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Miscellaneous - 520 FOSTER STREET 4/30/2018 (2)
IC _ 520 Foster street I r North Andover Board of Assessors Public Access Page 1 of 1 Parcel ID:210/104.B-0040-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge M3Y':�I 520 FOSTER STREET '• :' Location: 520 FOSTER STREET Owner Name: MATTHESON,FRANCES A ALAN R MATTHESON Owner Address: 520 FOSTER STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 1.1 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1670 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 353,500 329,600 Building Value: 170,900 160,600 Land Value: 182,600 169,000 Market Land Value: 182,600 Chapter Land Value: LATESTSALE Sale Price: 1 Sale Date: 08/09/1995 Arms Length Sale Code: A-NO-FAMILY Grantor: MATTHESON,FRANCES Cert Doc: Book: 04312 Page: 0347 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=807795 6/5/2006 Residential Property Record Card PARCEL_ID:210/104.6-0040-0000.0 MAP:104.13 BLOCK:0040 LOT:0000.0 PARCEL ADDRESS:520 FOSTER STREET PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 04312 Road Type: T Inspect Date: 11/13/2002 Tax Class: T Sale Date: 08/09/1995 Page: 0347 Rd Condition: P Meas Date: 11/13/2002 Owner: Tot Fin Area: 1670 Sale Type: P Cert/Doc: Traffic: M Entrance: X MATTHESON, FRANCES A Tot Land Area: 1.1 Sale Valid: A Water: Collect Id: RRC ALAN R MATTHESON Grantor: MATTHESON,FRANCES Sewer: Inspect Reas: C Address: 520 FOSTER STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-13/1-080 Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: BN Tot Rooms: 5 Main Fn Area: 1670 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Story Height: 1 Bedrooms: 2 Up Fn Area: Bsmt Area: 1670 Seg Type Code Method Sq-Ft Acres Influ-YIN Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 182,080 Ext Wall: WS Half Baths: Unfin Area: Bsmt Grade: 2 R 101 A 0.1 470 Masonry Trim: Ext Bath Fix: Tot Fin Area: 1670 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 141224 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good PIF/E/R Cost Class Kitch Qual: T Eff Yr Built: 1962 Mkt Adj: 1.2 SE S 120 2002 A A ///99 1,400 Heat Type: HW Ext Kitch: Year Built: 1950 Sound Value: Fuel Type: O Grade: A Cost Bldg: 169,500 VALUATION INFORMATION Fireplace: Bsmt Gar Cap: Condition: A Att Str Val 1: Current Total: 353,500 Bldg: 170,900 Land: 182,600 MktLnd: 182,600 Central AC: N Bsmt Gar SF: 550 Pct Complete: Att Str Va12: Prior Total: 329,600 Bldg: 160,600 Land: 169,000 MktLnd: 169,000 Att Gar SF: %Good P/F/E/R: //100/76 Porch Type Porch Area Porch Grade Factor i W 640 SKETCH PHOTO 40 640 Sq.R. 16 16 40 62 FM B � 16/70 Sq.R 550 Sq.R. 25 25 28 `1 Y 520 FOSTER STREET •• � Parcel ID:210/104.6-0040-0000.0 as of 6/5/06 Page 1 of 1 520 FOSTER STREET JS-2006-0880 Proiect Detail Report Printed On:Thu Jun 29,2006 ;Project Name: _ !GIS#: ;5858 Project No: JS-2006-0880 Owner of Record MATTHESON,FRANCES A& Of &OltTk qa Map_ - 4104.13 Date Submitted: Jun-29-2006 520 FOSTER STREET Block: 10040 Status: Open _ NORTH ANDOVER,MA 01845 Lot. Work Category: Work Location: 520 FOSTER STREET IZoning: Proposed Use: District: ---------- ''`���•.rn 'land Use: 101 Proposed Use Detail Subdivision r ------- ---- - ----- ---- �SS�ICHU4tS � ---- — ---- - - ,Description Septic System Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2006-0043 6/29/06-Thurs.-Left Jim Kellett a voice mail re:lack of copy of electrical permit(pump system).--p.d. In addition,plan was not approved,and the Local Health Bylaw Variance Request for 3 bedrooms in lieu of 4 bedroom minimum required by N.A. Sent Ben an e-mail re:this. Everything is on hold.--p.d. s Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2006-0204 Jun-29-2006 CURRENT JS-2006-0880 Repair-Complete �i'r'rr.z( l L�L•� i n (cm K C6 0A1 GeoTMS©2006 Des Lauriers Municipal Solutions,Inc. Page l of I / C 1 Commonwealth of Massachusetts _ City/Town of North Andover ° System Pumping Record I JUL 07 2014 Y p 9 , . Form 4 TOWN OF NOR-i H APIL r✓Eh ' ^w" HEALTH DEPART tE''T DEP has provided this form for use by local Boards of Health. Other forms may be used,but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the he tabcomputer, ����er use onlythe tab key to move your Address cursor-do not North Andover Ma 01886 use the return key. City/Town State Zip Code 2. System Owner: me Name return Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record ted q 1. Date of Pumping Date / 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 60 6. System Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 DelleChiaie, Pamela From: Jack Sullivan Dacksu1153@comcast.net] Sent: Tuesday, November 29, 2011 4:31 PM To: DelleChiaie, Pamela Subject: Re: 520 Foster St, North Andover That is fine...much appreciated. Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax From: "Pamela DelleChiaie" <Pdellech(ab-townofnorthandover.com> To: "Jack Sullivan" <6acksull53(cD_comcast.net> Sent: Tuesday, November 29, 20114:21:48 PM Subject: RE: 520 Foster St, North Andover Yes, I can pull and scan it,but it will have to be tomorrow morning. Is that okay? Sint Rgafrda, 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 IR Fax-978-688-8476 D Email-pdellechiaieotownofnorthandover.com -6 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 From: Jack Sullivan rmailto:iacksu1153(abcomcast.netI Sent: Tuesday, November 29, 20114:16 PM To: DelleChiaie, Pamela Subject: Re: 520 Foster St, North Andover Hi Pam, I think you offered to scan plans and e-mail them to me..if so, could you see if you have a septic design and a septic as-built plan for 520 Foster Street? I can also come by your office if that is easier. Hope you are enjoying this awesome weather...thanks!! Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax 1 From: "Jack Sullivan" <jacksu1153(cD-comcast.net> To: "Pamela DelleChiaie" <pdellech townofnorthandover.com> Sent: Friday, October 7, 2011 12:22:44 PM Subject: Re: I.R. - 295 Rea Street - Health Department Scanned File Thanks Pam...always nice to see you...I think my girls liked you (they are usually more shy) Have a great weekend. Sullivan Engineering Group, LLC Jack Sullivan 22 Mount Vernon Road Boxford, MA 01921 978-352-7871 phone + fax From: "Pamela DelleChiaie" <pdellech townofnorthandover.com> To: "Sullivan Jack (jacksu1153(@-comcast.net)" <iacksu1153(a-comcast.net> Sent: Friday, October 7, 2011 11:00:56 AM Subject: I.R. - 295 Rea Street - Health Department Scanned File Hijack, Here is a scanned copy of the file for 295 Rea Street for your records. Whenever we get information requests,I automatically scan them so that eventually we will have a scanned file database for as many records as possible. Enjoy your weekend with the girls! ;) They are adorable. Vial Rganda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street!Bldg 20 1 Suite 2-36 North Andover,MA 01845 Y Office-978-688-9540 R Fax-978-688-8476 O Email-ndellechiaiePtownofnorthandover.com -2S 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.'