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Miscellaneous - 491 SALEM STREET 4/30/2018 (2)
I' 491 SALEM STREET 'J 210/038.0-0010-0000.0 o , r • I North Andover Board of Assessors Public Access, ._ f 1 poerM rth. Andover Board of Assessors Qiy •�r.o��q� k SSACNUS� r � roperty Record Card Parcel ID :210/038.0-0010-0000.0 FY:2011 Community: North Andover 77 7T 7 -IM77777' Click on Sketch to Enlarge Click on Photo to Enlar e F , ;•I SIJ��: '��-'_�, C 491 SALEM STREET Location: 491 SALEM STREET Owner Name: _ .PROULX,PAUL E PROULX,ELAINE R Owner Address: `491 SALEM STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5-5 Land Area: 0.76 acres �Us'ecode_:_ "101-SNCL-FAM-RES Total Finished Area:_ �L2464 sgft Total Value: 478,200 k 497,300_ f Building Value: 284,200 303,300 Land Value: 194,000_ _ 194,000 _ Y; Market Land Value: 194,000 Chapter Land Value: _ i Sale Price: 11 Sale 06/09/2009 - - Date:. Arms Length Sale F-NO-CONVNIENT Grantor: PROULX,PAUL E Code: Cert Doc: Y Book: 11633 `Page 44 http://csc-ma.us/PROPAPP/display.do?linkld=1702164&town=NandoverPubAcc 10/7/2011 SUMMARY OF INVERTS BUILDING 'CIES ���- SEINER ® FDTN. 95.74 BLDG. CORNER A ° B C NOTQ* THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 95.21 SEPTIC TANK OUT 43.8 A3.3 A WARRANTY OF THE SUBSURFACE DISPOSAL ,SEPTIC TANK OUT 94.94 IPUMP TANK OUT 36.6 53.3 1 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK IN 94.87 DIST. BOX 18.8 68.8 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 96.42 COMPONENTS. DIST. BOX OUT 96.23 INV. IN CHAM, 96.18 BOTT. CRAM. 95.90 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE N/F DEM/RCO BERUNFHERI sk�:71APEiY D#u.Etd„;,;ED M IT u FAY no=0441RONMET TAL S,k.RVEbe"'S O=SER 20ti 13O,1Q' sa tea. m 9NP. ^ PORT LFACFI F1EID w_/ AG1oR til r ,s. �T°AL AW cs 1500 SEP TANS t D-sox p DECK t MST.4 KAK WAGE APPRU s f i g z EVST WTI ` L4.L c -a ( (33,096 &F.) y' a / -B9f SBY RS DE%v &IED ✓' y t 5M47CES OC746f>R 2011 • 1.;T.ORNAACE EASEMlAT 1 2A _ _ _ _ _ __ _ _ _ p _ _ _ _ - -- _ _ ...._ _.._ ......-- a SAS STREET �N flF�qs o� VLADn�� yG g NEMCHENOK �'„ LA AS BUILT PLAN ONA�Er OF Q SUBSURFACE DISPOSAL SYSTEM m LOCATED IN Q NORTH ANDOVER MASS. 491 SALEM STREET 0 D AS PREPARED FOR Df PAUL PROULX K Z TM: 38 mo zo DATE: 4-10-12 TL: 10 SCALE: 1"=40' 0 20 40 80 MERRIMAC K ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. 95.74 BLDG. CORNER A B C NIC TE.* THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 95.21 SEPTIC ,TANK OUT 43.8 43.3 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 94.94 PUMP TANK OUT 36.6 53.3 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK IN 94.87 IDIST. BOX 18.8 68.8 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 96.42 COMPONENTS. DIST. BOX OUT 96.23 INV. IN CHAM. 96.18 BOTT. CHAM. 95.90 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. i SIGNATURE OF DESIGNER DATE III N/FN i ARRCO t BERUNFUNFNERI DEMA lE1Y.At�i3 LtflAT�L3 mm BY PNOR7Z ENVR OIAE.NTAL SERVHCES OCME f 2iJf'i f30.f2' ea � FORLEACN FIELD =1"ATOR ' I 1000 CAL f PUMP TANK 150 CAL t v a SEPTIC TANK n b D-90X r I LOT C m (33,096 SF.) ey MORS Of1Pd'r.FiTED BY NORSE QJN1P,t2¢JpR¢,idTd�E. SEtd41 m c T 204Y . D6 j.---. yeti,..`",{.—....w. �g ,q�•--.-�n y f DnT. MAKAGE MtaMAT 261 � i SALEM , Simi ����N of M,gssq o� VLADIMIR L. CyG NEMCH£NOK ,p 0 g °„' , int . - - BUILT -- - ,off � �AS PLAN o�Fs�S.V OFL SUBSURFACE DISPOSAL SYSTEM LOCATED IN m* NORTH ANDOVER, MASS./491 SALEM STREET MR AS PREPARED FOR m 0 PAUL RROULX TM: 38 Z Z DATE: 4-10-12 TL: 1011111 NEI Zo r:� SCALE: 1"=40' -+T„ 0 20 40 80 X MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:WhenA. General Information Irk �G a filling out forms on the computer, use only the tab 1. Inspector: zO l l key to move your cursor-do not Neil James Bateson TOWN QE NORTI-1 AMr)t)VFR use the return Name of Inspector HEALTH DEPARTMENT key. Bateson Enterprises Inc Company Name 111 Argilla Road Company Address Andover MA 01810 Cityrrown State Zip Code 978-475-4786 SI-15 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 Z Conditionally Passes ❑ Fails ❑ ee s Further Evaluation by the Local Approving Authority 1 i 10/7/2011 InfipeloMignature Date The system ilispector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. **** only describes conditions at the time of inspection and under the conditions of use This report o P Y p at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 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. Check the box for"yes", "no"or"not determined"(Y, N, ND)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. ❑ Y © N ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ® N ❑ ND (Explain below): ❑ 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 ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): i C) Further Evaluation is Required 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 HeaNth 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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. : ElThe system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 must be attached to this form. 3. Other: Outlet tee in septic tank&d-box needs to be replaced D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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 9P 9P design flow of 10 000 d to 15 000 d. 9 � � 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 ❑ 0 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. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page City/Town 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? El ® 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 componentEl, 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, de th of sludge and depthth 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 600 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Citylrown State Zip Code Date of Inspection D. System Information Description: 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 ears usage d Yes 9 ( y 9 (9P ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: DCterent 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: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street ` Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2011, owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval.9 ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Original, owner. Has design plan, 4-1-1982 no as built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): 4"cast iron thru wall, 3"PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: .5 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'x 5'x 4' Sludge depth: 0 t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposai System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address / Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle N/A 2.. Scum thickness Distance from top of scum to top of outlet tee or baffle N/A =Outlet tee corroded off Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee corroded off. Depth of liquid at outlet invert. Outlet pipe into tank at steep angle , needs to be reset. Grease Trap(locate on site plan): Depth below grade: feet 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 l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityrrown 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.): �I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts MOM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. Evidence of solid carryover. D-box has corrosion holes. D-box needs to be replaced. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions. 1 field 30'x 50' ❑ 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.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Prouix Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Prouix Owner Owners Name information is required for every North Andover MA 01845 10/7/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Oe.c_k 0 0Str,�.Y� P7 11 �a '7 ')VV t 44110 =4� ``7 (� ~� 1311 t5ins•11/10 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4 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: 5/18/1981 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data shows at 5.5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of(Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 491 Salem Street Property Address Paul Proulx Owner Owner's Name information is required for every North Andover MA 01845 10/7/2011 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i Summary Record Card generated on 10/12/20112:11:45 PM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-038.0-0010-0000.0 Parcel Id 10234 491 SALEM STREET PROULX, PAUL 491 SALEM STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.76 Acres FY 2011 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until PROULX,PAUL Payor 491 SALEM STREET N.ANDOVER,MA 01845 UB Account Maint. Account No' Cycle Occupant Name Active/Inactive Bldg Id.16088.0-491 SALEM STREET Last Billing Date 10/4/2011 3160130 03 Cycle 03 Active UB Services Maint. Account No.3160130 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 217.22 /1 UB Meter Maintenance Account No.3160130 Serial No Status Location Brand Type Size YTD Cons 13242179 a Active 00 METE METE w Water 0.63 0.63 407 Date Reading Code Consumption Posted Date Variance 9/9/2011 928 a Actual. 46 10/13/2011 67% 6/2/2011 882 a Actual 25 7/20/2011 -7% 3/4/2011 857 a Actual 26 4/13/2011 14% 12!1/2010 831 a Actual 25 1/12/20'11 -46% 9/3/2010 806 a Actual 45 10/15/2010 50% 6/2/2010 761 a Actual 29 7/15/2010 26% 3/4/2010 732 a Actual 23 4/14/2010 -9% 12/4/2009 709 a Actual 26 1/12/2010 -20% 9/2/2009 683 a Actual 32 10/15/2009 18% 6/2/2009 651 a Actual 26 7/20/2009 14% 3/6/2009 625 a Actual 24 4/29/2009 -7% 12/3/2008 601 a Actual 25 1/20/2009 -14% 9/4/2008 576 a Actual 30 10/10/2008 16% 6/3/2008 546 a Actual 25 7/16/2008 20% 3/5/2008 521 a Actual 21 4/11/2008 -33% 12/5/2007 500 a Actual 29 1/22/2008 -13% 9/12/2007 471 a Actual 37 10/12/2007 2% 6/11/2007 434 a Actual 37 7/20/2007 29% 3/8/2007 397 a Actual 28 4/16/2007 -1% 12/5/2006 369 a Actual 27 1/19/2007 9% 9/7/2006 342 a Actual 25 10/20/2006 0% 6/9/2006 317 a Actual 22 7/10/200611% 3/22/2006 295 a Actual 25 4/17/2006 -16% 12/12/2005 270 'a Actual 27 1/17/2006 -43% 9/12/2005 243 a Actual 53 10/14/2005 136% 6/3/2005 190a Actual 20 7/15/2005 -43% 3/5/2005 170 .m Manual estimate 35 4/5/2005 -1% 12/6/2004 135 a Actual 35 1/14/2005 -36% 9/9/2004 100 a Actual 60 10/8/2004 130% 6/4/2004 40 a Actual 14 7/30/2004 -26% l • ' • • PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Cenificate of Compliance As of -AriC24, 2012 This is to cert that a S/A`IIS FACS ORT INSISECTIOX Was compCetedfor the: .Tuff Wepair o f an On Site Wastewater osaCSystem By: Todd Bateson at: 491 SaCem Street Parcel ID :210/038-0010-0000.0 North.,Andover, wA 01845 The Issuance of this certificate shaff not 6e construed as a guarantee that the On Site Sewage posafSystem wifffunction satisfactorify. usa T Sawye ;BEV Pu6fic.Yfeafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ORTN F 9 9SSACItt1°�ES PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System.(/) ( )repaired; V4 It By: To17(2 ��-rESo►� ��°� ' �� (Print Name) pf y{��W/ � IN Located at: ! 3 (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on 12" 1 0 ,with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: of-- Engineer Representative(Signature) And—Print Name Final Construction Inspection Date: ��� ' r Engineer Representative(Signature) Uw And-Print Name Installer: 8` tgffature) Date: Z�y t' ° ro And—Print Name Enginer: (1L•I /W'60 t�C C1�i�nature) Date: ?i And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com SFKILED I . • North Andover Health Department fommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORM 10 ADDRESS: � MAP: INSTALLED-:�/ DESIGNER: PLAN DATE��%��� ��'� BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: o<� DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base WgVeehole plugged gallon tank has been installed / loading Monolithic tank construction Water tightness of tank has been achieved by { testing Inlet tee installed, centered under access port r Q LJ Outlet tee installed, centered under access port gas baffle/effluent filter) ❑�� inch cover to within 6" of final grade 110 installed over one access port Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base ck'�At n0 W hole plugged . ❑ gallon Pump Chamber installed ❑ loading Monolithic tank construction [� Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base - ❑ Alarm float working El Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing Hydraulic cement around_ inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: r SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed �� ❑ Laterals installed and ends connected to header (and vented if impervious material 1U above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = BM = HR HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber, f� 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 10' ® 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, 1032, 10.54,and 10.3.0,respectively,pursuant to 15.211(3),also by NA wetland bylaws AS-BUILT CHECKLIST cS� V All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer r details of system components) Lot number, Street Name,Assessors Map and Parcel Number - RECEN Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,inclu mgr r-v TOWN OF NORTH ANDOVER Ties to dwelling or Permanent Structure&Wells HEALTH DAPARTMENT a.From Septic Tank b.From Leach Area Ties to Lot Lines from leach area . / Locations of Deep Holes&Peres Elevations of Disposal System Top of Foundation Elevation - Locations of Wells,Drains,Watercourses within 150 feet of system Location of water,gas,electric lines,cable Distances from Corners of House to Center of Tank&D-Box Location of Structures within 6 Inches of Finished Grade Original Stamp&Signature ��7 Location and holder of any easements which could impact the system ' A Impervious Areas;Driveways,etc North Arrow Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) / "I certi fy the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 I''l4 Commonwealth of Massachusetts Map-Block-Lot • BOARD OF HEALTH 038.00010----- - ------------ North Permit No orth Andover BHP-2012-0545 F.I. ----------------- FEE DISPOSAL WORKS CONSTRUCTIONT ---___$250.00 __ granted Todd Permission is herebyBateson PERMIT _------ to(Repair)an Individual Sewage Disposal System. at No 491 SALEM STREET ------------------------------------------------------------ as shown on the application for Disposal works Construction Permit --- BHP-2012-054 Dated March-3-0,-2-0-12 Issued On:Mar-30-2012 ------------- ------- - - -- -- -------------------------------------- BOARD OF HEALTH------------------ . 