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Miscellaneous - 545 JOHNSON STREET 4/30/2018 (2)
545 JOHNSON STREET j 210/098A-0013-D000_0 r J I+ 4 i I North Andover Board of Assessors Public Access Page 1 of 1 V • NORTH North Andover Board of Assessors •�'r was... F r S„CHU �� roperty Record Card Click Seal To Retum Parcel ID :210/098.A-0013-0000.0 FY:2010 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels F-1 Search for Sales Q. Summary Residence Detached Structure Condo 545 JOHNSON STREET Commercial Location: 545 JOHNSON STREET Owner Name: PELUSO,FRANK J VIRGINIA M PELUSO Owner Address: 545 JOHNSON STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:7:7 Land Area: 1.02 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1050 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 340,800 352,400 Building Value: 115,000 127,500 Land Value: 225,800 224,900 Market and Value: 225,800 Chapter Land Value: LATEST SALE Sale Price: 1 Sale 03/15/2001 Date: Arms Length Sale F-NO-CONVNIENT Grantor: FRANK PERRY Code: PELUSO Cert Doc: Book: 06050 Page: 0192 http://csc-ma.us/PROPAPP/display.do?linkld=1517097&town=NandoverPubAcc 9/16/2010 StiTTY ED, COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTI FIC3TE Off' C0.41PLIANCE As of: October 29, 2010 This is to cert that the individuafsu6surface dzrposaCsystem receiveda SATISIACT0RTI9VSTEM0-rArgf the: ftfitcement of an Individuaf On Site Sewage 04osalSyst•em By: Dan Briscoe Ai: 545 Johnson ,Street 9l ap-098.A--cParcef-0216 210/098.A-0013-0000.0 North Andover, 91A 01845 die Issuance of this certificate shal(not be construed as a guarantee that the system willfunction satisfactorify. -J'X Sp6i ,r&. Sauryerf-Woa)�U (Pu6Crc-VeaCth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP& PARCEL NUMBER LOT LINES &LOCATION OF DWELLINGS LOCATIONS &DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING WELLS b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM _ TOP OF FDN ELEVATION LOCATIONS OF WELLS DRAINS WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX y - / ORIGINAL STAMP& SIGNATURE v IMPERVIOUS AREAS -DRIVEWAYS, ETC. ��. NORTH ARROW , LOCATION&ELEVATIONS OF BENCHMARK USED Commonwealth of Massachusetts W City/Town of North Andover CU Certificate of ComplianceW%llown" Form 3 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 the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer, use ❑ Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date Frank Peluso hn Facility Owner 545 Johnson Street Street Address or Lot# North Andover MA 01845 Cityrrown State Zip Code Designer Information: P�jN OF MAssq� James Scanlan, P.E. 4JAMES l3 yGr Scanlan Engineering LLC Na g CIVIL Name of Company 0 o No.4MO 10/14/10 natureDate 090 �F6lSTE�'�� Installer Information: F�SsIONAtE��� Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc•06103 Certificate of Compliance•Page 1 of 1 AS-BUILT CHECKLIST LOT NUMBER, STR2NMME ASSESSORS MAP & PARCEL NUMBER LOT LINES &LOCATION OF DWELLINGS _ LOCATIONS &DIMENSIONS OF SYSTEM, -CALCI G RESERVE TIES TO LOT LINES &DWELLING, WELLS a. M E FROM LEACH AREA y LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM N TOP OF FDN ELEVATION LOCATIONS OF WELLS,DRAINS, WATERCOURSES � WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP& SIGNATURE / IMPERVIOUS AREAS -DRIVEWAYS, ETC. y NORTH ARROW . LOCATION &ELEVATIONS OF BENCHMARK USED ` NORTH D Q�ttL_ID 86g1,� O to � C'0 1% 0A cociiHawcw`�• Ar D �SSAC HUS�� PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 545 Johnson Street MAP: 98A LOT: 13 INSTALLER: Dan Briscoe DESIGNER: James Sand n PLAN DATE: 7/30/101 °I�� b BOH APPROVAL DATE ON PLAN: 9/14/10 INSPECTIONS TANK INSPECTION: I�-��l 0 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/4/10 DATE OF FINAL GRADE INSPECTION: 16 1 all b SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-20 loading ® Monolithic tank construction ® Watertightness of tank has been achieved by 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH d ,6 0 `,,t • 6 `O yr t �yy T T C'0 O cociiiwKw 1. gOaATE0 It C2 SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ® 20" inch cover to final grade installed over outlet access port ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 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 pump