—A 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:ham://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 i NE'w IENGLAI D ]ELGINEEr-JN(G 'SER1�17CES9 INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 May 31, 2006 Project # 1088 Ms. Sue Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 520 Foster Street North Andover, MA Local Health Bylaw Variance Request Dear Ms. Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following variance: Local Health Bylaw Variance Request Allow a septic system be designed to serve three bedrooms in lieu of four bedroom minimum required by local North Andover Health By-Law. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr. P.E. President y NE'w ENUI�-DIEN Gl-,'\�-Ei\,-G SERNIcES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 May 31, 2006 Project # 1088 Mrs. Susan Sawyer RECEIVED North Andover Board of Health 1600 Osgood Street JUN - � 2 Q Q 6 North Andover, MA 01845 TOWN:;F NJF2 CI-i ANDOVER HEALTH DEPARTMENT Re: 520 Foster Street,North Andover, MA Septic System Design Dear Mrs. Sawyer, The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (2) Copies of the Form 11 Soil Evaluator Sheets. 3. (2) Copies of the Form 12 Percolation Test. 4. (1) Copy of the Local Health Variance Request letter 5. (1) Copy of the Septic Plan Submittal Form. 6. (1) Check for Plan review fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr. P.E. President ` Commonwealth of Massachusetts City/Town of 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: When filling out A. Site Information forms on the computer,use Alan Matheson only the tab key Owner Name to move your 520 Foster Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 Cityrrown State Zip Code 978-685-0313 Contact Person(if different from Owner) Telephone Number B. Test Results 8-24-06 11:51 Date Time Date Time Observation Hole# PT1 Depth of Perc 36"/17" Start Pre-Soak 11:51 End Pre-Soak 12:06 Time at 12" 12:06 Time at 9" 12:20 Time at 6" 12:41 Time (9"-6") 21 Min Rate (Min./Inch) 7 Min/inch Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benajmin C. Osgood, Jr. P.E. Test Performed By: Randy Burley, Mill River Consulting Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Commonwealth of Massachusetts City/Town of No?,t h+ ANOo v6 tZ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information ALAA) NIATrN� ">OA_) Owner Name S-Z o FOS-76 R S Z-- Map/Lot 16 y B, Y O Street Address �l8 ,A)O RTri AA)Do vE R MA City[Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair ?. Published Soil Survey available? Yes No ❑ If yes: q I S.gyo C bC. — — Year Published Publication Scale Soil Map Unit CA,vT0A,/ VEt2� Srotiy FINE S XIA-1 LOA04 STaAu Y, S�6C_P sco P65, - — Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No If yes: - - - Year Published Publication Scale Map Unit ABLA4T-10IV T'iLL Al 1) 4I.0t3A 'tiE 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 [�Z] El � 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7 Commonwealth of Massachusetts City/Town of N. ANDD VE e, -= Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal <.N � 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal [. Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TP I � _ Zy'OS 10 , 00 SUNNY 750 Date Time Weather 1. Location Ground Elevation at Surface of Hole A 6-q�r Location (Identify on Plan ) r�O.uT Y�9« C�. "�� A)& 2. Land Use: IZES t (�E.uT'�� L— Slope e©ox.lo (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones P ( ) RA SS (o go u•u D Al iZA W6- 3A c.K Sc_oPE —_-- Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body 100 -t Drainage Way (000*' Possible Wet Area LOBy r feet feet feet Property Line ZQ Drinking Water Well _L t O Other feet feet 4. Parent Material: A 84.47-ion) TALL. Unsuitable Materials Present: Yes ❑ No CA If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: Q 1,0('0 IuCA6S v DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 2 of 7 Commonwealth of Massachusetts City/Town of N. AN Do vE r� _ = Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal inches elevation Deep Observation Hole Number: T P f Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones CD-6S rlLL 65.,, Z-s 1616 GS., !ori�sly a�;;�`` L S Additional Notes -/)Q W iC,loll 6 OR, STAti IJ: Co wf�l E tZ O SE fZ t1E Il DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts City/Town of A) - A�v D o V E K -- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole 97•o Location (Identify on Plan ) �(Q'y XA�c� SO uTrI ►ZE S LSE�v ' 7'rA�- �U C) - of 2. Land Use: Sloe (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones p ( ) 6 RA SS to R0L)x) D M o KA j;V6 Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body (Occi+ Drainage Way (000' Possible Wet Area 1060 fee feet feet Property Line ;Lo _ Drinking Water Well 100 Other feet feet 4. Parent Material: 4 9 LAMI ON ?'t LL Unsuitable Materials Present: Yes ❑ No IX If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 32 -4OTrZE$_) q y.'-/a inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7 !-!�L_1\ Commonwealth of Massachusetts City/Town of IV, AN DO vE f? -- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal a Deep Observation Hole Number: P Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles 8 Stones o-3a FILL WD1UM C Z s/ s�6 3�" IO Y��l� �os, Additional Notes /U 0 �J Pt�6 O R A'v .�16 �Ii4 08S6R O DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts C ity/Town of /V. AN Do V,6 R - _- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation TPI P_a- 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A. (,,5 B. -3 D. inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes%] No❑ 65- CrA , b. If yes, at what depth was it observed? Upper boundary: SX CTP Lower boundary: (T Pa. inches inches F. Certification I certify that I have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature of Soil Evaluator Date BE N3A KiA) C O5600 D SK NO V- t Ct 9 S Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam f�Ati A y �C� �Y r1�LL— tZ,\vE R �o.uS�lrR�S A b RT�t At14o vER Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 6 of 7 Commonwealth of Massachusetts City/Town of N. A.,J D ovd f: Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet for field diagrams: SES D(C S i 6AJ L,4/L) I I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7 North Andover Board of Assessors Public Access Page 1 of 1 NORTH North Andover Board of Assessors �7S eine..'•�q9 S,CNus° roperty Record Card Click seal To Return Parcel ID:210/104.B-0040-0000.0 FY:2009 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales •, � Summary Residence " Detached Structure . ., � L` Condo 520 FOSTER STREET t. Commercial Location: 520 FOSTER STREET Owner Name: MATTHESON,FRANCES A ALAN R MATTHESON Owner Address: 520 FOSTER STREET City: NORTH ANDOVER State: MA Zip: 01845 LNeighlborhood:5-5 Land Area: 1.10 acres ode: 101-SNGL-FAM-RFe T . ,r.-_: ea: 1670 sqft Av-`' o� REVIOUS YEAR Total 357,200 Built $,�OI G v S �G� 159,100 Land Q 198,100 Mark �2 (� 5 7 Chap Sale I Al 9/1995 Arms 6;rl CTHESON, Coder e Y � NCES 2 Page: 0347 11 http://csc-ma.us/PROPAPP/display.do?linkld=1464148&town=NandoverPubAcc 5/8/2009 ���� S �� r 4- �.