HomeMy WebLinkAboutMiscellaneous - 52 OLYMPIC LANE 4/30/2018 52 OLYMPIC LANE
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Residential Property Record Card
PARCEL ID:210/106.B-0111-0000.0 MAP:106.6 BLOCK:0111 LOT:0000.0 PARCEL ADDRESS:52 OLYMPIC LANE FY:2011
PARCEL INFORMATION Use-Code: 101 Sale Price: 200,000 Book: 04367 Road Type: T Inspect Date: 03/10/2010
Tax Class: T Sale Date: 10/26/95 Page: 0243 Rd Condition: P Meas Date: 03/10/2010
Owner: Tot - -- _ . T__
WerNSTEIN, PAUL D Tot Fin Area: 2464 Sale-Type'-70 Cert/Doc: Traffic: M Entrance: C
Address: Tot Land Area: 1.48 Sale Valid: N Water: Collect Id: RRC
52 OLYMPIC LANE Grantor: ARCIDIACONO,ROBERT Sewer: Inspect Reas: C
NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% /
RESIDENCE INFORMATION LAND INFORMATION .
Style: CL Tot Rooms: 7 Main Fn Area: 1232 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R1
Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1232 Bsmt Area: 1232 Seg Type —Code- Method Sq-Ft Acres Influ-Y/N Value Class
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 225,640 Q.
Ext Wall: FB Half Baths: Unfin Area: Bsmt Grade: 2 R 101 A 0 0.480 3,648
MasonryTrim: at Bath Fix 0 Tot Fin Area: 2464 VALUATION INFORMATION
Foundation: CN Bath Qua[: T RCNLD: 234641 _ Current Total: 463,900 Bldg: 234,600 Land: 229,300 MktLnd: 229,300
Ext tch: T e r Built: 1983_. Mkt n dj: Prior Total: 483,600 Bldg: 254,300 Land: 229,300 MktLnd: 229,300
Heat Type: HW Ext Kitch: Year Built: 197.9 Sound Value:
Fuel Type: G Grade: G Cost Bldg: 234,600
Fireplace: 1 Bsmt Gar Cap:2 Condition: FA Att Str Va11:
Central AC: Y Bsmt Gar SF: Oct Complete: Att Str Val2:
Att Gar SF: %Good P/F/E/R: /100/100/84
Porch Type Porch Area Porch Grade Factor
W 192
SKETCH PHOTO
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12 192 S%rt 12
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16 44
..... ....
FU/FM/B NOH
1232 S%Ft
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52 OLYMPIC LANE
Parcel ID:210/106.6-0111-0000.0 as of 1/25/11 Page 1 of 1
4
KINGSTOWN CORPORATION
61 CAMELOT DRIVE,PLYMOUTH,MA 02360
PHONE: (508)746-1101
FAX: (508)747-2021
Email: kingstonwcorp@comcast.net
November 28, 2012
Mr. Raj ender Dudani
Sayana Assets Investments, LLC
1970 Beacon St.
Waban, MA 02468
RE: Past due balance of$2316.85, J. Kellett Excavating, 52 Olympic Lane,N. Andover,
MA
Dear Mr. Dudani,
Kingstown Corporation delivered Title V Perk Fill to your house in September 2012 (see
attached invoice). After numerous calls and promises by Mr. Kellett to pay the full
balance $2316.85 the balance remains unpaid. Kingstown Corporation requests that any
and all monies owed by you to Mr. Kellett be held at this time.
Kingstown Corporation will be seeking attachments on any money, property or
equipment of Mr. Kellett's,because without these funds Kingstown will continue to
experience financial hardship.
I thank you for your immediate attention to this matter. If you have any questions please
feel free to contact me.
?eneral
cc: Kellett Excavating
400 Salem St. RECEMED
Lynnfield, MA 01940
Moon cc: Board of Health
�;Ei, 4 3 2012
Manager 1600 Osgood St. TOWN OF NORTH ANDOVER
JM/sld N. Andover, MA 01845 HEALTH DEPARTMENT
Cert./reg mail 7012 1010 0003 0654 9980, 9966, 9959
� � O � INVOICE
A V m.�jj- Ln I to wn CO'Z �zQtGO n
I� h
61 CAMELOT DRIVE •PI.YNIOUTH, A 02360
From Order# 22263
SOLD TO SHIPPED TO
KELLETT EXCAVATING OLYMPIC LN.