access port ® Watertightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 %►ORTH ,6'9ti� p t6 00 -A A OA COCMICMIWKw`V 0RATEo PPP (y �SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: Speed levelers do not prohibit the effluent from draining into laterals during dose. SOIL ABSORPTION SYSTEM (General) Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan NA Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH p�tt�aD bgti0 3? �� ° 0 o 0.9A cociiiww.w`y• ��SSACHUS���y PUBLIC HEALTH DEPARTMENT fommunity Development Division BM = 100.00 HR = 3.84 HI = 103.84 SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 100.00 Building Sewer OUT 6.21 97.28 97.4+/- Septic Tank IN 6.58 96.91 97.20 Septic Tank OUT 6.85 96.64 96.95 Pump Chamber IN 6.88 96.61 96.93 2" Pump Chamber OUT 6.50 97.17 97.18 2" Distribution Box IN 2.86 100.81 100.74 Distribution Box OUT 2.85 100.64 100.57 Lateral 1 TOP 292/307 Lateral 1 INVERT 100.57/100.42 100.54/100.40 Lateral 2 TOP 291/305 Lateral INVERT 100.58/100.44 100.54/100.40 Lateral 3 TOP 292/306 Lateral 3 INVERT 100.57/100.43 100.54/100.40 Lateral 4 TOP 293/306 Lateral 4 INVERT 100.56/100.43 100.54/100.40 Bottom of Bed 99.9 99.9 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 14ORTH q 0 tts,aO16tb�O0 3? L O 1A l 0AT D -pA cociiiwKw`�1' ��SSAC HUS���� 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 Inspection Form June 2008 FINAL GRADE I SPEC ION Date: '� Address: ZLOAMED? ❑ SEEDED? o,/COVER PER PLAN? r Other: E po c Moi*� Commonwealth of Massachusetts Map-Block-Lot 098.A0013 Board of HealthNo 4 p. Permit 01 i North Andover BHP-2010-0722 °. .;;::... •' ' P.I. FEE �,ss.+twa �t F.I. $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Daniel-R. Briscoe to(Repair)an Individual Sewage Disposal System. at No 545 JOHNSON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2010-072 Dated September 16,2010 ----------------- ----------------------------------------------- Issued --- ------- Issued On: Sep-16-2010 Board of Health aRTh Application for Septic Disposal System 3? •` �0 TOD 'S DA E Construction Permit - TOWN OF ORTH ANDOVER, MA 01845 250.00—Full t CHuSet omponen Important: Application is hereby made for a permit to: When filling out forms on the E] C struct a new on-site sewage disposal system* computer,use Repair o replac only the tab key ( existing on-site sewage disposal system* to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return key. A. Facility Inf--'' , �orm�o v '15 a,, s Q Address or Lot# D X II ti V City/Town 2.-*TYPE OF SEPTIC SYSTEM*: Pump El Gravity(choose one) **If pump system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Infor ation -e Name Address if different from above) Y4 vie City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company Address j rn ve 1�, City/Town Sate ��� Zi X7ole G�6.f S Telephone Number(Cell Phone#if possible please) 4. Designer Information L7ar+e3 �c 4� l�� -5 Name Name of Company .49 o. 9°lol Addr ss City/Town State � � iJ �� �p Code� 5 Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 y ` y � a°RxN Application for Septic Disposal System °-Construction Permit - TOWN OF TODAY'S DATE O , MA 01845 $250.00—Full Repair RTH ANDOVER .SAS�4CHU5° < $125.00-Component � PAGE 2 OF 2 A. Facility Information continued.... p� � 5. Type of Building: �gResidential Dwelling or❑Commercial B. Agreement , The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued this Board of Health. c� Name Date' Application App lved By: (Board Health Representative) � lt� NameDate Appy ionililsapproved r the foll ingreasons: For Office Use Only: L Fee Attached? Yep/ No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach copy ofElectrical Permit Yes V No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) A/ 5. Floor Plans?(new construction only): Yes fy No Application for Disposal System Construction Permit•Page 2 of 2 Wit. �.V//lYr/U/1 Plb�s9/6I/ 6�0 /'O�Yg�58Q�AI6d�Cd6� -- Q --' • Permit No. J ®epar'tment ®f Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (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 WINK OR TYPE ALL INFORMATION) Date: / b�� (� City or Town of: NORTH A"OVE a 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) �—q 11S�Zn c4_. Owner or Tenant FrC -rk\ &1 G\S6 Telephone No. ? `G S3--0(N Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building k�,� - a 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 i 9 rf ;flowing table may be waived by the Inspector of Wires. Date...... No.of Total Transformers KVA f N°nTM, Generators KVA °.