- ._ l �� '�__.. North Andover Board of Assessors Public Access Page 1 of 1 NORTH Forth Andover Board of Assessors < p w 9 � X 71,5 w+nc�At� S,cNus° roperty Record Card Click Seal To Return Parcel ID:210/104.B-0040-0000.0 FY:2009 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e x Search for Parcels .Y Search for Sales Summary = It Residence " Detached Structure Condo 520 FOSTER STREET L • Commercial Location: 520 FOSTER STREET Owner Name: MATTHESON,FRANCES A ALAN R MATTHESON Owner Address: 520 FOSTER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5-5 Land Area: 1.10 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1670 s ft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 359,500 357,200 Building Value: 161,400 159,100 Land Value: 198,100 198,100 Market Land Value: 198,100 Chapter Land Value: LATESTSALE Sale Price: 1 Sale Date: 08/09/1995 Arms Length Sale A-NO-FAMILY Grantor: MATTHESON, Code: FRANCES Cert Doc: Book: 04312 Page: 0347 http://csc-ma.us/PROPAPP/display.do?linkld=1464148&town=NandoverPubAcc 5/8/2009 A/+ " q cm -'ASSTs,r �.fix'�+"' 27r- *.�l e�•`"'�{,� ��� ta�»k� s�" �Y�:s f § s'�q"�'k� �m ya &3r'� 1��ii L,..s��', c4''y"' `¢ ij�+2 •�.f�� 4,., �` _ ..e�•,�'a� � 1e+4�.� � m' 'M�.g .::� 3 '�' , y � ti ?r t � *'`{ �m; � .� fit �� E x .+� ,� �,� � mob•. �« �� ��" ,��� � k� � '�,.,� �� � �` � '�:" .a 'm> ��� J� � ,,.,�; r �k�} ,� �"�"crr���� , s � C�yp �yu•x��� � �gtr. ,,:�r� -�`' F77�y r � _' ,.��^ �,fr� � z � �nye � t� �OY�-ax ' `te�a � �L s 4 3 rt�., :,:«,t±7 i 4X�,`:� ArK.y ;}_•# ': � at v: 3 � � � ,ate' M1;�;,�.:,_. �;2* x+' '�.:���,��.- X �a� &rs'uty3 a,,� . 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Y*x F s?;,t 5szf.7:Lig e T(ivn of N rth Andover / Health Department Date: 07 Location: (Indicate Addresk if Residential,or Name of Business) Check#: d Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ a- tic Disposal Works Construction(DWC)$ -J-5_e. ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials 1633 White-Applicant Yellow-Health Pink-Treasurer Application for Septic Disposal System of AH A �A Construction Permit - TOWN OF TODAY'S DATE y' NORTH ANDOVERMA 01845 $ 250.00— Full Repair , r $125.00 -Component 1'SSA C HU`��t Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Information key. 1. raD Address or Lot# —_ City/Town _-- — 2.- * PE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system,attach copy of electrical permit to application*** � Ui ventional System (pipe and stone system) Initrator 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 41,AV M Ig aP-J Name Address(if different from above) ---------- -------- ----------- ----- -- -- — ---------- City/Town State Zip Code Telephone Number 3. Installer Information Name z Name of Company Address City/Town State Zip Code `7 Telephone Number(Cell Phofre#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach Application for Disposal System Construction Permit-Page 1 of 2 4, Application for Septic Disposal System "` Lp Construction Permit - TOS OF TODAY'S DATE o.s $ 250.00-Full Repair NORTH ANDOVE R� MA 01845 $125.00 Component PAGE 2 OF 2 A. Facility Information ntinued.... 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 Nort Andover, and not to place the system in operation until a Certificate of Compliance has ben "ssued by thi B a of H alth. e Date x M� Application Approved By: (Board of Health Representative) TZ Name Date Application Disapproved for the following reasons: For Office Use Only: / V 1. Fee Attached.? Yes No 2. Project Manager Obligation Form Attached? Yes_ No 3. Pump S, stem? If so,Attach copy of Electrical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approz..red plan) 5. Floor Plans?(new construction only): Yes_ No A A Application for Disposal System Construction Permit•Page 2 of 2 ti INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at JAG F&'Ar-�.t S� relative to the application ofs), 61-GGrt dated_ V-2-�" forplansby ��=�s and IF dated P' V with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger,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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection - Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c). Final Grade-Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi ed Licensed S is Installer Date: RECEIVED Commonwealth of Ma sachjVLegq 200 S Official Use Only u Permit No. Department of Fire Vis..;-c- ,,,,,I RHEALTH DEPARTtviE v Pcc pancy and Fee Checked BOARD OF FIRE PREVENTIO 1/991 (leave blank) lg APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC).5'7 Cl R 12.00 (PLEASE PRINT IN INK OR TYPEALL INFOR�LI//ATION) Date: 1 /l O(0 _ City or Town of ,), To the Inspe for f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described'below. Location(Street& Number)x 5 A O P od4 r ) f Owner or Tenant 1•' !a c—d—L'—t a e W 0 Telephone No. Owner's Address Stg M-c Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building >w'?//tV�r Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Work: 1AI/t2-r SC l�,f c UM_=A)a *t"�t Ae4q n/e f q tU J><I SvJ C s �r Completion of the following table ntav be waived by the Inspector of Wires. No. of Total No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above In- No:o Emergency Lighting In- No. of Lighting Fixtures Swimming Pool �r ,t ❑ ter. ❑ RattFn'Tlnitc No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.o Detection and No. of Switches No.of Gas Burners Initiating Devices No. of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Disposers Heat Pump Number Tons hW No. of Self-Contained No.of Waste Dis P Totals: Detection/AlertinE Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Connection Other Heating Appliances K�4 Security Systems: No. of Dryers No.of Devices or Equivalent `o. o WateriVo- of No. of Data��'iring: Heaters KW Signs Ballasts No.of Devices or Equivalent r / Teleeommunications Wiring: No.Hydromassage Bathtubs No. of Motors J Total HP - /� No.of Devices or E uivalent OTHER: lc.�e e�c.'aior. dc:..il F:r._:_. ,.,;.c'ti,•.,1,etr.srectnrofti':r_: 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 c�erage is in force,and has exhibited proof ofsame to the ermit issuing office. CHECK ONE: INSURANCEBOND ❑ OTHER ❑ (Specify:) JN (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with hIEC Rule 10, and upon completion. I certify, under t a ns and penalties of perjury,that the information on this application is true and complete. ,ry FIRM NAME: V j y' y1 LIC.NO.: f't Licensee: Signatur I t' ,�� LIC.NO.: (!(applicable, enter "exempIt'•in the l erase number 1 e.) Bus.Tel.No.: Address: M,;!/OG(21eV Pl?)