400 SALEM ST. N. ANDOVER
LYNNFIELD, MA 01940
(781) 599-7934
Y -
KELL1001 NET 30 09/10/12
101 . 05 12 YRDS OF PERK FILL 12. 00 1212. 60
09/05/12
N. ANDOVER
69. 14 02 Tons of Sand 14 . 00 967 . 96
09/06/12
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FINANCE CHARGE
2180 . 56
A Service Charge of MISC. Charges
1-1/2% per month (18%per year►
will be charged on all unpaid 6 .2505ales Tax 136 . 29
balances over thirty days.
s.
a
THANK YOU
". ` , § ;�Y 2116 - 851
Phone:508-746-1101 • Fax:5n8.747-2021
tf.
J
• S�TTCED l�
North Andover Health Department
Community Development Division
July 15, 2011
Raj Dudani
52 Olympic Lane
North Andover, MA 01845
RE: Subsurface Sewage Disposal System Plan for 52 Olympic Lane, Map 106B, lot 111,
North Andover, Massachusetts
Dear Property Owner,
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 Merrimack Engineering Services,
dated May 23,2011, last revised June 27,2011. The design has been approved for use in the
construction of a replacement onsite septic system for a three bedroom design at 440 gallons per
day. Generally this plan would be good for three (3)-years from the date of approval, however
since this repair is the result of a Title V report failure,this system must be completed within two
(2)-years.
This includes the approval of local upgrades
1) To the vertical offset from the Soil Absorption System to the Estimated high water table
from 5 feet to 4 feet
2) Only having one deep hole in the disposal area
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.
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
52 Olympic July 15, 2011
This approval is also subject to the following conditions:
1. With the understanding that the granting of the reduction of the distance to the high
water table restricts future expansion of the buildings flow capacity beyond 440
gallons per day(4 bedroom,maximum 9 rooms),unless the system is upgraded to a
compliant distance of five feet to the water table. 310 CMR 15.405(4)
2. If site conditions are found in the field to be different from those indicated on the
design plan and/or soil evaluation,the originally issued Disposal System Construction
Permit is void,installation shall stop, and the applicant shall reapply for a new
Disposal Systems Construction Permit(3 10 CMR 15.020(1)).
3. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and
municipal requirements are met. These may include review by the Conservation
Commission, Zoning Board, Planning Board,Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit
shall not construe and/or imply compliance with any of the aforementioned
requirements.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
might have.
Sincerel
�S an Y. Sa er, RE S
Public Health Director
cc: Vladimir Nemchenok,Merrimack Engineering
file
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
d
D'
• S�'f� Icy •
North Andover Health Department
Community Development Division
July 5, 2011
Raj Dudani
52 Olympic Lane
North Andover,MA 01845
RE: Subsurface Sewage Disposal System Plan for 52 Olympic Lane, Map 106B, lot 111,
North Andover, Massachusetts
Dear Property Owner,
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 Merrimack Engineering Services,
dated May 23, 2011, last revised June 27, 2011. The design has been approved for use in the
construction of a replacement onsite septic system for a three bedroom design at 440 gallons per
day. Generally this plan would be good for 3-years from the date of approval,however since this
repair is the result of a Title V report failure,this system must be completed within two years
This includes the approval of local upgrades
1) To the vertical offset from the Soil Absorption System to the Estimated high water table
from 5 feet to 4 feet
2) Only having one deep hole in the disposal area
During this time, a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover. In the event an imminent health problem such as sewage backup into the dwelling is
occurring,the North Andover Board of Health may reduce the time period for which this plan is
valid.
This approval is also subject to the following conditions:
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
52 Olympic July 5, 2011
1. With the understanding that the granting of the reduction of the distance to the high
water table restricts future expansion of the buildings flow capacity beyond 440
gallons per day(4 bedroom,maximum 9 rooms),unless the system is upgraded to a
compliant distance of five feet to the water table. 310 CMR 15.405(4)
2. If site conditions are found in the field to be different from those indicated on the
design plan and/or soil evaluation,the originally issued Disposal System Construction
Permit is void, installation shall stop, and the applicant shall reapply for a new
Disposal Systems Construction Permit(3 10 CMR 15.020(1)).
3. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and
municipal requirements are met. These may include review by the Conservation
Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit
shall not construe and/or imply compliance with any of the aforementioned
requirements.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
might have.
Sincerely,
Susan Y. Sawyer, REHS/RS
Public Health Director
cc: Vladimir Nemchenok,Merrimack Engineering
file
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
f
Commonwealth of Massachusetts
City/Town of Raj Dundani
Local Upgrade Approval
Form 913
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address
on the computer,
use only the tab Raj Dundani
key to move your Name
cursor-do not 52 Olympic Lane
use the return
key. Street Address
North Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address(if different from above):
1970 Beacon Street
Name Street Address
Waban MA
City/Town State
02468 978 335-2366
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 ❑ RS
Name
66 Park Street Andover MA, 101810
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
52 Olympic form 9b 7-5-11.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
City/Town of Raj Dundani
a
o Local Upgrade Approval
Form 9B
B. Approval (continued)
® Reduction in separation between the SAS and high groundwater:
Separation reduction 1
ft.
Percolation rate <2 min/inch
min./inch
Depth to groundwater 4
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:
��- IBJ Y 7L In
Approving Authority
v s �►-, l!
Print or Type Name and Title _ �i nature' Date
52 Olympic form 9b 7-5-11.doc•rev.7/06 Local Upgrade Approval* Page 2 of 2
Commonwealth of Massachusetts
City/Town of Raj Dundani
e
Local Upgrade Approval
Form 913
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address
on the computer,
use only the tab Raj Dundani
key to move your Name
cursor-do not 52 Olympic Lane
use the return Street Address
key.
North Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address(if different from above):
1970 Beacon Street
Name Street Address
Waban MA
City/Town State
02468 978 335-2366
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 ❑ RS
Name
66 Park Street Andover MA, 101810
Address Cityrrown 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
52 Olympic form 9b 7-5-11.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
City/Town of Raj Dundani
d
Local Upgrade Approval
Form 9B
B. Approval (continued)
® Reduction in separation between the SAS and high groundwater:
Separation reduction 1
ft.
Percolation rate <2 min/inch
min./inch
Depth to groundwater 4
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:
��- 4-1, 1✓ �
Approving Authority
Print or Type Name and Title i nature Date
52 Olympic form 9b 7-5-11.doc•rev.7/06 Local Upgrade Approval* Page 2 of 2
• f
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET•ANDOVER,MASSACHUSETTS 01810-TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com
8 FANEUIL HALL MARKETPLACE-THIRD FLOOR•BOSTON,MASSACHUSETTS 02109•TEL(617)973-6462• FAX(617)973-6406
June 27, 2011
Susan Sawyer
"t.
Director of Public Health car1�
1600 Osgood Street i
Building 20, Suite 2-36 �d , �
North Andover, MA 01845 TOWN C*ill�I�HGALTH �
RE: 52 Olympic Lane
Dear Ms Sawyer,
We are in receipt of your review letter dated 6-14-11 for the above referenced project.
We have revised the plan with regards to item 3,4, 6, 12, 13, 16, 17 & 18 of your letter.
With regard to item 1,the plan does show the current owners name.
With regard to item 2,the local upgrade approvals are clearly listed on the plan as they
have always been in the past. The section cited by the reviewer refers to VARIANCES
which are not the same as LUA'S and are treated as a matter of maximum feasible
compliance approved by the local authority.
With regard to item 5,no impervious barrier is proposed because the break out elevation
is met at 15 ft. The 96 contour is shown at 15.5 ft from the edge of the s.a.s. not 10 ft. as
the reviewer states.
With regard to item 7, Title 5 requires either a tee filter or a gas baffle. A tee filter is
proposed so we are unsure as to the intent of the reviewers comment.
/With regard to item 8,the reviewer is incorrect as to their interpretation of Title 5. You
received D.E.P.'s opinion on this specific matter in the past and yet it has been expressed
again. We respectfully disagree.
With regard to item 9,the pump calculations specifically mention that flow back for 20
ft. of force main is negligible and it has been the opinion of your Board in the past that
flow back for any force mains less than 50 ft. is negligible. Friction loss has been
included in the TDH calculations.
With regard to item 10 and 11,neither of the sections specified by the reviewer require
that the control panel or alarm equipment specifications be listed on the plan as
Page 2 (Susan Sawyer)
6-27-11
mentioned. Furthermore,this has never been a requirement of the NA BOH in the past.