<"'..:•�.."°° TOWN OF NORTH ANDOVER No.of Emergency ig mg F . � a PERMIT FOR WIRING Battery Units « . FIRE ALARMS No.of Zones �o ,��•,•;r�o',,� No.of Detection and ,SSACNUS�� Initiating Devices No.of Alerting Devices This certifies thatp��.U............................... No.of Self-Contained .................(. Detection/Alerting Devices has permission to perform ........ r .......•...••.• ......... Local❑ Mun'ctl ❑ OtherConneion wiring in the building of AA�,. S. ?............................................. Security Systems:* ••••••••••• No.of Devices or Equivalent YS' ,T1J�wScrr. 51 North Andover Mass. Data Wiring: at........... ..................................................... . No.of Devices or Equivalent o Fee.. ..-'... Lic.Nof�:�lrt�9r yTelecommunications Wiring. .••••. No.of Devices or Equivalent t �LEC'rR(CAL INSPECTOR Check # 'lZil if desired, oras required by the Inspector of Wires. 111unicipal policy.) Jth MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Affir,J 1�. A,AU•f-)0-b Signature LIC.NO.: aSj .yy� (If applicable nter "exempt"in the I'cense number line.) 9 Bus.Tel.No.: Address: vl�• 41.1tic � _G (t)'1f ljc, ✓,t! Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 Owner/Agent PERMIT FEE: $ Signature Telephone No. SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: S 70AZ/2 S s�� sco., 41,1 &� (Address of septic system) Fir dans by t e (Engineer) Relative to the application of "7 j,7Dll o (Installer's name) And dated rigina ate Dated 111411 � ��/�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 plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection without completion of the items in accordance with Tide 5 and the Board of Health Regulations may result in a 550.00 fine being levied against me and/or MY company. a. Bottom of Bed—Generally,this is the first (V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK(or e-mail to: healthdept(@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover. 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 Q12ro ed plans No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: �� f (Today's Date) ame—Print) ame—Signed) 6.Vl111"U111 VWa1d1A us J-1anzpcl(wrIQd91=46 Si Permit No. � ?J Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELmECTRICAL, WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: `/ //0// o 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) ��qJ ©�n ,tn �• Owner or Tenant prc-tl V. e-A L':STelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building &<.' c9e 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 RECEIVED .y r� Ilowing table may be waived by the Inspector of Wires. 10 Date...... No.of Total OCT °' Transformers KVA MpRTy•1 OWH� Generators Of KVA c '`^` N OF NORTHEALTH DEPA R F NORTH ANDOVER o.of Emergency Lighting r . • '° PERMIT FOR WIRING Batter Units « : » FIRE ALARMS No.of Zones • °, .><-..•.-•<• ' No.of Detection and SACMUS Initiating Devices No.of Alerting Devices This certifies that ..................1:'.. ......1 ©' •U.•••.........................• -'w No.of Self-Contained .............. /t ;' Detection/Alerting Devices has permission to perform S'C,oT�c -� Ll�� E ............••• oca ❑ Municipal F] Other Connection wiring in the building of , � j/S. Security Systems: �' """"""""""""""""""" Security of Devices or Equivalent y� ,��.. l�.S'cry -'� ,North Andover,Mass. Data Wiring: at...........: ........................ .................�..'....... c o •. No.of Devices or Equivalent Telecommunications Wiring: Fee.. ............ Lic.No'_ e ............. ' No.of Devices or E uivalent RICAL INSPECTOR Check # 'i' if desired, or as required by the Inspector of Wires. Municipal policy.) ith MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: A/.�f e,; .- -,ko'(1\�b Signature , LIC.NO.: (If applicable4nter "exempt"in the I'cense number line.)] Bus.Tel.No.