a new 1,500 gallon septic tank, 1,000 gallon Pump Chamber and a 16'x 28'Conventional Leach Bed. 3. Local Upgrade Approval is requested for(check all that apply),: Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reductionT Reduction in separation between the SAS and high groundwater: 1' Separation reduction ft Percolation rate 4 Minutes Per Inch min./inch 3' Depth to groundwater ft. Local Upgrade Approval.doc rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP hasprovided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) El Relocation of water supply well(explain): Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area n 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: Isaac Rowe 6/21/11 Evaluator's Name(type or print) Signature Date'of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 isnot feasible: Due to the-high groundwater elevation it is not possible to locate the septic tank inlet and outlet tees 12-inches above the water table. We are seeking relief from the 4 foot setback to water table to keep the work outside of the 100 foot wetland buffer zone and to allow a Swale to be constructed along the abutting lot line to avoid shedding/trapping water between the system and the abutting:property. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system.would be cost prohibitive. Local Upgrade ApprovalAoc+rev.7106 Application for Local Upgrade Approval•Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A. — Application.for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here.Before using this form, check with your local Board of Health to determine the form they use. 'C. Explanation (continued) 3. A shared system is not feasible: Not available 4. Connection to a public sewer is not feasible: Non available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): Z Application for Disposal System Construction Permit 0 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 CMP,15.405(2). (] Other(List): D. Certification 1,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. f 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." Faci(tfy Owner's Signature Date Y Print Nade The Neve-Morin Group, Inc. Name of Prepares Date 447 Boston Street Topsfield' P-reparer's address — City/Town MA 01983 978-887=$586 State/ZIP Code Telephone Local Upgrade Approvai.doc•'rev.7106 Application for Local Upgrade Approval,Page 4 of 4 Pump Calculations September 9, 2011 466 Salem Street North Andover-., Massachusetts Prepared For: William & Rosemary Deyermond Prepared By. The Neve-Morin Group, Inc. 447 Old Boston Road— U.S. Rte. 1 Topsfield, Massachusetts (978) 887-8586 Pump Calculations . Dose Required (D): 82.5 gals. Daily Flow 330 gals. Doses Per Day 4 Backflow Calculations (130: Force Main: 1:5 inch Linear Feet of Run 33 ft .Radius 0.75 inch Bf= :Lf x[3.14(r/12)21 = 0.4 ft3 3.0 gals. Total Dose (DO: Dt = D + Bf 85:5 gals. 11.4 ft3 Dose Height Reg d (Ht) (L x W x Ht Dt) Tank Size 1000 gals. Length (Inside dimension) 8.83 ft Width (Inside dimension) 4 ft Dt 11.4 ft3 Ht 0.32 ft = 3.9 inches Use Ht: 0.33 ft = 4 inches Actual Dose To SysteMQA: (DA., [Ht x L x W x 7.48] - Bf) 130:8 gals. Float Elevations: Pump In Llevation: 07.47 ft Distance; Inlet to Tank Floor 4.25 ft Pump Off Elevation 93.72 ft Pump On Elevation= 94.05 ft (Pump Off + Ht) Alarm On Elevation= 94.55 ft (Pump On + 0.5) Storage Capacity (ST): 705 Gallons (Inv Out -Alarm On) x L x W x 7.48 Pump Chamber Outlet Elevation: 97.22 ft Storage Capacity.> Daily Flow OK Static Head (Hs)- .-D-Box Inlet Elevation= 102.28 ft -Hs: D-Box - Pump Off= 8.6 ft HS: D-Box - Pump On= 8.2 ft Dynamic Head(HD): Force Main 1.5 inches Flow 40 GPM Velocity 6.47 ft/sec Equivalent Length Method: # fitting equiv length 3 90 4 12 0 45 2.1 0 1 check 11 11 1 gate 1 1 1 union 0.5 0.5 Total Equivalent Length= 24.5 Total Equivalent Length Used= 24.5 d }4 ��}:rtA}`t.� � `�`�?r*P�'�-,i :t}*�'#",}:ra'� '?fir (� .s.i t sr. ,5'. 23 •.} +..s 1011 g: .. �- t=:t5 n +, # r 6, P-•L ���,�,-$i� '•;"�:�; Y���T 1` -'a 3 < a ,g �����7`�� -�,��'.'•' •'��.�i i (r r - �q� � Y s� � ��.� .��t'�' .rz ��,,,zt+t . . <�g,;�:- 2�., n'?��"a�r, ��•3+� c�';. •�. � ����, �r-#; "�c ' r�� r�SL Vt r, ..,'§ ��£ � r- � .� r•�L,�'s�:j £ ���. .. 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(�4§ ..<t+ .yi7t�R`hs�((t•t� I��r��,mt x `�$as< �,�'� m��t�#+ t;i''>`:., (^. }}?„�4+"&' g i'�. � ,a°e�,?t�sf`; ��s:F•1 0 1 t,t � .,f� -, +`C; } rw I.:r { "<t r si” t r`ilSs'f #,�,;ur# Y •wf�r s}' aTS}o e'� t7 tt r Ft 41`.{trfa LLfkj,Fr,,r{ s€� '«x,r°{rr }�Fy, t's, y{+. <t w£ \�� y ter . - F, ,ASH � o-�i')} §�'r( �# �" 3 u .�,>('7£g°r " ,��~'.� ...,.3-� � � L �•�' �.cf/s` R" Er,° ta. 7• 's cS `s 7 z, . �.� ,�.,it x. r"•j,SrY Sf s Sx `"r.{ rL4 {n 'S 5 0' ( �� •�' rex>> a4� r � {��I sr����Q\,�,.=,�'�f�,k a�}�0.�.+ ', r� �asg 1 � �`{� �s�_ �=ft�� ��% �'j{.�g't�'� �a'��:•�;1'&?}i r3 i;VV F���� e*r; �T�,-_ a,�sg-A�.r�.�X .�C §f y�,+ � k's£ qt sa� ♦ xf a ti.:R�. t�fk`r � �i� s3a=t�'(s { (,'�z. ,, � � d` r ra �. ��¢�'7"¢ Z } x un�:AT24k •a icyte` 7 •4s , £ L-'{ �; s xn �/ y x :w +;° e Y &x W �{�✓ �4 ���.� .qi v* �., t§i-�:""-.. Wig t`T,.�.+`���1!f-nfA 'All s •e`} yih *011' 4 not A K- mot ART L y q atr'� ;�; (�c {2:4 t, k r•� �.t�{ r t r�,q{i Mr. .g,'t; itt. „l; q °fi.- }a$ t ;y x yt ,1140 A G� k MAI too 'i n Y FEATURES The Hydromatic SKV40 submersible pump is specifically designed to meet the demands of residential wastewater and sewage applications, and the quality standards of the professional plumber. The 2 inch NPT discharge pump is available with a powerful 4/10 HP motor, in both automatic and manual configurations. The SKV40 can handle capacities up to 78 gallons per minute and heads to 1.9 feet. The SKV40 heavy-duty cast iron and engineered thermoplastic construction provides durability in rugged applications. The pump's :high-capacity, recessed, Vortex impeller is threaded toa. stainless steel shaft providing long life in demanding applications. The recessed impeller is capable of passing 2 inch spherical solids and Ii nt: The SKV40's oikfilled motor provides This oil-filled design also provides superior cooling and lubrication, allowing permanent. lubrication of the shaft bearings, thefor to mo run cool, quiet andtrouble minimizing maintenance and: extending the free for years. life of the pump. In addition, to protect against overheating and costly repairs, the Mz motor windings contain an automatic reset thermal overload. The Hydromatic wide-angle float switch " and diaphragm switch feature a unique piggyback plug arrangement. ' The pump power cord plugs � f � into the back of the switch plug to provide automatic r `' operation. To .operate the faa pump manually, simply plug Y , the pump power cord directly into the electrical outlet, bypassing the ¢ switch plug. When you need a pump for residential wastewater :and sewage applications, - the Hydromatic SKV40 is � F preferred by professionals. .y{ Y Zwi M-11 Fir Pentair Pump.Group Page 2 r$.