This equipment is provided by the pump manufacturer and it is noted on the plan that it
must be in compliance with Title 5. We question why this has been mentioned in this
instance, but never in the past.
With regard to item 14,the plan does specify that all components be marked with
magnetic marking tape if a comparable means is not provided.
Lastly,with regard to item 15,this is a requirement that all licensed contractors should be
aware of, it applies to all systems, and should be addressed in the field as site conditions
warrant.
Additionally, and in the interest of Public Health, we are frustrated by the inaccuracy,
senselessness and inconsistency of the review process which seems to only add time and
cost to the process in North Andover.
On behalf of the owner, we respectfully request that the plan be approved as re-submitted
so they may proceed with the upgrade of their failed septic system.
Yours truly,
William Dufresne
Merrimack Engineering
MERRIMACK ENGINEERING SERVICES,INC.
66 PARK STREET•ANDOVER,MASSACHUSETTS 0181 o
• S�T'CtilD'�� .
•
North Andover Health Department
Community Development Division
June 14, 2011
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover,MA 01810
Re: Subsurface Sewage Disposal System Plan for 52 Olympic Lane May 106B Lot 111
Dear Mr.Nemchenok:
The proposed wastewater system design plan for the above site dated May 23, 2011 and received
on May 31,2011 has been reviewed. Unfortunately,the plan cannot be approved until the
following items are corrected. Where applicable the specific section in Title 5: 310 CMR
15.000, or North Andover regulation that is not met by this design follows each item.
1. Name of owner appears as Paul D. Weinstein on assessor's field card. Please advise if
property has been sold since the assessor's cards were last updated as the local upgrade
approval form 9A has the owner as Raj Dudani of 1970 Beacon Street, Waban,MA.
2. The note listing the local upgrade approval requests does not include the citations from
the code(3 10 CMR 15.220(4)).
3. The distance between the tanks and the property line and the distance between the tanks,
leaching facility and the wetland area is not shown(North Andover Section 3.2).
4. The manufacturer of the distribution box is not called out(North Andover Section 3.2).
5. If no impervious barrier is to be installed the breakout elevation must be carried out 15'
from the edge of the sand bed. The plan view shows the breakout elevation of 96.17
being carried out 10' from the edge of the sand bed. (3 10 CMR 15.211)
6. It appears that the bottom of the septic tank may be below the ESHWT. Please provide
buoyancy calculations for the septic tank(3 10 CMR 15.221(8)).
7. A gas baffle is required on the outlet tee of the septic tank(3 10 CMR 15.227(4)).
8. The pump chamber's outlet invert_is not specified. Please provide this so it can be
confirmed that the invert is at least 12"above the ESHWT(3 10 CMR 15.227(5)).
9. Pump calculations do not include flow back volume or friction loss within the pipe. (310
CMR 15.231(2)).
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
10. Pump control manufacturer and model number to be specified (3 10 CMR 15.220(4)(r)
and North Andover Section 3.2).
11. Alarm equipment manufacturer and model number to be specified(3 10 CMR 15.231(2)
and North Andover Section 3.2).
12. The most current DEP soil evaluation form 11 and percolation test log 12 should be used
(North Andover Section 2.3).
13. Vent should have filter on it to protect from precipitation/animal entry(3 10 CMR
15.241(1)(b)).
14. Please specify all system components shall be marked magnetic marking tape including
the septic tank(3 10 CMR 15.221(12)).
15. Grading should slope away from dwelling where possible.
16. Will fence be removed from back yard or replaced when construction is complete? Also
grading is shown through what looks to be a shed. Will this be removed and relocated?
17. The infiltrator end section detail and the Quick 4 plus standard LP chamber detail on
sheet 2 both show the chamber but one has a height of 12"and the other has a height of
8". It is possible you meant to show the 8"chamber as detailed with the invert
elevations. Also on sheet one the note"Prop. Leach field w/48 quick 4 LP infiltrator
chambers in a 6' wide by 8' long configuration." It appears you meant"in a 6 chamber
wide by 8 chamber long configuration."
18. There is a spot elevation on the northwest corner of the dwelling of 94.0 but a 96 contour
comes out from it.
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.