�� eA��J I MA, Alt. Tel.No.: OWNER'SS I VSURA.NCE WMVER: I am aware that th ncensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: S Signature Telephone No. DAVID W.MEEHAN �J35- Ya°� 53-179/113 777 Q 0401092390 4 MULBERRY DR. o W W WEST PEABODY,MA 01960-4648 Q DATE > C111 +4 Ut' 1 1 �W1 *"� Z <; PAY TO $ V —� THE ORDERpt ..wF • W M J S /, DOLLARS . M x 331 (�Eastern Bank LYNNFIELD,MA 01940 1•900•EASTEFtNI—t—uank.Wo t _ n ryp MEMO 1:0 ; 1301 ?981: 04 01,09239011" 0 ? ? ? ZONING INFORMATION: ASSESSOR INFORMATION: OWNER INFORMATION: ZONING DISTRICT : R1 MAP 104B PARCEL 40 ALAN MATTHESON MIN. BLDG. SETBACKS: 520 FOSTER STREET FRONT 30 FEET DEED REFERENCE: NORTH ANDOVER, MASS SIDE 30 FEET BOOK: 4312 PAGE: 3447 ��� 03 13 REAR 30 FEET N63'20'44"E 254.34' LOT AREA 47,683 S.F.f 1,000 GALLON CONC. PUMP CHAMBER 3 126.5' _ 1,500 GALLON co c�o CONC. SEPTIC e .p 1 } ca TANK v p` N N PROP. 1 STORY ADDITION Z 593 SHED EX. DECK o i 1 N EX. 1 STORY 30.5' D—BOX WOOD FRAME 100.5' STRUCTURE DH FND i 17.1 0 8' 0 30.5' `r �ry,N 32'7' 30 O 25.5' .6' 87.6' CO ! S59'58'18"W I I 1 �o 234.83' PROP. DECK FOSTER STREET SEPTIC LEACHING FIELD I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED PLOT PLAN OF LAND BY AN INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN. 520 FOSTER STREET NORTH ANDOVER, MASS. �� s Ali OF PREPARED BY: y,s 6 �iVAN III JOHN D. SULLIVAN III, P.E. ^'� CIVIL y No.41X86 . 138'72 22 MOUNT VERNON ROAD �' TEt'�� ��� '�01STEb�� BOXFORD, MA 01921 �SS�ONAL��G\` � Rk�A�9 (978) 352-7871 SCALE: 1 "=40' DATE: 11 /29/11 v BUILDING PERMIT xAO R TH 0 .ct`Eo quo TOWN OF NORTH ANDOVER � �'_ "'" o APPLICATION FOR PLAN EXAMINATION100 Permit NO. Date Received / / ' °• '� - �9SSACHUS���y Date Issued: IMPORTANT:Applicant must complete all items on this page 1 LQCATI®N +Print e, PROPERTZY"Ol/1_%IVER?- b,� cti,,�._ M `C � Y� EMAP NQ PARCEL;= ZQNINGtDLSTRICTHistoriclDistnct t - ,Mp Village ryes, t TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family �Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �`Septii„ Well' p�Floodplam pilNetla ®tnds ❑ VVatersfiedr©sfrict .❑tl%Vater%Sewer R ? DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: rym,. �\e,Sv41 Phone: t,95--031 Address: � -1 e/L- 5:,\- (CONTRACTOR Name: t 3 Phone:. b8._ 3 i rAdd ress 1�r'I. _ T _ '. Supervisor siC:or s•truction License:_ 0 57,J- 'J 9 Ex xQ,ate - p _� l� ' Home�Improvement�Lcense __ �_ _ Ezp ARCHITECT/ENGINEER � Phone: c1!E-. -LU 5-115"D Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ U FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accT to the guaran fund Slgnatureof�A ent/Ovvner -: °-- �.-- 4 g a ll Plans Submitted' Plans Waived ❑ Certified Plot Pla_n_� Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on / 02 / Signature COMMENTS 06 WJ (64d lob d HEALTH Reviewed on Z3 P d Si nature OMMENTS 0 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Consen,,ation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 O ood Street FIREaDEPARTMENT - em s T Dumpsteron site .yes _ ._mo. Located at 124iM.ain�Streefi. t =. - - W - _cv cv N/F ARNOLD : Go EXISTING WELL TO BE ABANDONED ___102 102 _ - 100 10.0 _ EXISTING SEPTIC . EDGE OF LAWN �� 1500 GALLON TANK MONOLITHIC { SEPTIC TANK. r DECK 1000 GALLON MONOLITHIC -PUMP CHAMBER 128 .. 10.. 2" SCH. :40 PVC FORCE MAIN —+ 01 EXISTING THREE XISTIN 22' BEDROOM-DWELLING END CAPS (TYP.) . DISTRIBUTION BOX I SILL .ELEV. .:100.00• rr CF ELEV.. 93.15 ' .LIMIT. OF SAND 26' I � 4STRUCTION NOTE #3) ;� BENCHMARK: BOTTOM OF SIDING W 0 1 ELEV. 100.00 (ASSUMED DATUM). 0 MAPLE TREE � it TO BE REMOVED ( - i 20' �� II o i 40.KIIL IMPERVIOUS BARRIER SPECTION PORTS (TYP.) .4 I 'S TOP ELEV. 100.83 BOTTOM ELEV. 89.58 W j I `TP2. VENT'' N � _ _� o, 94— W EXISTING .WALL :AND STAIRS SEGMENTAL BLOCK RETAINING TOP. ELEV. 95:00.. r Fos STI-LP t►ORT►i OL O r' n LANG01 f en �9SSACHUS���� PUBLIC HEALTH DEPARTMENT Community Development Division August 4, 2006 Mr. Alan Mattheson 520 Foster Street North Andover, MA 01845 RE: Septic System Design, 520 Foster Street,North Andover,Map 104.B,Lot 40 Dear Mattheson, At a regularly scheduled meeting, on August 3, 2006,the North Andover Board of Health approved local upgrade approvals and variances for the above-mentioned property. With the items listed below,the three (3)bedroom, seven(7)room maximum design has been approved for use in the construction of an onsite subsurface disposal system. The design was submitted on your behalf by New England Engineering Services, dated May 30, 2006,with a revision dated July 11, 2006, and received by this office on July 18, 2006. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that does not meet the acceptable criteria in the state regulations. 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. Approval of Variance to Local Septic Regulations: ➢ The North Andover BOH approved a variance to the local regulations allowing the construction of a three (3)-bedroom septic system. Please provide proof of recording a document providing for a three (3)-bedroom deed restriction. (a sample of the restriction is attached for your convenience)NA 1.05 & 13.01. This paperwork is required prior to issuance of the final Certificate of Compliance by the Health Department. This approval is subject to the following conditions: 1. 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. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com v 2. 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 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. Sincer ly, usan Y. Sawyer Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services g g g 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.towoofnorthandover.com �I It is the responsibiCty of the apphcant to record the required deed restriction per 310 CWR15.000 Title 5. The jb&mdngisasu ested ormat, 6ut the&a(document should 6e approved 6y your attorney prior to recordirur. NOTICE Off'VA4UWCYE/'DEED 9M4gVjC 0qV' (Pursuant to 310 C9WR15.000 Titfe 5, andas a condition of septic plan approvar6y the North Andover Board of W eaCth, notice is hereby given that rearestate Located at: . JVbrthAndover, Wassachusetts, (aka Assessor's 911ap /Lot ), as described in a deedf vm t0 dated . 20 and recorded in the EsseX County fgistry of(Deeds in Boo f� andTage . andas(Document # is the subject of a variance from the Town ofNorthAndoverWinimum*quiremen tsfor the Subsurface(DisposaLof Sanitary Sewage A1.05 and C9.01(4� Said variance limits the maximum number of bedrooms at this dweiTing to bedrooms q-his variance is within the jurisdw- tion of the North Andover Board of 5fearth. Signed and seared this day of . 20 (Property Owner(s)Signatures CO9MOON"ALW OF W",XCVUSEgt]S Esse., ss (Date: . 20 Then personaay appeared the above-named and acknowredged the foregoing instrument to be his/her/their free act and deed, before me. Name Notary ftblu- Page 1 of 1 r DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Monday, September 18, 2006 1:58 PM To: Sawyer, Susan; 'Marianne Peters'; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 520 Foster Street Construction Notes I Are attached. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinp-.com 9/18/2006 • V►ORTH r aD i6 q�0 OL O * F- A A 140 DED �SSAC HUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 520 Foster Street MAP:104B LOT: 40 INSTALLER: Kellett DESIGNER: New England Engineering PLAN DATE:5/30/06 Rev. 7/11/06 BOH APPROVAL DATE ON PLAN: 8/9/06 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 8/29/06 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com pORTFt O�tt�eD 16,q�0 3� ��,,I •, 6 0L O to . * O44COCMIC�WKM`y1' DgAfED �SSACHU`��� PUBLIC HEALTH DEPARTMENT Community Development Division ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ❑ Combo Tank installed. Size: ® 1000 gallon Pump Chamber installed H-10 loading Monolithic 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" inch cover to within 6" of final grade installed over pump access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t1ORTH tl_eo '6gti0 OL O t cy T 0 [OCMit N�K• 1' � �.9 A�gATlO .Pa,t'�5 SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into 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 ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber Infiltrator Quick 4 ❑ Number of chambers per row 7 ❑ Number of rows (trenches) 4 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: ® Rated for exterior if placed outside ® Alarm signal located inside Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTi4 q p �S�eo �6�ati O O e ' � C(6 LAK 7 044TED �SSACHUS�� PUBLIC HEALTH DEPARTMENT fommunity Development Division SYSTEM ELEVATIONS INVERT INFIELD PLAN INVERT ELEV. Benchmark Building Sewer OUT 96.88 97.30 Septic Tank IN 96.68 97.10 Septic Tank OUT 96.35 96.85 Pump Chamber IN 96.33 96.83 Pump Chamber OUT 96.59 96.58 Distribution Box IN 100.77 100.77 Distribution Box OUT 100.61 100.60 Lateral 1 INV 100.50 100.50 Lateral 1 TOP 100.81 Lateral INV 100.50 100.50 Lateral 2 TOP 100.81 Lateral 3 INV 100.49 100.50 Lateral 3 TOP 100.80 Lateral 4INV 100.50 100.50 Lateral 4 TOP 100.84 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com pORTN q O ,�tLto 6�00 t, eyy yy� T °�q[OCN1[wlwKw`y1' T °gATe° �SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Friday, August 25, 2006 12:52 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Construction Inspection-520 Foster-Sched for Tues 29th We'll be doing the construction inspection for 520 Foster on Tuesday, 29th with Jim Kellett. 0 Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx 8/28/2006 Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, August 22, 2006 3:22 PM To: 'Marianne Peters' Subject: RE: Cannot get in touch with O'Neill Associates...? Pam is off this week. I will be checking her email occasionally. New England Engineering called to say that 520 Foster Street is ready for a final inspection by you. Jim Kellett is the Installer. 781 953-7146. Note that we have 066i i for �hattwell has b ected from th o ater connected. However, the p1-and o cal regs. requir a the well be aban you observe anythi ur site visit, plea a it on your report. Thanks Good luck finding O'neill. Susan � � �►� -----Original Message----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Tuesday, August 22, 2006 11:36 AM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Cannot get in touch with O'Neill Associates...? I've tried to call O'Neill Assoc. to set up soil test for 1475 Osgood; no answer. I called 411 to verify the phone number on your application....it's correct. I'll keep trying. If I can get in touch with them, we can set up for next Thursday. Z I Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx 8/22/2006 I I TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 C14„5< Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP:/C$ l) , LOT: �+ INSTALLER: kvw DESIGNER: ¢, p s a.W..d PLAN DATE: `3� C>I., BOH APPROVAL DATE ON PLAN: Ph evb INSPECTIONS TANK INSPECTION: ��t _,,WATE OF BED BOTTOM INSPECTION: ���A, DATE OF FINAL CONSTRUCTION INSPECTION: z- C- apt.z4 e DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned []Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent Ccs, v e- filter is present ❑ Hydraulic cement around inlet & outlet 0-QG ! V "� Wastewater System Documentation—Feb 2006 P ! Page 1 of 6 r i TOWN OF NORTH ANDOVER E HORTq Office of COMMUNITY DEVELOPMENT AND SERVICES o: HEALTH DEPARTMENT p 41 +4 4 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845CH„5��' Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic 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" inch cover to within 6" of final grade installed over pump access port ❑ Watertightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3+°et�•''�°�°�� HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ", . . NORTH ANDOVER, MASSACHUSETTS 01845 'i7ss^�Hus S4g Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM �( ❑ Bottom of SAS excavated down to soil layer, as b" 6provided on plan p +a.; .. m r ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed L,^' ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Peb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER f NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES �6D'� HEALTH DEPARTMENT ~ 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 "•", .,. +" NORTH ANDOVER, MASSACHUSETTS 01845 CN„g��' Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES o?�'�Il°. HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss �cHus Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings,etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains(Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s 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 Wastewater System Documentation—Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVERNCHTh , Office of COMMUNITY DEVELOPMENT AND SERVICES o: .o °+ HEALTH DEPARTMENT $- ° p 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ��SS��H�S tag Susan Y. Sawyer.. RENS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Wastewater System Documentation—Feb 2006 Page 6 of 6 It is the responsi6iCty of the appCuant to record the required deed restriction per 310 C'9KR 15.000 Title 5. The foCCawing is a mi j ested ornaat, 6ut the,final document should 6e approved 6y your attortteY prior to recording. 5V027CYE OF vAgANCE/QED Wg4UM09V' ftrsuant to 310 C9WR15.000 Title 5, and as a condition of septic plan approvaL6y the 9Vbrth Andover Board of NeaCth, notice is hereby given that reaf estate Located at. . NorthAndover, 9Kassachusetts, (aka Assessor's 9Kap /Lot I as described in a deedfrom to dated . 20 and recorded in the Essex County fgistry of Deeds in Book andWage . andas Document # is the subject of a varia ncefrom the Town of North Andover 9Kinimum ftq uireme n tsfor the Subsurface tDisposaLofSanitary Sewage Al.05 andC9.01(4). Saidvariance limits the maximum number of bedrooms at this dwelling to bedrooms This variance is within the jurisd tion of the North Andover Board of9feaCth. Signed and sealed this day of . 20 ftoperty Owner(s)Signatures C09K9WOAflWtEAL25f OT%fASSAC VSE`Z7.S Essex ss. (Date. . 20 Then personalty appeared the above-named and acknowledged the foregoing instrument to be his/her/their free act and deed, before me. Name Notary ft 6lu DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, August 09, 2006 11:01 AM To: DelleChiaie, Pamela Subject: 520 Foster J Deed Restriction deed restriction.doc Form.doc sample deed rest. I found on computer. Note one still has Wilmington in the letter. When we have deed restrictions you can send these along for samples. I put the changes needed to 520 Foster in your box Also use this type of language. 1. The N.Andover BOH approved a variance to the local regulations allowing the construction of a 3-bedroom septic system.Please provide proof of recording a document providing for a 3-bedroom deed restriction.