��, �� �wsdy',.� � 4�� o- �`�x x e,�� �$• ������� � ,i`F .'2' �7�'#L��`'`�r�Ar��� ,�' �` ��!�r'�+"$a� '�`s� Q �s� l� Awa0rm _ _:,+r,.*—rr•3,k,. ', 'et.a� rs. i.'�� i P 101 i9�' WWF y,5 : / { •- • • M— , #.a�, r• �. -- � r�'-L,€ sir �� LS' • - 0 • ?;f�, mi t+ tt�3r.'a_-r�'` :f' i,"':.} • • • - •,• • •. l rhYr� v�� t Sr-r_c ts�'•5 }r. pa:§-�: At {r "''�" i�siSi.� �.v�vx-�`�'. C yf l �ril�.h'Sx u i�+gyp .a._ • ✓ � �t s5, • . a j t+ ' 'aTF�,yf'r N[ 9 R 3 S 15] 2 �j�t p W1, rtt c �y .y�5 r� j1 f vv i r ,`atsk;r .f. h9l..Jr. 'wf rx $ „r`'•`` ai s � � s Details Pump Characteristics Performance Data Pump/fhotar Unit Submersible ' e - �s Manual Models SKV40M]---F SKV40M2 - Avian Models SKV40A1 SKV40A2 Horsepower 4/10 �o, Full Load Amps 12.6 6,4 Motor Type S 4/10 XP yP Shaded Pole(4 Pole) R.P.M. 1550 14•d '$ .-- Phase 0 1 ti 3.a Voltage 115 230 __ so Hertz GO a Operation, Int.ermlttent Temperalore 1201 Ambient NEMA Dost n A c�xeti_vsi.P.ia.°o so 4 a eo insulation Class A umi/srr�:a o t 2 , 4 s Dls(harge Size 2"NPT std. HS 'i_f Solids Handling 2r� Unit weight 35 lbs: - Dimensional Data Pow18/3,SHIN, 10,std. (20'opt.) Diaphrpgm Switch 230V=1On=8.7/80'std, Off=4.1/4 123/8 DISCHAHGEI(3 8)6 Venicol Smith (3 4) HEIGHT On-815/16 a Off=4.1116 Materials of Construction � �z 5°7I/16 wide Angle SNwh (1'38) On=12.1/2 Handle I Steel Off=6-1/2 labritaltng'U!i Dielectric Oil Motor Housing, Cast Iron V! 314 .Seal Plate Cast Iron (87 (120) Pum {asing Cast Iron Shaft 3"15/16 Stainless Steel 12'15/1s (yg) 12"3/8 DISCHARGE (328) Mechanical Seal Faces:Carbon/Ceramic (3 4) HEIGHT_ Shaft Seal Seal Body:Anodized Steel 3"3/1s. (80) Spring:Stainless Steel 5'7/16 Bellows:BunaN Impeller Engineered Thermoplastic Upper Bearing Brass-Sleeve Bearing All dimensions In inches.Metric for International use.Component dimensions may vary t 1/8 inch. Dimensional data not for construction purpose unless certified.Dimensions and weights are approximate. Lower Bearing Single Row Bull Bearing OR/Off fever adjustable.We reserve the right to make revisions to:our product and their specifications Fasteners Stainless Steel without notice. Your Au'nor zed total Distriboor— ��,, ° nYDRO�fiiATIC G �7 r' _ Pentair Pwup Group USA CANADA 1840 Boney Road Ashlond,Ohio 44805 vnw,,.hydromoJic.com 269 Trillium Drive Kitchener,Onlorio,Canada MG 4W5 Tel:419-289.3042 Fox:419-281.4087 ISO 9001 Registered Quolity System . Fax:519-896-6337 37 0 2001 liydrornotic' Ashland,Ohio, All Rights Reserved. .Item#:W-02.6730 4/01:5M he Neve -MorinT Group, Inc. October 11, 2011. Ms. Susan Sawyer, REHS/RS Public Health Director 1600 Osgood Street North Andover, MA 01845 Re: 466 Salem Street Owner/Applicant: William & Rosemary Deyermond Dear Susan: Please find attached revised plans and pump calculations based on your comments dated October 6, 2011. As requested we have revised the following: • The force main has been revised to a 2 inch, and the pump calculations have been revised accordingly. • We have also added the inlet of the pump chamber to the list of local upgrade approvals being requested due to the fact that it is less than the required 12 inches above the estimated seasonal high groundwater. • The brand and model number of the distribution box have been added as well as an indication that the d-box be an H-20 loading d-box. • The brand and model number of the effluent filter was added along with the required annual maintenance requirement. We are proposing the Tuf-Tite EF-4 or equal. ENGINEERS • SURVEYORS ENVIRONMENTAL CONSULTANTS • LAND USE PLANNERS 447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480 Providing Professional Services Since 1978 www.nevemorin.com Ms. Susan Sawyer Page 2 �'Y g October 11, 2011 Your comments state that the soil evaluation forms were not submitted to the Health Department. Please be aware that we mailed the soil evaluation forms to your office on June 29, 2011. If you should have any questions regarding this information please do not hesitate to contact our office. Sincerely, THE NEVE-MORIN GROUP, INC. Greg Hochmuth,RS Registered Sanitarian GH/kmm Attachments cc: Mr. & Mrs. William Deyermond FAKATHYM\Deyermond 2984\NABH Ltr Rev SSD.doc Pump Calculations September 9, 2011 Revised: October 11, 2011 466 Salem Street North Andover, Massachusetts Prepared For: William & Rosemary Deyermond Prepared By: The Neve-Morin Group, Inc. 447 Old Boston Road—U.S. Rte. 1 Topsfield, Massachusetts (978) 887-8586 Pump Calculations Dose Required (D): 82.5 gals. Daily Flow 330 gals. Doses Per Day 4 Backflow Calculations (Bf): Force Main: 2 inch Linear Feet of Run 33 ft Radius 1 inch Bf = Lf x [3.14(r/12)2] = 0.7 ft3 5.4 gals. Total Dose (DO: Dt = D + Bf 87.9 gals. 11.7 ft3 Dose Height Req'd (HO: (LxWxHt = Dt) Tank Size 1000 gals. Length (Inside dimension) 8.83 ft Width (Inside dimension) 4 ft Dt 11.7 ft3 Ht 0.33 ft = 4.0 inches Use Ht: 0.33 ft = 4 inches Actual Dose To SystemDa: (DA: [Ht x L x W x 7.48] - Bf) 130.8 gals. i i Float Elevations: Pump In Elevation: 97.47 ft Distance: Inlet to Tank Floor 4.25 ft i Pump Off Elevation= 93.72 ft Pump On Elevation= 94.05 ft (Pump Off+ Ht) Alarm On Elevation= 94.55 ft (Pump On + 0.5') Storage Capacity (ST): 705 Gallons (Inv Out -Alarm On) x L x W x 7.48 Pump Chamber Outlet Elevation: 97.22 ft Storage Capacity > Daily Flow OK Static Head (Hs): D-Box Inlet Elevation= 102.28 ft Hs: D-Box - Pump Off= 8.6 ft HS: D-Box - Pump On= 8.2 ft Dynamic Head (HD): Force Main 2 inches Flow 60 GPM Velocity 5.85 ft/sec Equivalent Length Method: # fitting equiv length 3 90 5.7 17.1 0 45 2.6 0 1 check 14 14 1 gate 1.2 1.2 1 union 0.5 0.5 Total Equivalent Length= 32.8 Total Equivalent Length Used= 33 ze Total Length 66 (length + Equiv. length) Head Loss in pipe 5.84 ft/100ft Ho = (fric. loss/100ft)(total length) 3.9 ft Total Dynamic Head (TDH) 12.4 ft (TDH = Hs + HD) 12.1 ft Pump Parameters TDH = 12.1 to 12.4 Flow= 60 GPM s k � ��� 0 1 i>rd�.