•�i� " �3"1 f b t Address: `1 l�(-? r,CtC �G rt)'1/f✓1�„n-t� rM, OIJ3� Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety S License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have th6 liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's Owner/Agent PERMIT FEE. $ Signature Telephone No. TOWN OF NORTH ANDOVER Permit Number ,3 U NORTH ANDOVER,MASSACHUSETTS 01845 ;711111411129 � /� R=h Date Issued Expiration Date Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant A,(Ae- (-�CQS- —7? c- Phone Cell Street Address �� Goreej �l cam, ,,T q�� Cityfrown MA I ZIP r Name of Excavator(if different from applicant) Phone Cell Street Address City/Town MA ZIP Name of Ow"r(s)of Property . Phone Cell ?�tT�res� v �� -PC-C�S O Street City/Town MA ZIP 0194-,%- Other f `%Other Contact Permit Fee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. Insurance Certificate 1 F 1 s Name and Contact Information of Insurer: s - r- Policy Ex iradon Date: Dig Safe#: ��0 C->I. Na a of Com tent Person(as defined by 520 CMR 7.02): Massachusetts Hoisting License# License Grade: Expiration Date: c BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.C. 82A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLIC TSIGNATURE Lpc_ G DATE f EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S SIGNATURE(IF DIFFERENT) DATE: 21Page `trJr.- =,'�.•=,.-:sr:', - :! ,t;*=- g�ia""' .i✓,�--aL:M =t�:i tom•_'' ?,✓'- _ "a� _ •� ..�w"��:: -.ryX� :,r:.:ar•,,-.r~uw� _ ';�-K �=."< <ca�r �. 'r f,�.sr - -`=•:.=:fir .lt - - - _,. ..:k .,��"j✓ `.z ,,.;.F•avr J- r��. Is;:.�-',y..u�k-a .uf.,:i.:.eeti.�l-.... M ..!"-.:`��jY c.'/.•-,"'.�.'rwn_i,'-.'"'..s.-'..•.•9�",'�"rr '�r1_ �;C-2.'�:'7T:r;'C;': �::G::�'' ...:c'"�' '^.rt��' -`2ar1.'� .,;y" ;:�' ::"h" _ w%z:...�"�-..^a;.='r.,„✓-"•°w., x��-,�,^:3�/�'... F__:24=.... �.rr>:^L-`.�..,, c =��r..u'"''-„s.c'._ _�✓t:.+=a:=,�,r`�-. ,3f5 .�',- �� �Cr -C.r•.::.�;=:rd. `�..iY,2>-..cv.A”��:.'�a�..K� ._,._:$T .ss�;Y='-0. 11"� i� � .����C'k -�-v ✓?G-9 '2, _,�:•, �:_ y�c,.•'`.`.'w.?..^Y;. M - crr' ..uc„-z::r<s .�+:_�— :2r^'.'--v:;ua. .-r: m.�G. �,�:.. _ _,,.;.�,.: w:;y ,.�;"'{G<.,r'”r...i, ✓%y c... l ice:_ _ N1.^i+'-fir':''.:(,=^���-�_.�,�..�y, J� �.^-� N"^.-.r, ,aa�-, x.�r�'r'�`�.'.*..',. '`IX^. w.'�.C�i�,. rkr:.i'¢ri'+..,=.�;:h -r,�r'a:r-�? — .a^ ,,,s:r't'.,. :.c:..y.:^�"r= .��. .�✓ ,x:^^;.-._.,�. CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application,the applicant understands and agrees to comply with the following: F. No trench may.be excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164(DIG SAFE); ii. Trenches may pose a significant health and safety hazard. Pursuant to Section i of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR 1926.650 et.seq.,entitled Subpart P"Excavations". iv. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et.seq.,entitled Subpart P"Excavations"as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www,mass.eov/das NORTH ANDOVER HEALTH DEPT. 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 3 1 P a g e • $�gTLED J�6' . • North Andover Health Department Community Development Division August 26, 2010 James Scanlan, P.E. Scanlan Engineering, LLC P.O. Box 906 Georgetown, MA 01833 Re:Subsurface Sewage Disposal System Plan for 545 Johnson Street(Map 98A.Lot 13) Dear Mr. Scanlan: The proposed wastewater system design plan for the above site dated July 30, 2010 and received on August 17, 2010 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Form 9A Local Upgrade Approval form is required. 2. Please indicate the effluent filter shall be maintained in accordance with 310 CMR 15.227(7). 3. Please indicate that the pump and alarm will be on separate circuits (3 10 CMR 15.231(9)). Please feel free to contact the office with an questions you may have. We look forward t any Y Y o 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. Sincer , Susan Y. Sawyer, I HS/RS Public Health Director cc: On Deck Properties File Page 1 of 1 North Andover Health Department, 1600 Osgood Street., Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval w„ 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 wi - 10 CMR 15.000. A. Facility Information SEP _8 2010 Important: When filling out 1. Facility Name and Address: TOM of N®ATW ANDOVER forms on the HEALTH DEPARTMENT computer,use Frank Peluso only the tab key Name to move your 545 Johnson Street cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code teb 2. Owner Name and Address (if different from above): Frank Peluso 545 Johnson Street Name Street Address North Andover MA Citylrown State 01845 (978)683-0048 Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 I I I Commonwealth of Massachusetts City/Town of North Andover o Form 9A - Application for Local Upgrade Approval M s DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 330 gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: New system including septic tank, pump chamber, dbox and leach field. 