4 w MORTp� Application for Septic Disposal System - �� 1 TODAY'S DATE �AConstructon Permit=TOWN OF ORTH AND OVER 11�A• 01845 $255.00-Full Repair Voila-� , .�'* $925.00-Component ,SSACIWg Important: Aoolication is herebv made for a permit to: When filling out []Construct a new on-site sewage disposal system* forms on the / computer,use ('Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. (�d�-._ �' f a/f1� I I Address or Lot# ~ CitylTown TOWN OF NOFjT14 ANDOVER 2e* PE OF SEPTIC SYSTEM*: HEALTH DEPARTMENT Pump 0 Gravity(choose one) ***If pump system,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) ylnfiltrator or Blodiffuser(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 li�llrou4X Name 5J- Address(if different from above) Ak Git town St to Zip Code X8'5 ba a Telephone Number 3. Installer Information Name Name of Co ON ENTERPRISES,INC. f Ar l i ll'4 ��• p1�11 ARGILLA ROAD Address .- —W W'.n'1VbiU1 S Ckyfrown State Zip Code m q1 /ls— Telephone Number(Cell Phone#if pow1ble please) 4. Designer Information _ Name game of Company Address Cityffown State Zip Cade Telephone Number(Best#ft Reach) Application for Disposal System Construction Permit•Page 1 of 2 °RtNApplication for Septic Disposal System ' 3?.•.+ • �'• o� TODAY'S DATE 4V =Construction Permit - TONVN. OF * -----� if ORTH ANDOVER, MA 01845 $250.00-Full Repair $125.00,-Component SSACµUSR PAGE 2OF2 A. Facility.lnformation continued.... 5. Type of Building,: Residential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been is y this Board of Health. Name Date Application App a y: (Board of Health Representative) Namef Date Application Disappr ed for the following reasons: For Office Use Only: 1 Fee Attached. Yes No 2. Project Manager Obligation Form Attached. Yes No 3.: Pump S stem? Ifsoj Attach copy ofElectrical Permit .; Yes No 4. Foundation As Built?(new construction ronly). Yes_ No (Same scale as approved plan) .5 Floor Plans?(new construction only), .Yes_ No Application for #0sal System Construction Permit Page 2 of 2 J ' • a SEPTIC SYSTEM.INSTALIER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction forthe septic system-for the property.at Y-21Com- For plans by (Address of septic system) �f (Engineer) Relative to the.application of 1 And dated (Installer's name) nginal date). Dated-- a-- With revisions dated Lo a s ate (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am.obligated to obtain all permits and Board of Health approved plans prior to :performing any work on a site. I must have the approved plans and the permit on site when any work is b`eini_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.b e.applicable. 3. As the installer,I atm-required to.have.the necessary work completed prior to the applicable inspections as indicated below: I understand that rec izesfin an inspection,without comliled6ft.of the items in.accordance with Title 5 and the] of Health Ieulations 2i7ay result.iin:a$50 OO fine bein . sn levied aQast:me..and/or tny, corn`Dany: a,. Bo'tfom of Bed-,-Generally,ibis is the.first(1' :inspectionunless.there is a`retaining wall,which shbuld•be donerst: The installer niust:request die iiispectiozl but sloes not have to be present. b. Final Construct ori.Itnspection—Engineer taust first:do their inspection for elevations;ties, etc. As-built of verbal OK(or e-mail to:healthdelitQLcL_ fnorthandover.com):from the engineer must be subtnitfed to.the.Board of.Health,aftet`which.instal'1er.cails 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 alainn to function.. c. FinatGtade Installer must 3requestinspection when: 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 d.Vle excavation)and I atri required to complete the installation of the system identified in.the:attached application:for.installation: _I further. .understand-that work done by others ui licenseda to-install septic systems-iii North Andover can constitute reasons for deinialof the system and/birevocation or suspension of-my license:to operate in.the Town.of North Andover,significant fines to.all t ersons-involved iie also possible. 5. As the.instiller,1 understand that)mu§t lie onsite during the•performance.of the following construction. steps:' a. Determination,that.the proper elevation of the evearation has been reached A Inspection ofthe sand and stone to be used. c. Final umspectr'on by Board ofHealth staffor consultant. d. Installation oftank,D Box;pipes,stone, vent,primp chamber,retaining wall and other components. 6. As the installer,I understand that I atn solely responsible for the installation.of the.system as per the approved Iilans No instructions by the homeowner,general.contractor_or any.other persons shall-absolve .. me pf this obligation. Undersigned Licensed Septic.Installer: )ae sdi✓ (Today's Date) .2 / are,= .nnt n rr r .. l.ommonwea[tfi o�//1a33aei� Official Use Only Permit No. 107 e(.JepartmenEn�,tise Jewice! Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/67] eaveblaok APPLICATION FOR PERMIT TO PERFORM ELECTRICAL.WORK All work to,be performed in accordance with_the Massachusetts Electrical Code(IEC),527 CUR 12.00 (PLEASEPRIN1.17V INK OR 2gPEALL INFO OA Date: 2 2j_a L Z City or Town of: t1J�t� �Q,�o o mak. To the Inspector of Wires: By this application the undersigned gives notice\of his or her intention to perform the electrical work described below. Location(Street&Number) Telephone No. l 7 G 77 ffLZ i� " Z 1612 -Q— (Check Appropriate Boa) Authorization No. - - Z TOWN OF NORTH ANDOVER Date..... .`�•••••• Undgrd❑ No.of Meters HEALTH DEPARTMENT Undgrd❑ No.of Meters g NORTH a'•«`° '•�"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING table may be waived by the Ins for Wires. . ,. b '°,,r.°.••'.ry •. a oi`"_ ictal.- 'ss^cHusE� Transformers KVA J- fit�} ,��� Generators KV This certifies that ................................................ ............... o.o Emergency g A .... ..... .. . BatteEX Units has permission to perform ...........5V- ...A ../Jf..........z........... g=ALARMS / ]No.of Zones wiring in the building of........... .oU./.. '............................................ No.o etectron an Initiating Devices at......L1q./... 