�z�h l,i r�''•��' e!.<,'�a x�� ��, t<�.,hq 6'k`i� � `� r d�`s ` �,: s�+$� r# ; y; ♦ • • • _ r Ik <f J I � * Al G� TIC s � lou ;FyFp Ali FES ROFE55� j f • ti FEATURES The Hydromatic SKV40 submersible pump is specifically designed to meet the demands of residential wastewater and sewage applications, and the quality standards of the professional plumber. The 2 inch NPT discharge pump is available with a powerful 4/10 HP motor, in both automatic and manual configurations. The SKV40 can handle capacities up to 78 gallons per minute and heads to 19 feet. The SKV40 heavy-duty cast iron and engineered thermoplastic construction provides durability in rugged applications. The pump's high-capacity, recessed, vortex impeller is threaded to a stainless steel shaft providing long life in demanding applications. The recessed impeller is capable of passing 2 inch spherical solids and lint. The SKV40's oil-filled motor provides This oil-filled design also provides superior cooling and lubrication, allowing permanent lubrication of the shaft bearings, the motor to run cool, quiet and trouble minimizing maintenance and extending the free for years. life of the pump. In addition, to protect against overheating and costly repairs, the motor windings contain an automatic reset thermal overload. mom The Hydromatic wide-angle float switch and diaphragm switch feature a unique piggyback plug arrangement. The pump power cord plugs into the back of the switch plug to provide automatic operation. To operate the r-T pump manually, simply plug the pump power cord directly into the electrical outlet, bypassing the switch plug. When you need a pump for residential wastewater and sewage applications, the Hydromatic SKV40 is preferred by professionals. m � i IHYDROMATIC ° Pentair Pump Group Page 2 BENEFITS The SKV40 is a completely submersible A. Water-resistant power cord with molded plug ejector pump for use in .handling wastewater and I is available in 10 or 20 foot lengths. sewage in residential and commercial building g Heavy-duty, cast iron construction provides applications; and is available in automatic or manual long life and assists in heat dissipation for configurations. Automatic models feature a wide-angle cooler motor operation. mechanical float switch or a diaphragm switch with C. Energy-efficient 4/10 HP motor runs cool piggyback plug-in arrangement. The switches are and quiet for long life. Motor windings adjustable, easy to service and allow for simple contain automatic-reset, thermal overload conversion to manual operation. protection. D. Oil-filled motor provides superior cooling and permanent lubrication of bearings minimizing maintenance and extending service life. E. Lower ball bearings support motor shaft, minimizing the effects of impeller thrust loads. This design resultsin minimum friction and perfect alignment of rotor, for z>. longer service from pump. F. Discharge is standard 2 inch NPT. G. Mechanical shaft seal is carbon and ceramic faced for long, leakproof life. z . H. Bottom inlet has no screen to become clogged, providing optimum pump performance and minimal maintenance. I. The high-capacity, vortex, thermoplastic impeller, which is threaded to a stainless steel shaft, efficiently handles up to 2 inch spherical solids. Pump-out vanes on back on impeller prevent stringy materials from binding impeller or shaft. ` I L no HYDROMATIC Pentair Pump Group Page 3 Details Pump Characteristics Performance Data Pump/Motor Unit Submersible ' e 25 Manual Models SKV40M1 SKV40M2 Automatic Models SKV40A1 I SKV4OA2 Horsepower 4/10 20 Full Load Amps 12.6 1 6.4 5 4/10 HP Motor Type Shaded Pole(4 Pole) f ;,5 LR. M. 1550 0se tfi 1124 —_ °-�- _age 115 230 12�110z 60 ' Operation Intermittent Temperature 1201 Ambient 2 0 NEMA Design A c.P.arpu.s.G.P.M. 0 20 a 80 Insulation Class A L11-/S,...a o , 2 a a 5 Discharge Size 2"NPT std. 56 i Solids Handling 2" Dimensional Data Unit Weight 35 lbs. Power Cord 18/3,SJTW, 10'std. Diaphragm Switch (20'opt.) On=8-7/8 230V= 10'std. Off=4-1/4 12"15/16 Vertical Switch 12"3/8 DISCHARGE (328) On=8-15/16 (3 4) HEIGHT Off=4-7/16 Materials of Construction 57/16 Wide Angle Switch (138) On=12-1/2 Handle Steel Off=6-1/2 Lubricating Oil Dielectric Oil Motor Housing Cast Iron 7/16 1 3/4 Seal Plate Cast Iron (87 (120) Pump Casing Cast Iron 3"15/16 12°1s/1s Shaft Stainless Steel DISCHARGE (328) (991 12"3/8 HEIGHT Mechanical Seal Faces:Carbon/Ceramic (314) Shaft Seal Seal Body:Anodized Steel � 3(aojs Spring:Stainless Steel (13/8) Bellows:Buna-N Impeller Engineered Thermoplastic Upper Bearing Brass Sleeve Bearing All dimensions in inches.Metric for international use.Component dimensions may vary t 1/8 inch. Dimensional data not for construction purpose unless certified.Dimensions and weights are approximate. Lower Bearing Single Row Ball Bearing On/Off level adjustable. We reserve the right to make revisions to our product and their specifications Fasteners Stainless Steel without notice. -Your Authorized Local Distributor- I�o HYDROMATIC Pentair Pump Group ja USA CANADA 1840 Baney Road Ashland,Ohio 44805 www.hydromatic.com 269 Trillium Drive Kitchener,Ontario,Canada N2G 4W5 Tel: 419-289-3042 Fax: 419-281-4087 ISO 9001 Registered Quality System Tel: 519-896-2163 Fax: 519-896-6337 I ©2001 Hydromatict Ashland,Ohio. All Rights Reserved. Item#:W-02-6730 4/01 5M The RECEf1/E -_ Neve -Morin , Group, Inc. THEAIOF RTHANDpVeR TH June 29, 2011 tpwN r �t1s1 Op h pr �oove Ms. Susan Sawyer, RS/REHSM Health Director 1600 Osgood Street North Andover, MA 01845 Re: 466 Salem Street—Soil Evaluation Forms Dear