Sin7YSa�er,
l
l" SusREHS
Public Health Dire or .
cc: File
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
TOWN OF NORTH ANDOVER Noa,M
Office of COMMUNITY DEVELOPMENT AND SERVICES o?•`
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 '� • •''''
NORTH ANDOVER,MASSACHUSETTS 01845 �'Ss4c"u,s
978.688.9540—Phone
Susan Y.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthdept@townofnorthandover.com
WEBSITE:http://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM _
Date of Submission:
Site Location: '57i C-2L`r" P �i 0��% FT,,"rAL,,,
NII M AI QVI:R
8 P�1RYM NT
Engineer: P1 6M kK-c-� CIS.610 Epe::�hQ 6 ff//P s�/ l/
New Plans? Yes V $225/Plan Check# 6 ( l (includes Is'submission and one re-
review only)
Revised Plans?Yes $75/Plan Check##
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? Yes v No
Telephone#:(°I'7t>) Q?13-3 "55 Fax#:
E-mail: W 17�p U �Vr-��N� �►'�Cks'� 1.7�
Homeowner n I
Name: QJ PW
OFFICE USE ONLY
When the subs ion is complete(including check):
➢ Date stamp plans and letter
➢ �/ Complete and attach Receipt
➢ Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
' 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.
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 Raj Dudani Residence
only the tab key Name
to move your 52 Olympic Lane
cursor-do not
use the return Street Address
key. North Andover MA 01845
Cityrrown State Zip Code
tab
2. Owner Name and Address(if different from above):
Raj Dudani 1970 Beacon Street
Name Street Address
Waban MA
City/Town State
02468 (978) 335-2336
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
Commonwealth of Massachusetts
Cityrrown of North Andover
a
Form 9A - Application for Local Upgrade Approval
•" DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: 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:
Totalreplacement(see-plan}---------
3.
see-plan}_ ,-----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
ff.
Percolation rate 2
min./inch
Depth to groundwater 4.0
ft.
LUA FORM t5fonn9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4
Commonwealth of Massachusetts
City/Town of North Andover
Form 9A - Application for Local Upgrade Approval
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
E 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 4-26-11
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:
High water table
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
City/Town of North Andover
a Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
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."
ww qj j L 5-24-11
Facility Owners Signature Date
Raj Dudani _
Print Name
Bill Dufresne/Merrimack Engineering 5-24-11
Name of Preparer Date
66 Park Street Andover
Preparers 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
Location Address: Owner's Name: Ll VAK- - Date: 4 -°-1
Address: � & k _ Time: 10 voAH
Or Lot #: 711H1 Qr& � -rL I I` Weather: �2�,t:;
Telephone #:C� �
Deep Hole Number: Location (Identify on site plan) ;
Soil Soil Matrix Redoximorphic Features Soil Coarse Fragments
Depth Horizon Color—moist Texture %by volume Soil Soil Consistence
(inches) or layer (Munsell) Depth Color Percent (USDA) Gravel Cobbles Structure (moist) Other
Additional Notes:
Unsuitable Materials Present: _ No Yes If yes: Disturbed soil Fill Material
Impervious layer(s) Weathered or Fractured Bedrock Bedrock
Groundwater Observed No Yes If yes: Depth Weeping from Pit Face: Standing Water in the Hole - �
-Esti mated Depth to Seasonal High Ground Water '�
Location Address: SZ QLt H Vii, LA&t Owner's Name: Pt4 oQ PL— Date:
Address: LebeTime: jg2f�,&0
Or Lot #: Ifiv WeatherVaj2ZLI�r ;V.50
Telephone
Deep Hole Number: Location (Identify on site plan) PAAJ .
Soil Soil Matrix Redoximorphic Features Soil Coarse Fragments
Depth Horizon Color'—Moist Texture .%by volume Soil Soil Consistence
(inches) or layer (Munsell) Depth Color Percent (USDA) Gravel Cobbles Structure (moist) Other
V,.P",10
Additional Notes:
Unsuitable Materials Present: _ No _ Yes If yes: Disturbed soil Fill Material
Impervious layer(s) Weathered or Fractured Bedrock Bedrock
Groundwater Observed : No _Yes If yes: Depth Weeping from Pit Face: ' Standing Water in the HoleZ.a b
141istimated Depth to Seasonal High Ground Water `
•
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: October 16, 2012
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair and Construction of an
On-Site Sewage Disposal System
By:
Jim Kellet
At:
52 Olympic Lane
Map 1068 Lot 111
North Andover, MA 01845
Wis.suy.cSe of this certifi shall not be construed as a guarantee that the system will function satisfactorily.
a r, RE S
Public Health Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
yORth
41 F p RECEIVED
• i �
SACHUS OCT7
C16 2012
PUBLIC HEALTH DEPARTMENT 'TOWN OF NORTH ANDOVER
Community Development Division HEALTH DEPARTMENT
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(• constructed;( )repaired;
(Print Name)
Located at: �j7/ Cm Id a� .