5,4e� .....5.,7_....... North Andover,M S. No:of Alerting Devices No.o - ontam ee. ............ Lic.No. ...5..73 ............ ........ .. I Detection/Alertin Devices E ECTRICAL INSPECTOR LocalE1 umc�p a /�� Connection .0 Other CheckeeuritySvstems: i No..of Devices or E nivalent 1 Data Wiring. o.of Devices orEquivalent Telecommunications Wu tng- " Jo°ioO No.of Devices or E ivalent OTHER:.;. - - •=_--- - - - _ _ _. Attach additional detail ifdesired oras required by Ae Inspector of Wires. Estimated Value of Electrical Work: . ` Q( (When required by municipal policy.) Work to Start: Inspections to be requested'in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete FIRMNAME: LIC.NO.: Licensee: �5.. a�y ace e-iLSignatare LIC.NO-:-79 f 73 (Ifgppllcabk enter`exempt"in the license nwmBus.Tel.No:7 �'7�t Address: Alt.Tel No.. *Per KG.L.c.147,s.57-61,sec mity work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAI VER. I am aware that the Licensee does not have the liability insurance coverage normally required by law.. By my si below,I hereby waive this requirement I am the(check one)❑owner ❑owner's agent Owner/Agent Signature Telephone No. .PERMIT FEE:S I 1 cfo•rk�tio Application for Septic Disposal# System :.;q `; o TODAY'S DATE - Xonstruct on P_ermlt TOWN OF ORTH ANDOVER. MA 01.845 $250.00.00 —Full Repair ,�•,�-�=-�� $725.00-Componen c►a� Important: Application is hereby made for a permit to: When filling out Lj Construct a new on-site sewage disposal system* forms on the computer,use ❑ Re air or replace an existing on-site sewage disposal system* _ only the tab key to move your epair or replace an existing system component—What? t0��7� jam- �— - � cursor-do not use the return A. Facility Information r - --- key. REC111VID ILS Address or Lot# IT { l ea sw t seam Cityfrown Y-e Tt:DUVIV C31`Nt3RTi•1 ANDOVER 2.-*TYPE OF SEPTIC SYSTEM*: HEALTH DEPARTMENT ❑Pump ravity(choose one) ***If pump system,attach copy of electrical permit to application*** Conventional System(pipe and stone system) ❑Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information (Y- Name Address(if different from above) Cityll`own State Zip Code Telephone Number 3. Installer Information I Name Name of C pa K-M-NISES,INC. I 11 RGILLA ROAD Address f `�%�/A OVER MA 01010 Ckyfrown State Zip Code Telephone Number(Cell Phone#if Possible please) 4. Desi ner Inform tion Name Name of Company Address Cityfrown State Zip Code Telephone Number(Best#to Reach) Application for Disposal[System Construction Perrntt•Page i of 2 ORT ty Application..for Septic Disposal System - �r TODAY'S DATE AConstruction Permit - TOWN. OF ORTH ANDOVER, MA 01845 $250.00-Full Repair $125.00-Component SS�cNus PAGE 2 OF 2 A. Facility-Information continued.... S. 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 North Andover,and not to place the system in operation until a Certificate of Compliance has been issu by this Board of Health. Nam Date Applicat' Approved By Board of Health Representative) > - if N eDate pplication Disa proved for the following reasons: For Office Use Only: 1 Fee Attached. Yes No 2. ProjectManager Obligation Form Attached? Yes� No 3, Pump3vstem? If so,Attach copy ofElectdcal Permit Yes_ No 4. Foundation As Built. (new construction ronly); Yes_ No (Same scale as approved plan) .5 F1oorPl2ns?(new construction only): Yes_ No Application!orpispotal System lConstructioh Permit Page 2 of 2 I t SEPTIC SYSTEM.INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andoverlicensed installer for the:construction for the septic system for.the property at (Address of septic system) For plans by (En eer) Relative to the application of And dated (Installer's name) ngina a e Dated �� f3-®'l/ with revisions date o a s ate (Last r sed 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=roved 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.y As the installer,I am required to.have the necessary work completed prior.to the applicable inspections as indicated belowa I understand that requesting an inspection,without c!m letion:of the items in.accordance with Title 5 and the Board of Health Regulations may:resiA' $50:00 fine being.levied against:me and/or my company. a B66m of Bed Generally,this is the first(19, is a retaining wall,which should be done first. The installer must request the:inspection.but sloes 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 io:healthde2t@townoffiorthand6Ver.co townofriorthandover.com) from the engineer mast 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 And can constitute reasons for denial of the system and/or:revocation or suspension of My liee_ nse to operate in the Town of North Andover,sigiuficant fines to all persons irivolvedare also possible. 5.. As the.:installer, I understand that I must he on-site during the.performance.of the following construction_ steps: a. Determination that.the proper elevation of the exe2 vation bas been reached. b. Inspection ofthe sand and stave to be used. c. Final mspecdon 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: oday's Date) r ame:= tint e n , TOWN OF NORTH ANDOVER f NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES ©,,�.o e�.r ' �e O HEALTH DEPARTMENT o ' ~ t _ 1 . 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 '" ..•�`'" NORTH ANDOVER, MASSACHUSETTS 01845 �Ss'41 U t� 978.688.9540—Phone Susan Y.Sawyer,RENS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM �y NW Date of Submission: I Tt3VN Of KATH-MO uovtk HEALT1I131w Site Location: /ALEVA 1 Engineer: o U- Wt!rk�c�m e /lam w1,Aeie�, SIJ G I e New Plans? Yes `�$225/Plan Check# *'041e) (includes I"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#: �� 20 Lf-75`3 555' Fax#: ,dj 77S E-mail: 1,A{Zhu. Gh�J��� 6&1-4 6&e.7-, Homeowner Name: �,� 11 ��2Ot.� L'-1-- OFFICE aCOFFICE USE ONLY When the submis 'on is complete (including check): )0- Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts Cityrrown 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. 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 Paul Proulx Residence only the tab key Name to move your 491 Salem Street cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code r� 2. Owner Name and Address(if different from above): ANA SAME '�fAf Name Street Address City/Town State (978)685-2240 Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 4 Commonwealth of Massachusetts City/Town of North Andover Y Form 9A - Application for Local Upgrade Approval �M 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: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 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: date of inspection 2. Describe the proposed upgrade to the system: 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 1.0 ft. Percolation rate 8 min./inch Depth to groundwater 3.0 LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 i Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M 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: Randy Burley 10-31-11 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: Full compliance would result in a high mound on a small lot creating drainage and grading difficulties in addition to unecessary financial burden. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval,Page 3 of 4 Commonwealth of Massachusetts Cityrrown of North Andover a Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete plans and specifications ® 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." 11-10-11s Facility Owner's Signature Date Paul Proulx Print Name Bill Dufresne/Merrimack Engineering 11-10-11 Name of Preparer Date 66 Park Street Andover Preparer's address Citylrown MA/01810 (978)475-3555 State/ZIP Code Telephone LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval, Page 4 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Paul Proulx Owner Name 491 Salem Street 38/10 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2008 1:15,840 421 2. Published Soil Survey Available? ® Yes ❑ No If yes: Year Published Publication Scale Soil Map Unit Canton Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No if yes: Year Published Publication Scale Map Unit Till Ground Moraine Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? [:] Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No ti 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): 10/2011 10/2011ar Range: ❑ Above Normal ® Normal ❑ Below Normal 7. Other references reviewed: Test Pit Form t5form11.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 —t\-, Commonwealth of Massachusetts City/Town of North Andover -- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Dee Observation Hole Number: T-1 10-31-11 1:00 pm sunny-40's P Date Time Weather 1. Location Ground Elevation at Surface of Hole: 96.1 Location (identify on plan): See plan House lot none 0-3 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Ground Moraine side slope Vegetation Landform Position on Landscape(attach sheet) 95 3. Distances from: Open Water Body feet>100 >100 Drainage Way feet Possible Wet Area feet Property Line 15 feet Drinking Water Well feet>100 Other feet 4. Parent Material: Till Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ® Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 42" ---- 5. Groundwater Observed: ® Yes F-1NoIf yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 39 92.8 inches elevation Test Pit Form t5form11.doc•rev. 1/10 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover A Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal wM C. On-Site Review(continued) Deep Observation Hole Number: T-1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Consistence Other Depth(in.) Layer Moist(Munsell) (USDA) Cobbles&' Structure Depth Color Percent Gravel (Moist) Stones 0-12 Fill 12-21 A 10YR2/2 FSL Wk Gran V Friable 21-42 B 10YR4/6 FSL Massive Friable 42-104 C 2.5Y5/4 39" 5Y6/2 >5 Gr SL >15 5 Massive Friable Uncompac ted Additional Notes: Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Dee Observation Hole Number: T-2 10-31-11 1:00 pm sunny-40's Deep Date Time Weather 1. Location Ground Elevation at Surface of Hole: 96.7 Location (identify on plan): See Plan House lot 0 0-3 2. Land Use (e.g.,woodland;agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn. Ground Moraine Side Slope Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body feet00 Drainage Way f et Possible Wet Area sot >100 Property Line est Drinking Water Well feet Other feet 4. Parent Material: Till Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ® Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 7011 5. Groundwater Observed: ® Yes ❑ NO If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 45 92.9 inches elevation Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Consistence Other Layer Moist(Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel (Moist) Stones- 0-35 Fill 35-41 A 10YR2/2 FSL Wk Gran Friable 41-51 B 10YR4/6 FSL Massive Friable 51-116 C 2.5Y5/4 45 5Y6/2 >5 Gr SL >15 5 Massive Friable 3 Additional Notes: Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: A. B. ❑ Depth observed standing water in observation hole inches inches A. B. ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) A. 39 B. 45inches inches A. B. ❑ Groundwater adjustment(USGS methodology) inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: 104/ 116 ninches a Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and thafthe above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. 11-4-11 Signature of Soil Evaluator Date William Dufresne 5-9-96 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Randy Burley Mill River Consulting for NA BOH Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. Test Pit Form t5form1l.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 _41N, Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 r Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer, use Paul Proulx only the tab key Owner Name to move your 491 Salem Street cursor-do not use the return Street Address or Lot# key. North Andover MA 01845 arown State Zip Code r� Contact Person(if different from Owner) Telephone Number B. Test Results Date Time Date Time Observation Hole# Depth of Perc Start Pre-Soak End Pre-Soak Time at 12" Time at 9" Time at 6" Time(9"-6") Rate (Min./Inch) Test Passed: ❑ Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnessed By: Comments: *SEE PARTICLE SIZE ANALYSIS BY TERRA FILTER DATED 11-9-11 in LIEU of a PERC TEST t5form12.doc•06/03 Perc Test•Page 1 of 1 3 TerraFilter,LLC. j P.O.Box 227 1001 St. Sturbridge,MA 01566 Tel: (508)347-5508 WbEvaFilter (877)347-9857 Fax:(508)347-9857 November 9,2011 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 RE: Particle Size Analysis (Alternative to Perc Test) 491 Salem Street, North Andover, MA Dear Bill: Below are the results of the particle size analysis from the sample submitted for the above referenced property. The analysis was performed utilizing the hydrometer method of Gee & Bauder (1986) in Methods of Soil Analysis, Part 1. Physical and Mineralogical Methods,2nd Edition. Sand Silt Clay (2.00 to.05mm) (05 to.002mm) (<.002mm) Portion Passing 83.4% 14.2% 2.4% #10 Sieve USDA Soil Textural Classification: Loamy Sand MA Section 15.243 Soil Classification: Class I Based upon the DEP's Title 5 Alternative to Percolation Testing Policy for System Upgrades, the following effluent loading rates apply: Un-compacted Soil 0.66gpd/sf Compacted Soil 0.15gpd/sf Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, Mark Farrell, Soil Scientist k TOWN OF NORTH ANDOVER Noerk Office of COMMUNITY DEVELOP MENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Q�S;Emus Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX _ healthde t townofnorth w ~ov www.townofnorthandov .com APPLICATION FOR SOIL TESTS mt,'T ;I 1 TOWN OP 1�ORTPI A 00A R DATE: I fJ�Z.