Ms. Sawyer: Please find enclosed copies of the soil evaluation forms for the soil testing that was conducted at the above-referenced property on June 21, 2011. If you should have any questions regarding any of this information please do not hesitate to contact our office. Sincerely, THE NEVE-MORIN GROUP, INC. Greg J. Hochmuth, RS, PWS Soil Evaluator GJH/kmm Enclosures cc: William & Rosemary Deyermond FAKATHYM\Deyermond 2984\NABH Ltr Soil Eval Forms.doc ENGINEERS • SURVEYORS • ENVIRONMENTAL CONSULTANTS LAND USE PLANNERS 447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480 Providing Professional Services Since 1978 www.nevemorin.com ► i FORM 11 SOIL EVALUATOR FORM Page 1 of 3 No. 2984 Date: June 21, 2011 Commonwealth of Massachusetts WORM. North Andover, Massachusetts LHJUL —1 Q�1 Soil Suitabili Assessment or On-site SewDOVER TM DEPARTMENT Performed By: Greg Hochmuth Date: 6/21/11 Witnessed By: Isaac Rowe Date: 6/21/11 Location Address or 466 Salem Street Owner's Name William & Rosemary Deyermond Lot# North Andover,MA 01845 Address and 466 Salem Street North Andover,MA 01845 Telephone# 978-6854966 New Construction Repair 0 Office Review Published.Soil Survey Available: No Yes Year Published 1981 Publication Scale F'= 1320' Soil Map Unit Canton FSL Drainage Class B Soil Limitations Surficial Geologic Report Available: No C_1 Yes Year Published Publication Scale Geologic Material(Map Unit) Landform Ground Morraine Flood.Insurance Rate Map: Above 500 year flood boundary No Yes X Within 500 year flood boundary No X Yes Within 100 year flood boundary No X Yes Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Range: Above Normal �— Normal Below Normal Other References Reviewed: s ti FORM 11 —SOIL EVALUATOR FORM Page 2a of 3 Location Address or Lot No. 466 Salem Street On Site Review Deep Hole Number TP-11-1 Date 6/21/11 Time 10:00 am Weather Sunny 75T Location(identify on site plan) See Plan Land Use Residential Slope(%) 3-8% Surface Stones NA Vegetation Lawn Landform Ground Morraine Position on landscape(sketch on the back) See Plan Distances from: Open Water Body >100 feet Drainage Way NA feet Possible Wet Area >100 feet Property Line >10 feet Drinking Water Well NA feet Other Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure.,Stones,Bounders, -Consistency,%Gravel) 0-12" Fill - - 12-18" Ab FSL 10YR3/2 18-26" Bw SL 10YR5/6 26-120" C LS 2.5Y4/4 Yes ESHWT @ 56" Roots to 42" *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Ablation Till Depth to Bedrock: NA Depth to Groundwater: Standing Water in the Hole: 89" Weeping from Pit Face: 89" i Estimated Seasonal High Ground Water: 56" DEP APPROVED FORM—12/7/95 DocumenQ DocumenC i i I i FORM 11 —SOIL EVALUATOR FORM Page 2b of 3 Location Address or Lot No. 466 Salem Street On Site Review Deep Hole Number TP-11-2 Date 6/21/11 Time 10:00 am Weather Sunny 75`F Location(identify on site plan) See Plan Land Use Residential Slope(%) 3-8% Surface Stones NA Vegetation Lawn Landform Ground Morraine Position on landscape(sketch on the back) See Plan Distances from: Open Water Body >100 feet Drainage Way NA feet Possible Wet Area >100 feet Property Line >10 feet Drinking Water Well NA feet Other Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Bounders, Consistency,%Gravel 0-6" A FSL 10YR3/2 6-11" Bw SL 10YR5/6 11-120" C LS 2.5Y4/4 Yes ESHWT @ 32" *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Ablation Till Depth to Bedrock: NA Depth to Groundwater: Standing Water in the Hole: 98" Weeping from Pit Face: 93" Estimated Seasonal High Ground Water: 32" DEP APPROVED FORM—12/7/95 DocumenU Document2 1 O FORM 11 —SOIL EVALUATOR FORM Page 3a of 3 . Location Address or Lot No. 466 Salem Street Determination for Seasonal High Water Table TP 11-1 Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles 56 inches Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on 11/13/03 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature - Date DEP APPROVED FORM—12/7/95 Document6 FORM 11 —SOIL EVALUATOR FORM Page 3b of 3 Location Address or Lot No 466 Salem Street Determination for Seasonal High Water Table TP 11-2 Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles 32 inches Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on 11/13/03 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date it DEP APPROVED FORME-12/7/95 Document6 ii FORM 12—PERCOLATION TEST Location Address or Lot No. 466 Salem Street COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test* Date: 6/21/11 Time: 10:28 AM Observation Hole # Perc 1 Depth of Perc 44" Start Pre-soak 11:22 End Pre-soak 11:37 Time at 12" 11:37 Time at 9" 11:46 Time at 6" 11:58 Time 9"-6" 12 Minutes Rate Min./Inch 4 Minutes Per Inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed �- Site Failed Performed by: Greg Hochmuth,Neve-Morin Witnessed by: Isaac Rowe, Mill River Consulting, Inc. Comments: DEP APPROVED FORM—12/07/95 Document4 1 uRTp 56't 1 F 9 j Town. of North Andover t .. HEALTH DEPARTMENT f �Ss�cNustK � F CHECK#: A . LOCATION: H/O NAM �Xi4 ¢s CONTR A . E: ell Type of Permit or License:(Check box ❑ Animal $ ❑ Body Art Establishment $ # ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ e ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $. ' ❑ Recreational Camp ❑ Sun tanning $ i ❑ Swimming Pool $ 3 ❑ Tobacco $ j i ❑ Trash/Solid Waste Hauler $ I � ❑ Well Construction $ E' , i SEPTIC Systems: ❑ Sep ' -Soil Testing $ Septic-Design Approval $ O. ❑ Septic Disposal Works Construction(DWC) $ r ❑ Septic Disposal Works Installers(DWI) $ } ❑ Title 5 Inspector $ G ❑ Title 5 Report $ , ❑ Other:(Indicate) $ s =i Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer'.;: 1 t F' he Neve -Morin ATn Group, Inc. KA September 23, 2011 SEP 111.7 Z01i TOWN Or N041'N ANDOVER Board of Health __ AL PANMfN' 1600 Osgood Street North Andover, MA 01845 Re: 466 Salem Street Owner/Applicant: William & Rosemary Deyermond Dear Board Members: Our office was hired by the owners of the above referenced property to assist them with the permitting required to replace their existing failed septic system. The existing 39,000 square foot lot is surrounded by jurisdictional wetland