(a sample of the restriction is attached for your convenience)-NA 1.05& 13.01 thanks Susan Sawyer, R.S. Public Health Director office 978 688-9540 fax 978 688-8476 t NEw ENGLAND IENGINE]EMG SERVICES, INC. 00 Osgood Street k6IB—Cuilding 20 Suite 2-64 North Andover, MA 01845 -Tel: (978) 686-1768 • Fax: (978) 327-6138 Benjamin C. Osgood, Jr., P.E. President July 13,2006 NEES file# 1088 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover,MA 01845 FHE��AOLTH 52O 1 3 2006 Re:�- ,Septic System Design RTH ANDOVER EPARTMENT Dear Susan: Enclosed are revised plans for the above referenced septic system design. These plans include a revised pump on elevation to correct a typographical error. In regards to your other concern,soil testing was not performed on the north side of the leach field due to the fact that the existing system is located in that area. Several pits were attempted in that area,all of which encountered the existing system which is flooded with septic effluent. I will be at your next board of health meeting to discuss the waivers which are needed for approval of the plans. If you have any questions,or need additional information,please do not hesitate to contact this office. Sincerely, 1; C Benjamin C. Osgood,Jr.,P.E. President 1 L pE 4i�eo e 1ti 3r ��`f •, sOOG � p ACNUg S Health Department June 20, 2006 Benjamin Osgood, PE New England Engineering Services 60 Beechwood Drive North Andover, MA 01845 RE: 520 Foster Street, North Andover,MA,Map 104B,Lot 40 Dear Mr. Osgood, The proposed septic system design plans for the above site dated May 30, 2006, and received on June 2, 2006 has been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval, with the section of Title 5 (3 10 CMR 15.000)noted: 1. Please correct the values for the pump float elevations. The elevations between the "ON" and"OFF" floats does not provide 0.33' (4"). 2. Please provide a reason for not performing soil testing in the north side of the leaching field, or provide for an additional confirmatory soil test at the time of excavation of the leaching field. 15.102(2) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director cc: Homeowner File 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 { a N IES c LND IENG � ,,ERJN,G SERVI CU9, ��c 1600 Osgood Street Building 20 Suite 2-64 North Andover, VIA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 May 31, 2006 Project# 1088 Ms. Sue Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 520 Foster Street North Andover, MA Local Health Bylaw Variance Request Dear Ms, Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following variance: Local Health Bylaw Variance Request Allow a septic system be designed to serve three bedrooms in lieu of four bedroom minimum required by local North Andover Health By-Law. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr. P.E. President 1 Official Use Only I Commonwealth of Massachusetts i � �� Department of Fire Services Permit No. i Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),517 C%R 12.00 (PLEASE PRINT INNK OR TYPE ALL INFORVATION) Date:_ // O Citv or Town of: To the Inspe for f TVires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number)x Owner or Tenant Y 1a f, a,�ij 06 Telephone No. Owner's Address "A (s? 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 ❑ Undbrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Ibleters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �_r)1 t2 c. `>e c�0 UM,,�. ACI�(✓� 1G3R n c f e table may be waived by the Inspector of Wires. No. of Total Transformers KVA Date.................. ...........� Generators KVA , iN0 ot Emergency Lighting HORTN R'lttam-T{nitc :° `' " TOWN OF NORTH ANDOVER F p FIRE ALARMS No. of Zones PERMIT FOR WIRING No.of Detection and " " Initiating Devices •o,,r,; No.of Alerting Devices ,SSACNUS� No.of Self-Contained Detection/Alerting Devices MunicipaLocal [I Connection This certifiesn El Other that ...............�..�L�-��`.,;� �'�.�:s`:.� .......................... Security Systems: ' No.of Devices or Equivalent has permission to perform .........�.�... .... - .....-? t!'�'�.. .t'd�............... Data Wiring: wiring in the building of 'l - / S ]—Telecommunications No.of Devices or Equivalent . . .. .... ............. Wiring:No.of Devices or Equivalent .....•...................... .North Andover,Mass. Fee.. ° .:v...�'-. Lic.No. L�"�.......... . .C�................✓r ��r: -` a., .J •. r{.,ICsrartnrn({t:r,.. ELECTRICAL INSPECTOR ;i a ormance of electrical work may issue unless ti y r Check # % < f :overagepor its substantial equivalent. The to the ermit issuing office. r..r o t I (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) York [o Start: -"" v�G Inspections to be requested in accordance with iv4EC Rule 10, and upon completion. I certify, render t/lc. .q ns and penalties of perjur?•, that the information on tris application is true and complete. _ FIRM NAME: t'. t_' Yi. T�. �_ LIC. NO.: Licensee: _ Sianatur ,t-t; iY f�j _ LIC.NO.: _ (1,"applicable, enter "erempt"in file 11"em r�rcntI I�,�.) Bus. Tel.No.-,D—3.2 -)5 a�> :Address: 4 /lJ,.:l�r/?, I/ :)��%VP (` Q1� -1 f�t� Alt.Tel. No.:Q'7 OWNER'S INSURANCE WAIVER: I am aware that the` icensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. ONsner/Agent PERAHT FEE: Signature _ ---^,-- Telephone Nn. —-, ,-- w TRANSMISSION VERIFICATION REPORT TIME 08109/2006 11:48 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 0004J120960 DATE DIME 08109 11:47 FAX NO./NAME 89786851099 DURATION 00:01:08 PAGE(S) 04 RESULT OK MODE STANDARD ECM Noah Andover 1 1/7/� OOR'rs# 1600 Osgood St' �� os t °�{i'`° °•e��p Building 20, Sui North Andover, Gel ' 978.688• 978.688. ossaC HuS hL althdept@towna www.townofnorthal TO: BENJAMIN I COMPANY: NEW ENG' a Re,Health Department:Assistant Re: Phone: 978.686.1768 �cA-C- fax: 978.685.1099 We pre sending you: R view Left Or CIrAROVED ONOTQPPROVER D System Construttion follow-up ©Other These are transmitted as checked below: CCAs Required 13 As Requested 0For your File REMARKS: COPY TO: Homeowner Fox# i i I i I /�/� s�� s�- �� �� . �- � . � � �� �� 1 FICATIQN REPORT ; 08J09H 006 11;45 ISSIDN VERT TIME HEALgSS476 TRANSM FAX : 9?86 4 31 g8 20960 TE\- 000E SER .# I 1 11;47 1 89 86850$99 00;01 e4 1 D pX 46/NAME E DARD quRpTI6N p951E T� MADE ,0814 qN 1 t F T end qhs P pndo�er�o ILette sAN�� 1 1600 Osgood S"""' � suiteA 01845 / o� Building�Q' � M Page� �,orth �odpve � -pone 918.68%.9540 978•9788476►PuX email.688' hnndova .cam a{nab �0t15►te � !�� artln��� �85iStitnt ealthde t tO ea►n- ppTE: w aw afnarthan ova • ameba De11eGh�aia'Faalth Dep ww F.E. bSNaDDlR.►' 1N�• FRQM gEN��►M�N �NEER.1Ne SERVICES, >�� Y NEW kND1.AN COMP�N 976.686116a L.3 Nor 4PPROVEP Fhane: PR pVEl� 978.685'10�g '� - ©ether Fax: �, review Letter o11ou�•�P stel" construction f We ore siending Y°"' L] Y these are transm�ttea ns checked bei°"'' pFor your File 1 Q As�egaestea �gr, Required � / ARKS - � Fn COF'� North Andover Health Department NORT#1 q 1600 Osgood Street 3?o`�t�•D '`'6 0 Building20, Suite 2-36 letter of Transmittal North Andover, MA 01845 ey� 978.688.9540 - Phone pa e / of °4A «���:'K.,?. * 978.688.8476 — Fax g �.