(Installation Address)
Was installed inconformancewith the North Andover Board of Health approved plan,originally dated
0-49-I 1 yyand last revised on 6 -14- 1 with a design flow of
e4gy 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:
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date:
i
Du
Engineer Repres ntative(Signature)
BILV rV-61St70
And—Print e
3 /�'-' ' Ke lett
Installer: ( (Signature) Date: 46 — 1 /Z__
/ And— rint Name
Enginer: G � �l�it � ignature) Date: 0
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
•
• S�fTMD76yc
North Andover Health Department
Community Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 52 Olympic Lane MAP: 106B LOT: 111
INSTALLER: Jim Kellett
DESIGNER: Vladimir Nemchenok
PLAN DATE: 5/23/11
BOH APPROVAL DATE ON PLAN: 8/27/12
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 9/19/12
DATE OF FINAL GRADE INSPECTION: IdI (ig-
SITE CONDITIONS
n/a Contractor reports any changes to design plan
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
Comments:
SEPTIC TANK
® Building sewer in continuous grade, on
compacted firm base
n/a Cleanouts per plan
Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading
® Monolithic tank construction
®
Watertightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
(effluent filter)
® 20" inch cover to finish grade installed over
outlet
® Neoprene boots around inlet & outlet
Comments:
PUMP CHAMBER
] Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon Pump Chamber installed
® H-10 loading
® Monolithic tank construction
® Inlet tee installed, centered under access port
® Pump(s) installed on stable base
® Alarm float working
® Pump On/Off floats working
® Separate on/off floats
® Drain hole in pressure line
® 24" cover at final grade installed over outlet
® Water tightness of tank has been achieved by
visual testing
® Neoprene boots 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
n/a Speed levelers provided (not required)
Comments:
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
n/a 40 Mil HDPE barrier installed
® Laterals installed and ends connected to
header (and vented if impervious material
above)
® Elevations of laterals and chambers installed as on
approved plan
® 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 Low Profile
® Number of chambers per row: 8
® Number of rows (trenches): 6
Comments: Total Chambers = 48
BM = 96.1
HR = 2.47
Hl = 98.57
SYSTEM ELEVATIONS
ROD AS-BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark 96.1
Building Sewer OUT 3.89 94.33 94.62
Septic Tank IN 3.98 94.24 94.26
Septic Tank OUT 4.18 94.04 94.00
Pump Chamber IN 4.20 94.02 93.95
2" Pump Chamber OUT 4.02 94.38 ----------
4" Distribution Box IN 2.00 96.22 96.00
Distribution Box OUT 2.16 96.06 95.83
Lateral 1 TOP 2.37
Lateral 1 INVERT 95.85 95.78
Lateral 2 TOP 2.39 95.78
Lateral 2 INVERT 95.83 95.78
Lateral 3 TOP 2.37 95.78
Lateral 3 INVERT 95.85 95.78
Lateral 4 TOP 2.37 95.78
Lateral 4 INVERT 95.85 95.78
Lateral 5 TOP 2.38 95.78
Lateral 5 INVERT 95.84 95.78
Lateral 6 TOP 2.38 95.78
Lateral 6 INVERT 95.84
Top of Chamberl 2.38 96.19 96.17
Bottom of Bed/Chamberl 95.52 95.50
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, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA
wetland bylaws
Application for Septic Disposal System 6 — rZ-
'�
Construction Permit - TOWN OF TODAY'S DATE
''�•' • �`' ORTH ANDOVER, MA 01845 $260.00-Full Repair
$125.00-Component
Important: Application is hereby made for a permit to:
When filling out
forms on the ❑ Construct a new on-site sewage disposal system*
computer,use �f 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
key. A. Facility Information
VQ 51- 6Ly#4j0)C
Address or Lot#
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
Pump ❑Gravity(choose one)
***If pump system,attach copy of electrical permit to application***
❑Conventional System (pipe and stone system)
IV 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
R A.T- --b
Name
Z � IA 4 �..