resource areas and almost the entire lot is within the 100 foot wetland buffer zone. Prior to the soiltesting -effort our office delineated the wetland resource areas affecting the property. Based on the delineation we were able to identify a small area in the front of the house that fell outside of the 100 foot wetland buffer zone. This is the area that we targeted for our soil evaluation. As you can see from the design plan the soils on the lot are a loamy sand, Class I, with a percolation rate of 4 minutes per inch which is ideal, however, the estimated seasonal high groundwater elevation is extremely high, 32 inches from the soil surface. Because of the high groundwater we are seeking. relief from the setback distance from seasonal high groundwater to soil absorption system and relief from separation distance from inlet and outlet tees and high groundwater to septic tank. Please find attached a Local Upgrade Approval application. By reducing the required setback distance from seasonal high groundwater to soil absorption system by one foot we are able to avoid working within the North Andover Conservation Commission's jurisdiction, and we are able to provide a swale on the south side of the proposed leach bed to sheet flow surface runoff away from the abutting property owner and away from the leaching facility. ENGINEERS • SURVEYORS • ENVIRONMENTAL CONSULTANTS • LAND USE PLANNERS 447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480 Providing Professional Services Since 1978 www.nevemorin.com r Board of Health Page 2 September 23, 2011 If you should have any questions regarding this information please do not hesitate to contact our office. Sincerely, THE NEVE-MORIN GROUP, INC. � O Greg Hochmuth, RS Registered Sanitarian GH/kmm Attachments cc: Mr. & Mrs. William Deyermond FAKATHYM\Deyermond 2984\NABH LUA Ltr.doc TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOI} STREET, BUILDING 20: SC-ITE 2-36 NORTH j AS, C'H� SETTS 01545 97).6'o'13,9540 tiu an Y. S �tizrer,RENS ; ..4 F_ Y Public.HeMth Director E :.L,-k1L. Ej ITF. l=tts_ ..>>, iefi>>otll,_iii -oil' SEPTIC PLAN SUBMITTAL FORM Date of Submission: September 23, 2011 iy Site Location: 466 Salem Street lroWN OP MORtW ANDOVER Engineer: The Neve-Morin Group, Inc. HEALTH DEPARTMENT New Plans? Yes ®$225/Plan Check#1024 (includes lst submission and one re-review only) Revised Plans? Yes ❑$75/Plan Check# Site Evaluation Forms Included? Yes ® No ❑ Local Upgrade Form Included? Yes ® No ❑ Telephone#:978-887-8586 Fax#:978-887-3480 E-mail:Greg_nnevemorin.com Homeowner Name: Rosemary & William Deyermond 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 F:Voanne\TOWN OF NORTH ANDOVER Septic Plan Submittal Form.doc ar �� Vanguard®Prime WILLIAM M. DEYERMOND& 1 X24 Money Market Fund ROSEMARY DEYERMOND JT TEN WROS. 466 SALEM ST. NORTH ANDOVER.MA 01845-31.10 j DATE .� /� d/� 62122/311 $ J , UU PAY TOTHE ORDER F DOLLARS ' NOT VALID FOR LESS THAN$250.00 Payable Through Wachovia Bank,National Association Wilmi gton; DE 19803- N' P LO 300 L 4 2►�'�:0 3 11 0 2 2 S11:850 9 49 70 70 u■ I „ ` Commonwealth of Massachusetts City/Town of North Andover W 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 c`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 Rosemary &William Deyermond only the tab key Name to move your 466 Salem Street cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code tab 2. Owner Name and Address (if different from above): �0 Name - Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Home with 3 Bedrooms 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Septic.Tank D-Box and 2 Trenches Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover W Form 9A- Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: 330 Design flow of existing system: gpd gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: 5/8/2011date of inspection 2. Describe the proposed upgrade to the system: The proposed upgrade will be a new 1,500 gallon septic tank, 1,000 gallon Pump Chamber and a 16'x 28' Conventional Leach Bed. 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction ft' 4 Minutes Per Inch Percolation rate min./inch Depth to groundwater ftI Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 ' Commonwealth of Massachusetts City/Town of North Andover Form 9A— Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe 6/21/11 Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: Due to the high groundwater elevation it is not possible to locate the septic tank inlet and outlet tees 12-inches above the water table. We are seeking relief from the 4 foot setback to water table to keep the work outside of the 100 foot wetland buffer zone and to allow a swale to be constructed along the abutting lot line to avoid shedding/trapping water between the system and the abutting property. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative system would be cost prohibitive. �I Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval• Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A— Application for Local Upgrade Approval _ o 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: Not available 4. Connection to a public sewer is not feasible: Non available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ® A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. 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." 6aSaw•l-,« ,xe4 9li31 it racirfy Owner's Signature Date 6r;, �fti Print Naftfe The Neve-Morin Group, Inc. Name of Preparer Date 447 Boston Street Topsfield Preparer's address City/Town MA 01983 978-887-8586 State/ZIP Code Telephone Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 Pump Calculations September 9, 2011 466 Salem Street North Andover, Massachusetts Prepared For: William & Rosemary Deyermond Prepared By: The Neve-Morin Group, Inc. 447 Old Boston Road—U.S. Rte. 1 Topsfield, Massachusetts (978) 887-8586 Pump Calculations Dose Required (D): 82.5 gals. Daily Flow 330 gals. Doses Per Day 4 Backflow Calculations (Bf): Force Main: 1.5 inch Linear Feet of Run 33 ft Radius 0.75 inch Bf= Lf x [3.14(r/12)2] = 0.4 ft3 3.0 gals. Total Dose (DO: Dt = D + Bf 85.5 gals. 11.4 ft3 Dose Height Req'd (Ht): (LxWxHt = Dt) Tank Size 1000 gals. Length (Inside dimension) 8.83 ft Width (Inside dimension) 4 ft Dt 11.4 ft3 Ht 0.32 ft = 3.9 inches Use Ht: 0.33 ft = 4 inches Actual Dose To SystemDA: (DA: [Ht x L x W x 7.48] - Bf) 130.8 gals. Float Elevations: Pump In Elevation: 97.47 ft Distance: Inlet to Tank Floor 4.25 ft Pump Off Elevation= 93.72 ft Pump On Elevation= 94.05 ft (Pump Off + Ht) Alarm On Elevation= 94.55 ft (Pump On + 0.5') Storage Capacity (ST). 