�� I I MAP&PARCEL: J . _ DEpgRTlyE1V7' LOCATION OF SOIL TESTS: i !SAL O 42 r'r' OWNER: l � �,�(� Contact#� _7(�� APPLICANT: LJ/� Contact#: ADDRESS: 49 ENGINEER:}Jft,1?-II ,C1/� &(' n�4 /� Contact#: ��j' �7�' rj�7`j }[• 2�J CERTIFIED SOIL EVALUATOR:A21 Intended Use of Land: Reside ial Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing Upgrade for Ad ition:a 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 elan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Boar/of ealth O „� showing the location of all tests(including aborted tests). j wv ➢ Within 60 days of testing soil evaluation forms shall be submitted. C' l� Please Do Not Write Below This Line N.A. Conservation Commission Approval ate: 7 Signature of Conservation Agent: Date back to Health Department: (stamp in): �I 1 y 96 6 .94 LD �► f 5761 ;= FRO?OSED ,s ,, F-��E�ci•IT pp t 77, t j ► N J r {yq� r` �`L�'T* ., y R�tt JO q � �77CJCIW 4t ,37f — ` r $ia41�YfRgtyT 24 R S�;SUr�r�r i' 1 P1f+(�H4 (ntGJrTiJSHED Sid E CONDITIONS.:.� CWIDTt,,J8 :E,,M STREET. � LTY C4Rp NOTE LOT LOCATtOtr/�HO'SURVEY13 --YR d SCA'GEJ 4O':. ED�l`E 1I-1-G'2 EJ]GINERItpA7ED$g HJ 56-9 "`t i DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, November 01, 2011 8:55 AM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: Emailing: 491 Salem St soils.PDF Attachments: 491 Salem St soils.PDF Please find attached the results of soil testing at 491 Salem St yesterday. Thank you, Randy Burley The message is ready to be sent with the following file or link attachments: 491 Salem St soils.PDF Note:To protect against computer viruses,e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 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 ::a# '- -.« s a a..., `•'n- r - .. , .'. `. X S i 17112 »++�sw :?r �",,Y •, r ,� '7-'._".. ,. - .� t. - 11 Will illm _ r a ni F r , I I i I t t I r� ll ��` � i t i � II � � l na0r i _. }_ } ��I �_ - � J'1b7 l� � h�j�D j ���i � _{ _�.•-I - - l� + � ; F XLi I �— ' 1�� { i 1 s 11 t a •I ___ � ' ' I 1 i - � i [J� � i I I tl ro, �,y•1 �,� r i -._`(vri.�d!--t- -} �i f,������I , �� ��✓j I i �� i f�-� __ -':.r� .:I-.�,•,-_-�Y ,�r., DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, April 24, 2012 10:20 AM To: 'wrdufresne@comcast.net' Cc: DelleChiaie, Pamela Subject: as builts Good morning Bill, I am going over the 491 Salem as-built and the scale is fine, but I cannot read the small type like the BM and type in the building's details...Even with Sandy's old magnifying glass. Could you please blow up this section for me on 491 and send it over, so I can attach it?Also, In the future,at this scale,would you please increase the type? It would be greatly appreciated. Thanks Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg.20,Unit 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.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:htti)://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 i DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, April 10, 2012 8:35 AM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: Emailing: Construction Inspection Form 4-9-12.doc Attachments: Construction Inspection Form 4-9-12.doc Please find attached the results of the final inspection at 491 Salem Street with Todd Bateson. Sincerely, Randy Burley The message is ready to be sent with the following file or link attachments: Construction Inspection Form 4-9-12.doc Note:To protect against computer viruses,e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. 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:htt2://www.sec.state.ma.us/pre/Xreidx.htm. Please consider the environment before printing this email. i Sent: Friday, March 30, 2012 3:51:34 PM Subject: Septic Plan Approval with variances - 491 Salem Street Hi Bill, Attached is the approval for 491 Salem Street septic plan including the variances that Susan brought to the BOH last night which were also approved. The original was mailed to the homeowners,Mr. and Mrs.Proux. Todd Bateson applied for construction permits for this one and 332 R.T. Lane. I spoke with him today that they are ready for pickup (permits/plans). The only thing I still need are copies of the electrical permits for the pumps. Have a great weekend! Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street ! Bldg.20 ! Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.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 referto:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, April 04, 2012 10:15 AM To: DelleChiaie, Pamela Subject: FW: Septic Plan Approval with variances-491 Salem Street Not sure how we will handle Bill's next submission. In regards to $$ and review. Just an FYI, of what I am thinking. S From: Sawyer, Susan Sent: Wednesday, April 04, 2012 10:13 AM To: 'Dan Ottenheimer' Subject: FW: Septic Plan Approval with variances - 491 Salem Street Dan, PIs read Bill's email below. He will be submitting a plan for chambers once the pipe and stone plan is approved. I haven't seen this before, so my question is. Do you think I need to send this plan to Mill River? And charge them again? If I send it,would you charge a full review fee? Just Debating Thx From: wrdufresne(&comcast.net [mailto:wrdufresne(atcomcast.net1 Sent: Tuesday, April 03, 2012 3:34 PM To: DelleChiaie, Pamela l Cc: george haseltine Subject: Re: Septic Plan Approval with varian es - 491 Salem Street Pam, I was just checking on the status of the plan review for the 2 new contruction septic designs submitted at 2001 & 2005 Salem Street for George Haseltine. Once the reviews are completed, and it has been demonstrated that the requirements of Title 5 have been met for a conventional design, we are prepared to submit alternative designs using Infiltrator Chambers. we would like to submit those designs in conjunction with the conventional plan revisions so as to expedite the review & approval process as quickly as possible. Please let me know as soon as you hear anything back from Mill River. Thank you, Bill From: "Pamela DelleChiaie" <pdellech townofnorthandover.com> To: "Bill Dufresne (wrd ufres n ea-com cast.net)" <wrd ufres nea-com cast.net> Cc: "Susan Sawyer" <ssawyer townofnorthandover.com> I North Andover Health Department (ommunity Development Division March 30,2012 Paul Proux 491 Salem Street North Andover,MA 01845 RE: Subsurface Disposal System Plan,491 Salem St,Map 38 lot 10 Dear Property Owners, 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 Merrimack Engineering Services,dated November 10,2011, last revised December 13,2011. The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(max. nine room house). This plan is good for 3-years from the date of approval. 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 The following local variances have been approved at a Board of Health meeting on March 29, 2012. 1) The soil absorption system distance to a wetland is reduced from 100 feet required to 60 feet 2) The distance from the septic tank and the wetland is reduced from 75 feet to 58 feet This approval is 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. 