Address TfefenAfrMm abode
City/Town State Zip Code
Telephone Number
3. Installer Information
�T�;A^-e-J RL K'V_U'e t--t- � �t-t o�,� --1 A1CF-
Name Name of Company
'406 S'4t (r P4 a-/--
Address
ETNA/�C/LrL� /�✓P O/I`�0
City/Town State q Zip Code
Telephone Number(Cell Phone#if possible please)
4. Designer Information
�c� VL,,a_p1 Pi)✓L
Na/me Name of Company
644 ` A&,t
Address
,4A.-� eez/rte
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
Application for Septic Disposal Svstem Y-;o•-)J,
}Construction Permit - TOWN OF TODAY'S DATE
ORTH ANDOVER, MA 01845 $250.00—Full Repair
'*sk $125.00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: Residential Dwelling or❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
een issued by this Board of Health.
Name Date
Application Approved By: (Board of Health Representative)
Name Date
Application Disapproved for the following reasons:
For Office Use Only:
L Fee Attached. Yes No
2. Project Manager Obligation Form Attached? Yes No
3. Pump System? Ifso,Attach copy ofElectrical Permit Yes No
4. Foundation As-Built?(new construction ronly): Yes No
(Same scale as approved plan)
5. Floor Plans?(new construction only): Yes No
I
Application for Disposal System Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
5,2 d CY?-A ,AV1!�
(Address of septic system) For plans by �L��a�Ac'K �N 6-1NE�riri--(ill�
- / (Engineer)
Relative to the application of-,J—,4$A es Kau,0-t
(Installer's name) And dated - Z-3- ! I
rignna ate
Dated �f� 2p - 1'Z,_ 6 _ /y
o ay s ate With revisions dated /
(Last revised date)
I understand the following obligations for management of this project:
1. As the installer,I am obligated to obtain all permits and Board of Health approved plansrior to
performing any work on a site. I must have the approved plans and the permit on site when any work is
being done.
2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager,or any
other person not associated with my company schedules an inspection and the system is not ready,then
item three shall be applicable.
3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
my company.
a. Bottom of Bed—Generally, this is the first(Vinspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties,etc.
As-built of verbal OK (or e-mail to:healthdept antownofnorthandover com) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of
North Andover. significant fines to all persons involved are also possible
5. As the installer,I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer_ I understand that I am solely responsible for the installation of the system as per the
approved Mans. No instructions by the homeowner,general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date) CF'�'U r
\],I`AAL zJ T�. lCELL L7f-�- �.
ame—Print) Coe— igne )
�L\ Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev-9/05] leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 20,2012
City or Town of North Andover 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) 52 Olympic Lane
Owner or Tenant Raj Dudani Telephone No.
Owner's Address 52 Olympic Lane North Andover MA
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
tches and high water alarm panel.
Date . table may be waived by the Inspector of Wires.
•.b�Ti�TD� ' , No.of Total
. :• Transformers KVA
TOWN OF NORTH ANDOVER Generators KVA
PERMIT FOR WIRING No.ot Emergency Lighting
1W 11 Battery Units
' FIRE ALARMS No.of Zones
This certifies that . . . 'fv�,(� �F fl �� ,/� 1 No.of Detection and
's 7 /
Initiating Devices
has permission to perform . . .� ��t�S! �I No.of Alerting Devices
No.of Self-Contained
wiring in the building of . . . . . . Detection/Alerting Devices
Local❑ Municipal El Other
at . . .�.,� . .��,��/,/.L(Pi,C_. . . . . . . . , ,North Andover, Mass. � Connection
Security Systems:*
ee . 7. , Lie. No.sFf 2.W?l No.of Devices or Equivalent
Data Wiring:
ELCTRICAL INSPEC •OR No.of Devices or Equivalent
Check# d 2 6P? Telecommunications Wiring:
No.of Devices or Equivalent
11034 q— 7-L Z-- ��/f esired, or as required by the Inspector of Wires.
pal policy.)