705 Gallons (Inv Out -Alarm On) x L x W x 7.48 Pump Chamber Outlet Elevation: 97.22 ft Storage Capacity > Daily Flow OK Static Head D-Box Inlet Elevation= 102.28 ft Hs: D-Box - Pump Off= 8.6 ft HS: D-Box - Pump On= 8.2 ft Dynamic Head (HD): Force Main 1.5 inches Flow 40 GPM Velocity 6.47 ft/sec Equivalent Length Method: # fitting equiv length 3 90 4 12 0 45 2.1 0 1 check 11 11 1 gate 1 1 1 union 0.5 0.5 Total Equivalent Length= 24.5 Total Equivalent Length Used= 24.5 Total Lenqth 57.5 (length + Equiv. length) Head Loss in pipe 9.43 ft/100ft Ho = (fric. loss/100ft)(total length) 5.4 ft Total Dynamic Head (TDH) 14.0 ft (TDH = Hs + Ho) 13.7 ft Pump Parameters TDH = 13.7 to 14.0 Flow= 40 GPM tA „s� -.t. � �_ I I r A I J r F- f� i i - r S � r � f O�oMpi1C i ry�pROFE55�oaPv } 6 TV r4i 14 FEATURES The Hydromatic SKV40 submersible pump is specifically designed to meet the demands of residential wastewater and sewage applications, and the quality standards of the professional plumber. The 2 inch NPT discharge pump is available with a powerful 4/10 HP motor, in both automatic and manual configurations. The SKV40 can handle capacities up to 78 gallons per minute and heads to 19 feet. The SKV40 heavy-duty cast iron and engineered thermoplastic construction provides durability in rugged applications. The pump's high-capacity, recessed, vortex impeller is threaded to a stainless steel shaft.providing long life in demanding applications. The recessed impeller is capable of passing 2 inch spherical solids and lint. The SKV40's oil-filled motor provides This oil-filled design also provides superior cooling and lubrication, allowing permanent lubrication of the shaft bearings, the motor to run cool, quiet and trouble - minimizing maintenance and extending the free for years. life of the pump. In addition, to protect against overheating and costly repairs, the motor windings contain an automatic reset thermal overload. The Hydromatic wide-angle float switch and diaphragm switch feature a unique 1 piggyback plug arrangement. The pump power cord plugs into the back of the switch • plug to provide automatic _ operation. To operate the rT pump manually, simply plug the pump power cord directly into the electrical outlet, bypassing the switch plug. When you need a pump for residential wastewater and sewage applications, the Hydromatic SKV40 is preferred by professionals. 4 a r i o O HYDROMATIC Pentair Pump Group Page 2 BENEFITS The SKV40 is a completely submersible A. Water-resistant power cord with molded plug ejector pump for use in .handling wastewater and is available in 10 or 20 foot lengths. sewage in residential and commercial building B. Heavy-duty, cast iron construction provides applications; and is available in automatic or manual long life and assists in heat dissipation for configurations. Automatic models feature a wide-angle cooler motor operation. mechanical float switch or a diaphragm switch with C. Energy-efficient 4/10 HP motor runs cool piggyback plug-in arrangement. The switches are and quiet for long life. Motor windings adjustable, easy to service and allow for simple contain automatic-reset, thermal overload conversion to manual operation. protection. D. Oil-filled motor provides superior cooling and permanent lubrication of bearings minimizing maintenance and extending service life. E. Lower ball bearings support motor shaft, minimizing the effects of impeller thrust loads. This design results in minimum friction and perfect alignment of rotor, for longer service from pump. xr; F. Discharge is standard 2 inch NPT. G. Mechanical shaft seal is carbon and ceramic faced for long, leakproof life. H. Bottom inlet has no screen to become clogged, providing optimum pump performance and minimal maintenance. I. The high-capacity, vortex, thermoplastic impeller, which is threaded to a stainless steel shaft, efficiently handles up to 2 inch spherical solids. Pump-out vanes on back on impeller prevent stringy materials from binding impeller or shaft, P I �� HYDROMATIC Pentair Pump Group Page 3 Details Pump Characteristics Performance Data Pump/Motor Unit Submersible ' e 25 Manual Models SKV40M1 1 SKV40M2 - Automatic Models SKV40A1 1 SKV40A2 Horsepower 4/10 2C Full load Amps 12.6 6.4 s41 1 HP Motor Type Shaded Pole(4 Pole) W R.P.M. 1550 e4.a f ;15 Phase 0 1 °3 = 4 = Voltage 115 230 Hertz 60 3— 1077T 71� T 77 Operation Intermittent Temperature 120°F Ambient 2 0 NEMA Desi n A Cepadtl-U.S.G.p.111. 0 20 4 6 so Insulation Class A Ul-/S....a o 1 2 a s Discharge Size 2-NPT std. Solids Handling 2" Dimensional Data Unit Weight 35 lbs. Power Cord 18/3,SJTW, 10'std. Diaphragm Switch (20'opt.) On=8.1/8 230V= 10'std. Off=4.1/4 1215/16 Vertical Switch 12"3/8 DISCHARGE (328) On=8-15/16 (314) HEIGHT Off=4-7/16 Materials of Construction �16 Wide Angle Switch (138) On=12-1/2 Handle Steel Off=6-1/2 Lubricating Oil Dielectric Oil Motor Housing Cast Iron 3.. 4"7/16 3/4 Seal Plate Cast Iron (87 (120) 01110 Pump Casing Cast Iron 3"1 t Shaft Stainless Steel 12"15/16 (99) 12"3/8 DISCHARGE (328) Mechanical Seal Faces:Carbon/Ceramic (314) HEIGHT Shaft Seal Seal Body:Anodized Steel 3(8/0)6 Spring:Stainless Steel 57/16 (138) Bellows:Buna-N Impeller Engineered Thermoplastic Upper Bearing Brass Sleeve Bearing All dimensions in inches.Metric for international use.Component dimensions may vary f 1/8 inch. Dimensional data not for construction purpose unless certified.Dimensions and weights are approximate. Lower Bearing Single Row Ball Bearing On/Off level adjustable.We reserve the right to make revisions to our product and their specifications Fasteners Stainless Steel without notice. -� Your Authorized Local Distributor- � HYDROMATIC Pentair Pump Group USA CANADA 1840 Boney Road Ashland,Ohio 44805 www.hydromatic.com 269 Trillium Drive Kitchener,Ontario,Canada N2G 4W5 Tel: 419-289-3042 Fax:419-281-4087 ISO 9001 Registered Quality System Tel: 519-896-2163 Fax: 519-896-6337 ©2001 Hydrornofic® Ashland,Ohio. All Rights Reserved. Item#:W-02-6730 4/01 5M OE HORT.,� 5521 . O Town of North Andover +�'•�,,,,,..