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com 4 System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 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 may have. Sincere'V Su an Y. aS e , HS/R Public Health Director Encl: list of licensed septic system installers Form 9b Cc: Merrimack Eng. Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts W City/Town of Local Upgrade Approval Form 913 M 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 Paul Proulx key to move your Name cursor-do not 491 Salem Street use the return key. Street Address 40----h North Andover MA 01845 1�=V City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State. Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok ® PE [:IRS Name 66 Park Street Andover MA 01810 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 491 Salem Street491 Salem st 9b 3.30.12.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of a Local Upgrade Approval Form 9B i M Sye B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 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 Print or Type Name and Title mature �'' �--" Date 491 Salem Street491 Salem st 9b 3.30.12.doc•rev.7/06 Local Upgrade Approval* Page 2 of 2 MERRIMACK ENGINEERING SERVICES, INC. ` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET• ANDOVER,MA 01810•(978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com December 14, 2011 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 o2.�p North Andover, MA 01845 To 00 No- INY �2 RE: 491 Salem Street Dear Ms. Sawyer, We received your review letter dated 12-12-11 for the above referenced site. We revised the plan and soil evaluation forms with regard to all items of your letter. We feel we have adequately addressed your concerns and respectfully request that the plans be approved as re-submitted. Yours truly William Dufresne Merrimack Engineering Services. I MERRIMACK ENGINEERING SERVICES, INC, ` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET•ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1 1 neenng.com December 13, 2011 , Susan Sawyer Public Health Director 1r OF THANno HEALTH RAtiINT. 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: 491 Salem Street Dear Ms. Sawyer, We have completed a septic system upgrade design for the above referenced site. Due to psite constraints,primarily the presence of wetlands,we are unable to meet the Local required setback distance from the septic tank and the soil absorption system to a wetland. The system, as designed,proposes a setback of 60 ft. from the s.a.s. to a wetland where 100 ft. is required and 58 ft. from the septic tank to a wetland where 75 ft. is required. The system, as designed, does meet all state required setbacks from wetlands. On behalf of our client, we respectfully request that this matter be placed on your earliest available meeting agenda for consideration of these local variance requests. Thank you for your prompt attention to this matter. Yours truly, William Dufresne Merrimack Engineering Services s DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Wednesday, October 26, 2011 1:17 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer'; 'Isaac Rowe'; 'Peters, Marianne' Subject: RE: Soil Testing Scheduling requested -491 Salem Street I spoke with Bill and we are going to do both that day. Thank you, Randy Burley Project Manager 978-282-0014 From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Wednesday, October 26, 2011 10:34 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: Soil Testing Scheduling requested - 491 Salem Street Hello, Conservations comments: 10/25/2011 -"test pits to be more than 50 feet from wetlands." Please call Bill Dufresne to schedule this testing. Is it possible to piggy back to the 940 Johnson testing on 10/31? Thank you. gist RePaU4, 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 R Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com '2S Website http://www.townofnorthandover.com/Pam/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."—Anonymous From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net] Sent: Wednesday, October 26, 2011 10:30 AM To: DelleChiaie, Pamela Subject: Re: 491 Salem Street Pam, Heidi called me yesterday and said that she looked at 491 Johnson Street and would be signing off on it. Can I contact Mill River to schedule the testing, please advise. Thanks, Bill i `i 'Prom: "Pamela DelleChiaie" <pdellech@townofnorthand over.com> To: "wrd ufresne@comcast.net" <wrd ufresne@ com cast.net> Cc: "Susan Sawyer" <ssawyer@townofnorthandover.com>, "Jennifer Hughes" <jhughes@townofnorthandover.com>, "Heidi Gaffney" <HGaffney@townofnorthandover.com> Sent: Monday, October 24, 2011 12:41:38 PM Subject: RE: 491 Salem Street Hi Bill, I did request that Conservation look at the site as soon as they can. Once I get their comments back,I will ask Mill River to schedule. Please note that I did just receive this application late Friday afternoon from the homeowner. real Rigaada, 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 11 Fax-978-688-8476 0 Email-ndellechiaieotownofnorthandover.com '� Website http://www.townofnorthandover.com/Pages/index "We can never see the Bath of our life if we are too busy focusing on the pebbles under our feet."—Anonymous From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net] Sent: Monday, October 24, 2011 11:44 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan Subject: 491 Salem Street Pam The season is quickly coming to an end, I just had soil testing moved up to October 31st for 904 Johnson Street, Mill River mentioned they are very busy, did you receive the test pit application and fee for 491 Salem Street, and if so, can we schedule it for the same day as 904 Johnson Street, Mill River confirmed to me that they are able to do both on that day. Please let me know, Thanks, Bill From: "Pamela DelleChiaie" <pdellech@townofnorthandover.com> To: "GEORGE.HASELTINE@GMAIL.COM" <GEORGE.HASELTINE@GMAIL.COM> Cc: "Bill Dufresne (wrd ufres ne@com cast.net)" <wrd ufres ne@com cast.net>, "Susan Sawyer" <ssawyer@townofnorthandover.com> Sent: Friday, October 21, 2011 3:36:15 PM Subject: Septic - 2009 Salem Street (Map 108.A-Lot2) - Septic Plan Approval Hello George, Attached is your septic design plan approval for use in the construction of a replacement,three bedroom,on- site septic system. This plan is good for three years from the date of approval. Please review the additional information in the letter and form atttached. 2 .PAlso included is your Local Upgrade Approval-Form 9B to allow the Reduction in separation between the SAS and high groundwater. Please call the office if you have any questions. The original,hard copy of this letter has been sent via regular mail. Have a wonderful weekend!O Vint 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 W Office-978-688-9540 It Fax-978-688-8476 0 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 If you are happy with the customer service you have received from town departments,please let us know...feel free to complete the general Comment Form (link below): http://www.townofnorthandover.com/Pages/NAndoverMA WebDocs/contact 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. 