Work to Start: 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 certiA under the pains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: David W Meehan LIC.NO.: 81296A
Licensee: David W Meehan Signatu LIC.NO.: 8126A
(If applicable, enter "exempt"in the license number line) Bus.Tel.No.:_978-587-7518
Address: 4 Mulberry Drive Peabody,MA.01960 Alt.Tel.No.: 978-535-4022
*Security System Contractor License required for this work;if applicable,enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage.normally re-
quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$
o
Y
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES Fr °p
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH A TTS 01845 ,SSACMUSEt
�C�E
Susan Y.Sawyer,RENS,RS - �y,'' 8.688.9540—Phone
Public Health Director j1 78.688.8476—FAX
R �,�D ealthde t townofnorthandover.com
7711 ww.townofnorthandover.com
TOWN OF N07TH ANDOVER
HEALTH DEPARTMENT
APPLICATION FOR SOIL TESTS
ff
DATE: MAP&PARCEL: l ( j
LOCATION OF SOIL TESTS: � '� 0j,0'eA'i p^,C_L,A 4i
OWNER: A-YA r4H ,+`� c 'i�� a rig�G ;Oji,."j:. Contact#: 1 "' s s Z,—
APPLICANT: l�'t�a ���'' 1 'j Contact#:
ADDRESS: r)j A► ter 0 �Ji(6
ENGINEER: kCRt&01 AAC Vi" C4 Contact#:D J Y7'
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Resident rSubdivision Single Family Hom Commercial
Is This: Repair Testing: Undeveloped Lot Testing Upgrade for
Additio .F
In the Lake Cochichewick Watershed? Yes No
C/
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership(Tax bill,or letter from owner permitting test)
➢ 8.5"x II"Plot plan&Location of Testin lease in t i on the lap
➢ Fee of$425.00 per lot for new construction. This cover a minimum o deep holes and
two percolation tests required for each disposal area. Fe of$360.00 per to for repairs or upgrades.
GENERAL INF RMATION
➢ Only Certified Soil Evaluators may perform deep hole in ections.
➢ Only Mass.Registered Sanitarians and Professional Engine sign septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
➢ !A.'-.thin 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date: I
^A 4
Signature of Conservation Agent: Q s� 1 (.cJ1 I
Date back to Health Department:(stamp in):
w 04(a
�t�t— &41 :N4 C. P\,O-,,\ �1
01
10•
4 Ila
9-elleChiale, Pamela
From: Randy Burley[rburley@millriverconsulting.com]
Sent: Tuesday, April 26, 20114:28 PM
To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela;
Sawyer, Susan
Subject: 52 Olympic Lane
Attachments: 52 Olympic Ln soils.PDF
Please find attached the results of the soil testing today at 52 Olympic Lane.
Sincerely,
Randy Burley
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930
Ph 978-282-0014
Fx 978-282-1318
www.millriverconsulting.com
rburley@millriverconsulting.com
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more
information please refer to:http://www.sec.state.ma.us/pre/l)reidx.htm.
Please consider the environment before printing this email.
1
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01
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j
17,
SUMMARY OF INVERTS BUILDING TIES
SEWER ® FDTN. PRE.-EXIST. BLDG. CORNER A B C THIS PLAN & CERTIFICATION IS NOT
SEPTIC TANK IN 94.14 SEPTIC TANK OUT U 36.3 26.0 A WARRANTY OF THE SUBSURFACE DISPOSAL
SEPTIC TANK OUT 93.93 PUMP TANK OUT 28.5 34.3 SYSTEM. IT 1S A RECORD OF THE LOCATION
PUMP TANK IN 93.91 IDIST. BOX 42.0 28.7 AND ELEVATION OF THE EXISTING SYSTEM
DIST. BOX IN 96.13 COMPONENTS.
DIST. BOX OUT 95.98
INV. IN CRAM. 95.76 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
BOTT. CHAM. 1 95.50 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 ,NET."
APPROVED DESIGNS PLANS.
SIGNATURE OF DESIGNER DATE
s>sr.
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AS BUILT PLAN NAL
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
NORTH ANDOVER, MASS./52 OLYMPIC LANE
AS PREPARED FOR
RAJ DUDANI TM: 106B
DATE: 9-20-12 TL: 111
SCALE: 1"=40'
0 20 40 80
MERRIMACK ENGINEERING SERVICES
66 PARD; STREET
ANDOVER, MASSACHUSETTS 01810
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