`f, HEALTH DEPARTMENT ,SS�CMUS�t CHECK#: c% DAT / LOCATION: H/0 NAME: 7 CONTRACTOR NAME: f Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ; i ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ U 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 $ her:(Indicate) i Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer w w Lam'' TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 41845 �R*h Date Issued G D�O� p t4�ao k 6 . 3?®d°s' � •d ppL Expiration Date . �1 O x � � �9 sacKus Jackie's Law - Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant T>l-T.g2 r6 a ly Phone ll Ce Street Address `"8 0,7 7)77i, `7W /i (;Yf�vN� 67 % City/Town MA I ZIP N, ANoov13 Y, d1 aYS' Name of Excavator(if different from applicant) Phone Cell Street Address City/Town MA I ZIP Name of Owners)of a Phone Cell Strfrt Pdress (/ 4q S�ALEP% gfqfhwn MA ZIP i4 , ArD-j",r y C) Other Contact Permit Fee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. Insurance Certificate#: Y L Name and Contact Information of Insurer: oe Policy Expiration Date: Dig Safe#: ,�Q/// S- Z-z_ Name of Competent Person(as defined by 520 CMR 7.02): D®V$ Massachusetts Hoisting License License Grade: Z�� , Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.a 82A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. AM4AqANT SIGNATURE DATE Z EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S SIGNATURE(IF DIFFERENT) DATE: l I', i - v r 2r M. CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application,the applicant understands and agrees to comply with the following: i. No trench maybe excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164(DIG SAFE); ii. Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with e required or recommended b said department in excavations and open trenches and the procedures eq y p order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR 1926.650 et.seq.,entitled Subpart P`Excavations". iv. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et.seq.,entitled Subpart P"Excavations"as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www-mass.eov/dns/dns PAGE 01/01 �. 06/02/2011 12:46 9786833147 DATE(MMIDD/VY►Y) acoRD�' CERTIFICATE OF LIABILITY INSURANCE 5/2/11 THS CERTIFICATE NOT AFFIRMATiVELAS A OR Id1:GATNELY AMEND,OF IWORMATION rAND CONFERS NO RlGHTS UPON THE cMFICATE HDI nER THIS E7CTEt� OR ALTER THE COVERAGE AFFORDED t3Y THE POUCIEs CERTIFICATE DUES AUTHORIZED BELOW. THS 17ERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1N5URER(S), BELOW. OR PRODUCER,AND THE CERTIFICATE HOMER. YYftt�lEfl; IB 4 PMTA�S- - SAL#NSUREI,bepetl-116 ust#�e=eldorssd=-- - the terms and conditions of the policy,Certain policies may require an endorsement. A sblOnlOnt on this certificate does not eoAvfier ngh ta- certif"te holder in lieu of such endorsernen CO PRODUCER NAME: PHONE Fi►X N M.F. Robertsl InsuranCO Agency 1060 Osgood Street ADIYis: North Andovetr, MA 01845 CU. t Vilna: NAIG!! INSUMNS)AFFORDING COVERAGE INSURED INSURCM A: — PETER BREEN EXCAVATING INC ,A•/0 TRAVIS Si TIM CONSTRUCTION tNSURE q:ACE USA 774 HOXFORD STREETIl�U80t13 .. —_ NORTH ANDOVER, MA 01845 INSUPER F COVERAGE g CERTIFICATE NUMBER: REVISION NUMBER: DRELOA,1, EWOS I _ISOCTHAT THE POLICIES OF INSURANCE BEL A1v1E BEEI4I$SUEDT0 'IE INS N OANY CONTRACT OR OTHER DOCUMERH RESPECT TWHIC THIS INDICATED. NONTHSTANDNG ANfREQUIREMrTT4�M OR CERTFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE Pq.1CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.L IMrrS SHOWN MAY HAVE BEEEN RE'PAJ*Y EFF pUCED 6Y PAID CLAW•I LIMTS TYPE CIF(NSURANCE AW, 9u6lt POLICY MiMaRtt EACH OCCURRENCE ; .�------- CmutALLWDILn" D4MGETO RENTED COfIry1ERC1ALGENERALLIABILITY RE�ALSES..(Ea4 �)— ------- NED SIP(A%r*P '> s CLAMAIADE 17 OCCUR PE_RSONAL&ADV INJURY S – - GENERALAGGRE __ PRODUCTS-COMP�G9. $ $ — C£N'LAGGREGATELFMITAPPLESPER E POLICY PRO L4C COMBINED SINGLE LN9rT AUTCUODSLE LIABILITY (Ep gcclperf) �_ ANYAUM BODILY INJURY(Par PSMO.M) 8 ALLOWNED AUTOS BODILY INJURY(Pet aloin)'S SCHEDULEDAUTOS PROPERIYDAMAC;E 9 HIRCD AUTOS & NON-OW NE D A UTOS - $ UN®riELLAUp6 OCCUR EACMOCCURRENCE 3 EXCESSUAD CLAIMS-MADE AGGREGATE — .. DEDUCTIBLE RETENTION 1 WC STAT OTH- C %*RK°+s GOMPEWATIO01 500 OOO ANDEMPLOMMLIABIUTY YIN ]C46385937 11/13/1011/13/11 E.L.EACHACCIDEW 3 +---0 ANY PROPRIETORMARTNERIE)(ECUTIVE "T NIA pppICERM1EfvBERDCLIbED? _1 E.L.DISEA9E-EA fLOYE S SOU.1000 PAsndg7DfY In NH) n daacr{Deunder EL DIS EASE•POLICY LPAIT 3 5OO OQO .0 ESCRIPTION OF OF ERATIONS WOW DESCRIPTIONOFoPERATM]NS/LOCAmoNSIVEma= (AtteehACORD107.Add%QM,R mfteaedum,kuw*spaceIarequlrod) CER TIFICATE HOLE)ER CANCELLATION SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FJ(PIRATION DATE TmERFOF, NOTICE SHILL. BE DELIVERED M TOWN OF NORTH ANDOVER AOCOROANCE WITH THE POLICY PROVISIONS OSGOO)0 STREET AU NORTH ANDOVER, bM 01845 THOR�n REF7�sEiVTA7NE 0 1"8-2009 ACORD CORPORATION. Ali rights reserver ACORD 25(200 9109) The ACORD name and logo are registered marks of ACORD f DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, June 06, 2011 3:33 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: Soil Test Application -466 Salem Street-(H/O: DEYERMOND) Attachments: 20110601094811412 Importance: High Conservation comments: 466 Salem Street -North Andover- "Testing in front yard only- wetland resource area to the rear. -per. Jennifer Hughes -6/6/2011" Please go ahead and schedule with!kH=Dufiwsne. Thank your. feat ,lAlle—�r/,v Jv � Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 9 Office-978-688-9540 1 Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com `SLS Website httl2://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: DelleChiaie, Pamela Sent: Wednesday, June 01, 2011 10:17 AM To: Gaffney, Heidi Cc: Hughes, Jennifer; Sawyer, Susan Subject: Soil Test Application - 466 Salem Street- (H/0: DEYERMOND) Importance: High Hello Heidi, Here is a new Soil Test Application for 466 Salem Street. When you have a chance to review the site,please let me know your comments. I left a hard copy on your desk as a reference for you. Once you are all set,I will forward to our consultant for scheduling with the soil evaluator Thank you!