� °R lc SSACHUS� healthdept(C-b-townofnorthandover.com-E-mail www.townofnorthandover.com-Website TO: BENJAMIN C. OSGOOD,JR., P.E. DATE: COMPANY: NEW ENGLAND ENGINEERING SERVICES, INC. FROM: Pamela DelleChiaie, Health Department Assistant Re: Phone: 978.686.1768 Fax: 978.685.1099 We are sending you: Review Letter 4 PROVED O NOrAPPROVED O System Construction fo/%w-UP O Other These are transmitted as checked below: 0 A Required 0 A Requested []For your File REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# Or Mailed Town of North Andover Health Department Date: 4 * Location:— (Indicate Address, if Residential,or Name of Business) Check#: Tyne of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-.Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: , ❑ Septic-Soil Testing $ U--, ptic-Design Approval ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Tras4lSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 1-222�z.� Health Agent Initials i 571 White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER of NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES `'`�•• �°p HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'SswcMU Susan Y.Sawyer,REHS/RS 978.688.9540—Phone978.688.8476—FAX Public Health Director E-MAIL:healthdePt@townofnorthandover.com WEBSITE:hqp://www.townofnorthandover.com RECEIVED SEPTIC PLAN SUBMITTAL FORM JUN - 2 2006 Date of Submission: 310 TOWN UF NORTH ANDOVER HEALTH DEPARTMENT Site Location: 01 1a0 1'�StCJ� S-�Yee� Engineer: S O od (. [. New Plans? Yes $225/Plan Check# (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 No Telephone#: 6 Fax#: 3a 7' C0 E-mail: CMj ao con? Homeowner Name: OFFICE USE ONLY When the submiisssion is complete (including check): . Date stamp plans and letter ➢ , Complete and attach Receipt ➢ ,Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database 1 NEw ENGLAND IENGINEIEMG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 May 31, 2006 Project# 1088 Ms. Sue Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 520 Foster Street North Andover, MA Local Health Bylaw Variance Request Dear Ms. Sawyer, The purpose of this letter is to request that the above referenced property be included in the upcoming Board of Health meeting agenda to discuss the following variance: Local Health Bylaw Variance Request Allow a septic system be designed to serve three bedrooms in lieu of four bedroom minimum required by local North Andover Health By-Law. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr. P.E. President NEw ENG A-ND ENGINE]EMG SERVICES, INC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 11e1: (978) 686-1768 • Fax: (978) 327-6138 May 31, 2006 Project# 1088 Mrs. Susan Sawyer RECEIVED North Andover Board of Health 1600 Osgood Street JUN - 2 2006 North Andover, MA 01845 TOWN Of NOft"rl-I ANDOVER HEALTH DEPARTMENT Re: 520 Foster Street,North Andover, MA Septic System Design Dear Mrs. Sawyer, The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (2) Copies of the Form 11 Soil Evaluator Sheets. 3. (2) Copies of the Form 12 Percolation Test. 4. (1) Copy of the Local Health Variance Request letter 5. (1) Copy of the Septic Plan Submittal Form. 6. (1) Check for Plan review fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr. P.E. President 1 Commonwealth of Massachusetts City/Town of 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: When filling out A. Site Information forms on the computer,use Alan Matheson only the tab key Owner Name to move your 520 Foster Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code 978-685-0313 Contact Person(if different from Owner) Telephone Number B. Test Results 8-24-06 11:51 Date Time Date Time Observation Hole# PT1 Depth of Perc 36'717" Start Pre-Soak 11:51 End Pre-Soak 12:06 Time at 12" 12:06 Time at 9" 12:20 Time at 6" 12:41 Time (9n-6°) 21 Min Rate (Min./Inch) 7 Min/Inch Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benajmin C. Osgood, Jr. P.E. Test Performed By: Randy Burley, Mill River Consulting Witnessed By: Comments: t5formI2.doc•06/03 Perc Test•Page 1 of 1 Commonwealth of Massachusetts City/Town of iVc>9--t-14 A vDo v6 R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information , IAV MA JC_S0A-) Owner Name 7? FOST� sT— Map/Lot Street Address MA A)O E TN A A)Leo V E R City/Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair 19 Is-.8y0 C bC. 2. Published Soil Survey available? Yes ® No ❑ If yes: Year Published u fished Publ�ation scale Soil Map Unit CANTt:>A) VC-RI ST'o•Vy F►,vE Sa.�aI LOAM STb�yy, SCEP Seo PCS - Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No [A If yes: Year Published Publication Scale Map Unit /I B 1-,4ri o V T'i L-c_ 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 [jA Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map unit Name _ Wetlands Conservancy Program Map Name Map Unit DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 1 of 7 Commonwealth of Massachusetts City/Town of N. ANDo vE? Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) g " ®s Range: Above Normal ❑ Normal [j. Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: Zy'Os 10'. 00 5we eY 75c' Date Time 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) r(_o�uT RES t (��iVTi/-T L �� �—C©� 2. Land Use: Surface Stones Slope (e.g.woodland,agricultural field,vacant lot,etc.) (%) (o' D �o(ZASS go uv Nlo�AtNE BA�KS[-oP� Landform Position on landscape(attach sheet) Vegetation 3. Distances from: Open Water Body l00 Drainage Wayf t o00� Possible Wet Area feet d T feet Property Line ZO .. Drinking Water Well l t 0 Other feet feet 4. Parent Material: A8LAT;OA) TILL Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: i►+cr1< S Q I. INCWbs t DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 2 of 7 Commonwealth of Massachusetts City/Town of IV. /4/v Do VE R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 71 inches elevation Deep Observation Hole Number: T P Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones X5.115 C Z.5- 161(, �S 10Y�sl+� o�irrL S Additional Notes /V CJ W Ply 6 o STA V D-",u(a `'JA 76 tZ O v 6 I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts City/Town of N • AN D oV6 R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: TPS 8 ' Z�-OS l0: 00 SvyNy 7S� Date Time Weather 1. Location Ground Elevation at Surface of Hole c(? Location (Identify on Plan ) FCo'u �Afct SpvT`r� Lute,ST_ �E S I! DE iv -�A�- Sloopp- iU c� r o/ 2. Land Use: Surface Stones e(%) (e.g.woodland,agricultural field,vacant lot,etc.) 6RA5S 6ROv.jD Moe. ;V4 PcK s�caPE Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body (001-1 + Drainage Way fe(0>t Possible Wet Area feeC 1 feet Property Line ;L0- Drinking Water Well 100 Other feet feet 4. Parent Material: AS LAT-i ON T•t LL Unsuitable Materials Present: Yes ❑ Nov If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed:. Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole MorrLES� oal G N•c Estimated Depth to High Groundwater: 3?inch (m elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of N. AN Do vE 4 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: `FPa Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth (USDA) (Moist) Layer (Munsell) (In.) Depth Color Percent Gravel Cobbles &Stones o-3a MEDIUM Additional Notes /V 0 W P��6 O AA A)6 LVA:—(- OaSE VE DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of N• AN Do VE R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation -rpt TP-X 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches [?� Depth to soil redoximorphic features (mottles) A. (057 B. 3;L_ inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes%] No❑ 65- CrP , ) 115- �TP b. If yes, at what depth was it observed? Upper boundary: 3X (,T-P,?,) Lower boundary: 4� (_ inches inches F. Certification I certify that I have passed the soil evaluator examination"approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature of Soil Evaluator Date E36 N3A t-ttA1 G c75�c�o D �R NO�- 1195 'Date of Soil Evaluator Exam Typed or Printed Name of Soil Evaluator Boa RANp`l C�vcL�y rt,L� r2,yER �o•uS�LTq�S ,rd fRHealt A,�QOVER Name of Board of Health Witness Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 6 of 7 Commonwealth of Massachusetts _ City/Town of N. A.✓b ovE f: Form 11 - Soil Suitability Assessment for On-Site Sewage DisposalIp t Use this sheet for field diagrams: p C 5 i(Aj PLAN f I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 7 of 7 Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Tuesday, August 30, 2005 11:03 AM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 520 Foster Street Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 11/22/2005 ' r:l N Pert ; Sb L �llat L✓0.'tJ� 16 i" Or voce /"�� (�/I Q. J T///� Arlf ; i 1- 5 z.sYN ,tee aQ- d;If. ca ,4, , 161 -Ta - $'� c, CS 2.s%/ wr. Qi s /vo f le °� f U Ti, Tr BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 ( APPLICATION FOR SOIL TESTS DATE: D MAP&PARCEL: 1D�. Ig Z/Q LOCATION OF SOIL TESTS: �OS7 sfj'CCJ' /�. d OWNER: tt l-� X�IGtQ(ilPS0i1TES,.NO.: - _ ADDRESS:_ .5040 lFy�l ,S' A) Ad m ENGINEER: an%11MI'l _ . ds44C , /^ TEL.NO.:-j ' CERTIFIED SOIL EVALUATOR: i Intended use of land: Residential Subdivision ingle Family Home Commerciale Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No I/ THE FOLLOWING MUST BE INCLUDED WrrH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of 425 00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upzades. GENERAL INFORMATION 1• Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass,Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than Ir-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not WritjPA=This Line N.A.Conservation Commission Approval: t Date Received: Check Amount: Check Date: WIV �►a� riunw: !9 c VVIl�iT STREET 133 4' /OF HEARIN REALTY TRUST DR .. ��azg'5$" a tE OF APPROVAL: 9 AF ILEs H X63 ti a 13M D qL E� H.FNM. �, LAUD ROPO ED NEW 7 �9 :• ��r�11 ��� T a3 � 3�0 - 15ti :fly,�l 11D�• yp�33 D.H.FND. D.H.FND. D.H.FND. 5,7 N/F N 8007'26"W (p49.27'ESON 49.27' 47,800 s.£ SEE PLAN#3834 D.H.FNIC LOT 48A 65,371 S.F. aoo I�/X k �s� Town of North Andover Health Department Datl Location:C5O?(D (Indicate Address, if Residential,or Name of Business) Check#: Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ A Massage Practice ➢ Offal(Septic)Hauler y ➢ Recreational Camp ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing Sow.( i ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ �' ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER(Indicate) r r.r . 465 �A e Healtht Initials White-Applicant Yellow-Health Pink-Treasurer NEW ENGLAND ENGINEERING SERVICES,INC. 8174 Town of North Andover 8/16/2005 520 Fpster Street soil test 360.00 Checking-Banknorth 360.00 s I ti LETTER OF TRANSMITTAL poRTH North Andover Health Department o �TUeo 16;1'O 400 Osgood Street at? e`.; 6 oL North Andover, MA 01845 0 w ' 978.688.9540 - Phone ! •"" 978.688.8476 - Fax �' o� c�«�:'�•�• healthdegt(&townofnorthandover.com - E-mail �4 Aow^*•o ''���'� www.townofnorthandover.com - Website Page of SsgcHugE TO: DATE: Daniel Ottenheimer COMPANY: FROM:Pamela DelleChiaie, Health Dept. Assistant Mill River Consulting RE. ✓ Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We are sending you: IsoilTest OPlans or Review L7 Other all in below) a . t � ' These are transmitted as checked below: OFor Review and comment OAs Requested DAs Requi /11-7 % v REMARKS: COPY TO: COPY TO: l t COPY TO: SIGNED: I / r � � i �'` �� L� ��� LETTER OF TRANSMITTAL poRTH North Andover Health Department f%.20 , 400 Osgood Street 3�' b!'` �'6 �oL North Andover,MA 01845 978.688.9540 - Phone � � •" 978.688.8476 - Fax04 Coe K« gDwwTlD healthdept(a,townofnorthandover.com - E-mail -9SSACHusE�'�' www.townofnorthandover.com -Website Page of TO: DATE: Daniel Ottenheimer COMPANY: FROM:Pamela DelleChiaie, Health Dept. Assistant Mill River Consulting ✓ Phone: 1.800.377.3044 or 978.282.0014 RE. Fax: 978.282.0012 We are sendin ou: IsoilTest OPlans or Review L7 Other ill in below) AW'_ t o -= G These are transmitted as checked below: 17For Review and comment OAs Requested OAs Required OFor Your Use REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: 130ARD+OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 �1 APPLICATION FOR SOIL TESTS DATE: hzhMAP&PARCEL: LOCATION OF SOIL TESTS: OWNER:_jqla4RQJ( 2x.2611 TEL.NO.: ADDRESS: 5-go FnStw S e AdOP&L, ENGINEER:RJW1 Qa!7ill G • TEL.NO.: CERTIFIED SOIL EVALUATOR: / P U Intended use of land: Residential Subdivision Lgleamily Home Commercial Is This: Repair testing Undeveloped lot testing Upgrade for additions In the Lake Cochichewick Watershed? Yes No I/ THE FOLLOWING MUST BE INCLUDED WrM THIS FORM: 1 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1"-1001)shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: TE OF F ILH c.: 60 N/F 133.04, V;R,4M STREET TE OF HEARINGE�, � REALTY TRUST D H.FNDIL oZg�58"E 33 TE OF APPROVAL: 9 l AR o 63o.�p3 'L5�`3� /rt>:s 0.122 � AaE t LAO D. FNA. : • PROPOSED��ANEW 711-07 io 9 . o S6 �,� o y33 D.H.FND.'• D.x FND. •D.H.FND. �y N �N/F N 8007126"W e �a MATTE ESON 49.27' 47,800 s.f. 5 SEE PLAN#3834 V' D.H.FND. LOT 48A 65,371 S.F. aoo •tr4.1k 1 � � �a, i� '-�yy',,�tff¢�vVk_F.y�.'.��'jro-l.{r,r{.• u\�tJ'( F . ��lifi4§'F,{II.VIJ , •s 7r. .. �.f'y't •(IY)Vr�17]'�r�'t("'�ars,Y S O�rttr i`� J�`ttr ��' + �, 4HEALTH �onwealth of Massachus,City/Town`'of NORTH ANDOVUS TTS ysfem Perm in Recordpg �Fonn'4 DEP has provided this form for use by loyal Boards of Health. The System Pumping Record n be submitted to the local Board of Health or other approving authority. Facility Information .anC Ailing out 1. System Locat! n; ,)n the Wr,use 3 tab key Address. )yourk).. Rn _P6: do,not r;l /Town returri ty State IJp Code 2, System Owner Name / .. Address(If different from location) i, Cltyrrown State Zip Code Telephone Number 6, Pumping Record 1, Date of Pumping1 2. Quantity Pumped: A Data ry p Gallons 3..,Type of system: . . ❑ Cesspool(s) [Z,$eptic Tank ❑ Tight Tank CL _ y� Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If ye`s`vvas it cleaned? ❑ Yes ❑ No 5. Conditlon of System: 6.. S stem Pumpe By: me. Vehicle Ucense Number Company.:. 7Locatio where contents were disposed: J S nat of Ha Date w.mass.gov/d.epiWater/ approvalsA5forms.htm#inspect c 08/03 n, System Pumping Record•Page 1 of i