3 DelleChiaie, Pamela From: wrdufresne@comcast.net Sent: Monday, December 12, 2011 5:39 PM To: DelleChiaie, Pamela Subject: Re: 491 Salem Street, North Andover Pam will get that letter to you ASAP From: "Pamela DelleChiaie" <Pdellech .townofnorthandover.com> To: "Bill Dufresne (wrd ufres n ea-com cast.net)" <wrd ufresnea-com cast.net> Sent: Monday, December 12, 2011 2:27:10 PM Subject: 491 Salem Street, North Andover From: Sawyer, Susan Sent: Monday, December 12, 20112:15 PM To: DelleChiaie, Pamela Subject: 491 Salem They need to be on a meeting for the variances. Please ask Bill to send a request letter listing the variances and LUA's. thx Stm att SatvyeA J ub&Xeaft 1Dhwdan 1600 Uogaad Stud 53edg 20,unit 2-36 ✓ et&andauen,✓to 01845 affce 978 688-9540 lax 978 688-8476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. 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 ♦ SF''fD��6 ♦ i^'1 R � CCI 9 .�. North Andover Health Department Community Development Division December 12, 2011 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 491 Salem Street,Map 38, Lot 10 Dear Mr. Nemchenok: The proposed wastewater system design plan for the above site dated November 10, 2011 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. Please note all LUA requests on plan NA 3.2 2. Please depict distance from rear wetland to tanks(s) 3. A variance to the local NA regulation will be required to be requested to have the leaching facility less than 100' to the wetland resource area NA Table 1 4. A variance to the local NA regulation will be required to be requested to have the tank(s) less than 75' to the wetland resource area NA Table 1 5. Page 3 of 4 lists "Randy Burley" as the soil evaluator. I believe you were the evaluator and Mr. Burley was the witness, please revise and sign where indicated on that page 6. Please provide a pump curve 15.220(4)(r) 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 4 491 Salem Street December 12, 2011 Page 2 of 2 Please note the reviewer has observed a repeated problem in the field, and has the following recommendation, though not required by the code. Depict a gas baffle 15.227(4); while Title 5 says for an effluent filter or gas baffle, the preference is for both, for the reason that if the effluent filter is removed and not reinstalled, the gas baffle feature is also lost. This is not a deficiency only an observation. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Ausan er, REHSh Director cc: File Homeowner—Paul E. Proulx &Elaine R. Proulx Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ;y 3.4 Design plans for a tight tank shall require approval of the Board of Health at a public hearing. 3.5 All drilled or(lug wells shall meet all setbacks and be considered potable water supply wells. 3.6 Wetlands resource area setbacks as described in these regulations and in Title 5 are to be measured from the resource as may be jurisdictional under federal,state or North Andover requirements. 3.7 No well shall be constructed or placed within the distance specified in Table 1 from the component of an existing onsite wastewater system. 3.8 If a variance to the North Andover Board of Health regulations, Title 5 Local Upgrade Approval and/or Title 5 variance can be met with the incorporation of a Massachusetts Department of Environmental Protection(DEP)-approved device which reduces wastewater to levels below 30 mg/L BOD and 30 mg/L TSS,then the design plan can be approved by the Health Department and does not require a hearing before the Board of Health unless otherwise required. 3.9 Per the current fee schedule,the fee for the onsite wastewater system plan review shall be paid upon Initial submission and will cover the first revision if applicable. Each subsequent revision will require a separate fee. TABLE 1 -SETBACK DISTANCE TABLE Resource Build Septic Tanks,Pump Tanks, Soil iug Treatment Units,Tight Absorption Sewer 'Tanks,Grease Traps(feet) System (feet) Deck on footings 5 10 Tributaries to Surface Water Supply 325 325 Watercourses or Wetland - Resource Areas 75 100 Wetlands Bordering Surface 150 150 Water Supply or Tributary in watershed district) Private Well 50 (setbacks are supplemented to AfADEP 310CMR 15) _— - _ -- Page 6 Town of North Andover t NORTH , OFFICE OF �2 0�t, L COMMUNITY DEVELOPMENT AND SERVICES O A 27 Charles Street ` 09 e North Andover,Massachusetts 01845 Ssnc►+usE�th WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 Elaine Proulx 491 Salem Street No. Andover,MA 01845 January 12,2000 Dear Elaine, This correspondence is in regard to your question about selling your goods out of town. I spoke with Patti Craft, the Health Agent for the Town of Andover. I told her about the recollection you had concerning a reciprocal agreement with the two towns. She stated that she was not aware of any such agreement and does not have any home cooks with similar circumstances. Basically, she would not allow it,and therefore I have to agree. However, she does permit the Blue Cow, and suggested that possibly you might consider doing your prep work at their location. That would be fine with our department and would not have any bearing on your local permit. I hope this answers your question. If you have additional concerns feel free to call me at the number below. Thank you. ZSincererd BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i FRANK S.GILES II DATE:JULY 25,2005 SCOTT L.,GILES PLAN OF LAND REVISIONS: FRANK S. GILES LOCATION JULY 25,2005 SURVEYING 1 491 SALEM STREET MAP 38 SCALE: 1"=20' 50 DEERMEADOW ROAD 01 NORTH ANDOVER, MA PARCEL 9 2040 NO.ANDOVER,MA 01845 978-683-2645 —� FrankGilesSurvey@comcast.net PREPARED FOR JULY 25 2005 PAUL PROULX ZONING DISTRICT RI WO GRADING TO BE DONE. 54i S5�QQ g ��9 SUBJECT PROPERTY THE GRADING SHALL NOT BE ALTERED. MAP 38,PARCEL 10 PAUL E.&ELAINE R.PROULX 491 SALEM STREET NORTH ANDOVER,MA.01845 TEL.978-685-2240 BK. 1685,PG. 143 �� Jy AREA=0.76 D.O.S=6/15/83 SEE PLAN#8650 a5,6 � RECEIVE® j MAl'L °o PARCEL 10 JUL 2 9 2005 0 fr 33,017 E.F. S.F. ��, ±-4 e4 NORTH ANDOVER CONSERVATION COMMISSION 5 / W ETLAN I? Q s, d �o 0V. 71l' L L(– I JIM I 110clIEI'll.i?F.M 7/27/Oi ;v\l MAP 38 ROPOSED DECK PARCEL 300 O y NO FOUNDATION AREA=281 S.F. 0 0 SIISATION TWO 1"X 1"X 3' "38 I CONTFENROL STAKESINEACH BALE o PARCEL 107 v�R>fs { —VARIES e O O MAP 38 O� O T PARCEL 299 RUNOFF pp2 CONTROL HAY B FENCE TOBUTT tt TOGETHER o Eg}5 VAC` PLAN END VIEW Y` NOT TO SCALE NOT TO SCALE SILTATION CONTROL FENCE 1"X1"OAKSTAKES .] BACKED BY STAKED HAY BALES WIRE TIE(TYP.) 6" EXISTING GROUND 1 4 EROSION CONTROL DETAIL PROFILE Norro SCALE C:\CLIENTS\PROULN\PLAN.DRG