--0 diet�igarda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 2 Fax-978-688-8476 El Email-pdellechiaiePtownofnorthandover.com '16 Website bM://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 t TONVIN OF NORTH ANDOVER �,MN�•� Office of C'O;N111UNITP DEVELOPMENT AND SERVIC_E5 HEALTH DEPART.-IEN'T tl ; 1600 OSGOOD STREET;BUILDING 20;SUITE 2-36 'L� f 'NORTH a\DOVER,1AASSACHUSETTSOIS45 t1'Siu»r�`4 Susan Y.Wmtr.RENS.RS 976 6SS.9540—Pltone Public Health Director 97S.03.84:6—FAX :teatgtdeo:$to;ntofitortltand�rex:cont Irw%e lcntta[n•±elltnnAct'er.wu APPLICATION FOR SOIL TESTS RECEIVED DATE:May 27.2011 MAP&PARCEL:Map 38,Parcel 253 MAY 31 Z U 11 TOWN OF NOR't 0 ANDOVER LOCATION OF SOIL TESTS: 466 Salem Street HEALTH DEPARTMENT OWNER: William&Rosemary Deyermond Contact#: 978-685-4966 -- _ RECI APPLICANT: Same as owner Contact#: ADDRESS: 466 Salem Street JUN — 7 201 ENGINEER:The Neve-Morin Group,Inc. Contact#: 978-887-8586 TOWN OF NORTH ANDOVER HEALTPi DEPARTMENT CERTIFIED SOIL EVALUATOR: Greg Hochmuth Intended Use of Land: ❑ Residential Subdivision ® Single Family Home ❑ 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.S"-r 11"Plot plan&Location of Testing(please Inrlleate test Lit sites on the plait) ➢ 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. Conserttatlou Commission Ap oval Date: Signature of Conservation Agent- Date back to Health Department: amp itt): 67 14 j1C)4 WOW A.YdL4.f/B if99%Ar eVAI*',NY- - oe1Y2,A.. ol PLAN OF LAND Lor 3 IN KTO NO. ANDOVER MASS. rap d%r- . � �� omw®�iwwaomot�I�wt�Rmr.er .A tm�.��nh mtliK R than. __ _� �.�-�iiwv��it••i�iu z L4/1Mi t.I.M/@NCO E�{S�. .1C.REO,O RMM/.11t pptVD Lor z Tc -'_T ,: ti:. for.i .............. y f owy- i... ,0�Z3 I �l 5457 7 Town of North Andover +�'••,,,,•.. �, HEALTH DEPARTMENT ,SSACMUStt k P CHECK#: � DATE: LOCATION: H/O NAME: CONTRACTOR NAME: _, TYpe of Permit or License: (Check box) ❑ Animal $ s ❑ 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 $ i ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ffl_"Septic-Soil Testing $ c.g7 ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ IF Health Agent Initials-`.. White-Applicant Yellow-Health fink-Treasurer { TOWN OF NORTH ANDOVER Office of C 011' UNITY DEVELOPMENT ANDSERVICES HEALTH DEPART"TIENT Iv+itE C>�L.C)L SIT STREET:SL ILDI>G0 SL"ITE Z-36 ��. tiORTH-ANDOViER .'.L-k«AC UsETTti .:'_S47 ». usan Y.SaNr ver.REHs.R u Public Health Dirwor GS.3477 6 ie tidy.:.; i�iti iL nlrr;� c=t,y VED APPLICATION FOR SOIL TESTS ' CEI DATE: May 27,2011 MAP&PARCEL: Map 38,Parcel 253 TOWN OF Tdt31"t`l'a-1 ANDOVER LOCATION OF SOIL TESTS: 466 Salem Street I HEALTH DEPARTMENT OWNER: William&Rosemary Deyermond Contact#: 978-685-4966 APPLICANT: Same as owner Contact#: ADDRESS: 466 Salem Street ENGINEER: The Neve-Morin Group,Inc. Contact#: 978-887-8586 CERTIFIED SOIL EVALUATOR: Greg Hochmuth Intended Use of Land: ❑ Residential Subdivision ® Single Family Home ❑ 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 Testiniz(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: Signature of Conservation Agent: Date back to Health Department: (stamp in): $$5770 QUITCLAIM DEED No. John Drives And Lisa Drives of North Andover, Essex county, Massachusetts being married, and in full consideration of Two Bandred sixty-Six Thousand and 00/100 ($266,000.00) Dollars paid grant to Nilliaa M. Deyermond and Rosemary Deyerstond, husband and o wife, **.Tenants by the Entirety 7 v of 466 Sales Street, North Andover, Essex County, Massachusetts 4 with QUITCLAIM COVENANTS 1C A certain parcel of land, situated in North Andover, Essex County, Commonwealth of Massachusetts, bounded and described as follower V Being Lot i2 as shown on Plan of Land in No. Andover, Mass., V containing 39,000 square feet, located on Salem Street as shown on Plan #10859, recorded in North Essex Registry of Deeds. Said Plan y is entitled "Plan of Land in No. Andover, Mass.*, dated July 16, 19870 Hayes Engineering, Inc., Civil Engineers and Land Surveyors. Reference is made to said plan for a more particular description. Subject to a drainage easement as indicated on said Plan. e ✓ Being the same premises conveyed to John Drives and Lisa Drives by N deed of Donald F. Johnton t Co., Inc. dated June 10, 1988 and 9recordedat the Essex County North District Registry of Deeds at Book 2746, Page 64. 4 N .Okr witness our hands and weals this 29th day of June, 1993. �6 R Jo n Dr vns k ✓� Lisa Dr vas aoc:JahZ:, TAX 1212.96 GHLK !212.46 � lL:14 EXCISE �qX 313770 E I m CONNOMUs1 LIN or musus118R'm 1 1ish7ir es. Jain 79,1993 Thou personally •d above naw d John Orivas arA Lisa ` Drivas aolasorl•dq•dhr tlw"oinq instruarnt to be their fres not sd { adeed before es votary #60"w NY oas9ission•spiv si January 29, 1999 I i • n: NEW ENGLAND POlYE,P LO.f/PgNV ���.�.— , moo � n,ves eucirvecaruc. nuc. 7 p) Pf PLAN OF LAND x Lor 3 IN NO. ANDOVER, MASS. 81t W� o� 4���) %9� Le�s�i�`divtir /r�/m..w.,Piwr:oxrr o-/.rrw,�/o.. "«ew�:•e:`ec. x m —--�%yam— ,�,E ��,.�a.�,.�E„sn�•,���./�,.��,.�. �— � 6.,--. w: vweel, ------------------------------ LOT ------------------------------ L07 s LOT ^ _>e PEa >,r h p 9a �veuair� nFu'n { ai SAZEM Authorization Form Re: 466 Salem Street,North Andover I, Rosemary Deyermond, authorize The Neve-Morin Group to sign any and all applications to the Town of North Andover on my behalf regarding the above-referenced property. i I Ros mary De-ye ZZ Date i I I j ♦ a ♦ ♦ i Vanguard"Prime WILLIAM M.DEYERMOND& i- Money Market Fund ROSEMARY pEYERMOND 1023 JT TEN WROS 466 SALEM ST. NORTH ANDOVER MA 01845-3110 DATE 62.22/311 50 PAY TO THE ORDER OF 34; DOLLARS Payable Through NOT VALID FOR LESS THAN$250.00 Wachovia Bank, National Association Wilmington, DE 19803 .. FOR ii' 100 300 LO 2 er:0 3 1 100 2 2 SIM 509 49 70 709 1 o