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 ft. Percolation rate 10 min./inch Depth to groundwater 3 ft. t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Otherp fY ❑ q Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe 7/22/10 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: The existing building sewer pipe exits dwelling at elevation which puts the septic tank inverts at the ESHGW elevation, with a minimum slope between the dwelling and proposed septic tank. The reduction to ESHGW at the leach field is to minimize the mound required by the ESHGW. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative is not desired by client, and would not have an impact on the septic tank invert elevations. The owner would choose other options over installing an alternative technology. t5form9a•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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: There is no interest in a shared system. 4. Connection to a public sewer is not feasible: There is no public sewer in the area. 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." Facility Own s SignatureV r- / Date ` Print Name TO Jim Scanlan Name of Preparer Date PO Box 906 Georgetown Preparer's address City/Town MA 01833 978-372-3440 State/ZIP Code Telephone t5form9a-rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Thursday, August 26, 2010 12:37 PM To: 'Daniel Ottenheimer; Grant, Michele; irowe@miliriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 545 Johnson Street Attachments: 545 Johnson Street- Disapproval Letter 8-26-10.doc Susan, Please find attached the disapproval letter for the above referenced property. Jim Scanlan did a good job on this plan. There are only a few minor comments. It would be nice to have more plans like this! I should be sending over the review for 1503 Osgood St later today. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting ' 6 Sargent Street 1 -F[ �� Y • S�gTGED l6ge . North Andover Health Department Community Development Division September 14, 2010 Frank Peluso 545 Johnson Street North Andover, MA 01845 RE: Septic System Design, 545 Johnson Street,Map 98 A,block 13, Lot 0 Dear Mr. Peluso, 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 Scanlan Engineering, LLC dated July 30, 2010, last revised September 8, 2010 and received September 8,2010. This plan has been approved. The approval includes Local Upgrade approvals granted by the North Andover Health Department for the distance from the soil absorption between the SAS and the High Groundwater from 4 feet to 3 feet, and a reduction of 12-inch separation between inlet and outlet tees and high groundwater. Please keep a copy of this approval with your household records. The design has been approved for use in the construction of an onsite septic system for a 3- bedroom house (maximum 7-room). In accordance with state subsurface disposal regulations plans shall expire three years from the date approved unless construction on the lot has begun. 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. 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. 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. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com P ry 545 Johnson Street Septic System Approval September 14, 2010 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. Sincerely, SjIsan Y.S, er, S/RS`s Public Health D'rector Cc: James Scanlan, P.E. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of North Andover a o Local Upgrade Approval Form 913 7y Sy`' 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 Frank Peluso key to move your Name cursor-do not 545 Johnson Street use the return Street Address key. North Andover MA 01845 � City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3: Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 gpd 5. System Designer: James Scanlan ❑ PE ❑ RS Name P.O. Box 906 Georgetown MA, 0184 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 545 Johnson Street 913 914 10•rev.7/06 Local Upgrade Approval*Page 1 of 2 ~, Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 9B o GSM yvV B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1ft ft. Percolation rate 10 min/in min./inch Depth to groundwater 3 ft. ft. ❑ Relocation of water supply well (explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department 1 Approving Authority Susan Sawyer, Health Director September 14, 2010 Print or Type Name and Title 8ignature Date 545 Johnson Street 9B 9 14 10•rev.7/06 Local Upgrade Approval*Page 2 of 2 TOWN OF NORTH ANDOVER t MORTp Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOGD STREET;BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdei)t@townofnorthandover.com WEBSITE:htty://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM ' rAUG � � �01gDate of Submission: / CJOWN OP NOWN ANdOM Site Location: '51/5 JC)H'u50A/ ST2FFT HmTH DEPARTMEN7' Engineer:j/m 6LaA&&—j - YO-ndZ6d LLC- New Plans? Yes J $225/Plan Check# (includes I"submission and one re- review only) Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yes V No, Local Upgrade Form Included? Yes V No ' Telephone#:177 ,3i-1 �a Fax#: E-mail: j1rry16?aC.af)/a 1P. 1 neerim • CoLn Homeowner Name:t:79A�[K JOEL( 30 OFFICE USE ONLY When the subm Sion is complete(including check): ➢ 7 Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, t4�e 7 j A`t"A/A'Y1V6C ,MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location 5q6 I Owner's Name FRPA-hK P4FV6) Map/Parcel# g8A4 j3 p Address 6_Y JUHNSOtJ v Lot# Telephone# y _ ,S _ 00Y8 Installer's Name Designer's Name SCA�J C 45AJ6, Address Address PO /-30< ROO 6�Z1266_V�CAJ Telephone# Telephone# q78- 372-34140 Type of Building 5 w6l E GA-m i_y Lot Size by(03Y:� sq.ft. Dwelling-No.of Bedrooms 1 H e.E �3) Garbage grinder(NO Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 33G gpd Calculated design flow ":g 3 C) Design flow provided 3 gpd Plan: Date 7!3o 10 Number of sheets Z Revision Date Title S L Description of Soil(s) 67 Z Soil Evaluator Form No. SE-Z 15- i Name of Soil Evaluator-JI Pen Stf4&lLPNDate of Evaluation 7 ZZ1 )0 DESCRIPTION OF REPAIRS OR ALTERATIONS S7 R;A N The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgr de1�4;Ral DEP has provided this form for use by local Boards of Health. Other for 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 Frank Peluso only the tab key Name to move your 545 Johnson Street cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Frank Peluso 545 Johnson Street M7°' Name Street Address North Andover MA Citylrown State 01845 (978)683-0048 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Dwelling 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Leach Field t5form9a•rev.7106 Application for Local Upgrade Approval* Page 1 of 4 t 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: 330 Design flow of existing system: gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: New system including septic tank pump chamber dbox and leach field. 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 ft. 10 Percolation rate min./inch Depth to groundwater ft t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 a t Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval w DEP has provided this form for use by local Boards of Health. Other forms may be used, but the j 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): I ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe 7/22/10 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: The existing building sewer pipe exits dwelling at elevation which puts the septic tank inverts at the ESHGW elevation, with a minimum slope between the dwelling and proposed p setic tank. The reduction to ESHGW at the leach field is to minimize the mound required by the ESHGW. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: An alternative is not desired by client, and would not have an impact on the septic tank invert elevations The owner would choose other options over installing an alternative technology. t5form9a•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 i Commonwealth of Massachusetts City/Town of North Andover 0 Form 9A - Application for Local Upgrade Approval w 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: There is no interest in a shared system 4. Connection to a public sewer is not feasible: There is no public sewer in the area 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 "l, 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' � 43/� Facility Owner's Signature Date Print Name Jim Scanlan Name of Preparer Dat PO Box 906 Georgetown Preparer's address City/Town MA 01833 978-372-3440 State/ZIP Code Telephone NG 17 2010 N"AWDOM t5form9a•rev. 7/06 Application for Local i I f Commonwealth of Massachusetts City/Town of 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 7RECIEIVED Frank Peluso Owner Name 7 2010 545 Johnson Street Map/Block/Lot 98A/13/0 Street Address North Andover MA 01845 TOWN OF NORTH ANDOVER City/Town State Zip Code HEALTH DEPARTMENT B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. Published Soil Survey available? Yes ® No ❑ If yes: 8/2008 1:1220 420B Year Published Publication Scale Soil Map Unit Canton Fine Sandy Loam Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit 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 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑ Month/Year 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 1 of 7 Commonwealth of Massachusetts Cityffown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal i C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TT=1 7/22/10 Clear Warm 80F Date Time Weather 1. Location Ground Elevation at Surface of Hole 99.4 Location (Identify on Plan ) 2. Land Use: Yard None 33=8 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body N/A Drainage Way N/A Possible Wet Area N/A feet feet feet Property Line 10+ Drinking Water Well 100+ Other Feet feet 4. Parent Material: Outwash 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 None Depth Standing Water in Hole None Estimated Depth to High Groundwater: 30 96.9 inches elevation i I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts City/Town of 'WIE, Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number:T=1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 A 10yr3/3' Fine Sandy Massive Friable Loam 8-17 C1 2.5y6/3 Fine Massive Friable Loamy Sand 17-40 C2 2.5y6/3 30 2.5y7/1, >5% Fine Crumb Firm 7.5yr5/8 Loamy Sand 40-120 C3 2.5y5/4 Medium Single Grain Loose Sand Additional Notes ESHGW CcD-30" - No Observed standing Water- No Refusal DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: T_2 7/22/10 Clear Warm 80F Date Time Weather 1. Location Ground Elevation at Surface of Hole 99.1 Location (Identify on Plan ) 2. Land Use: Yard None 33=8 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body N/A Drainage Way N/A Possible Wet Area N/A feet feet feet Property Line 10+ Drinking Water Well 100+ Other Feet feet 4. Parent Material: Outwash 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 None Depth Standing Water in Hole None Estimated Depth to High Groundwater: 30 96.6 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Numbeff-22 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 A 10yr3/3 Fine Sandy Massive Friable Loam 8-20 C1 2.5y6/3 Fine Massive Friable Loamy Sand 20-50 C2 2.5y6/3 30 2.5y7/1, >5 Fine Crumb Firm 7.5yr5/8 Loamy Sand 50-120 C3 2.5y5/4 Medium Single Grain Loose Sand Additional Notes ESHGW(aD-30" - No Observed standinq Water- No Refusal DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 7 Commonwealth of Massachusetts t City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal M D. Determination of High Groundwater Elevation 1. Method used: ® Depth observed standing water in observation hole A. None B. None inches inches ® Depth weeping from side of observation hole A. None B. None inches inches ® Depth to soil redoximorphic features (mottles) A. 30 B. 30 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❑ b. If yes, at what depth was it observed? Upper boundary: 8 Lower boundary: 120 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 pert by me onsist nt with the required training, expertise and experience described in 310 CMR 15.017. i ature of Soil Evaluator Date mes Scanlan April 1995 Typed or Printed Name of Soil Evaluator "Date of Soil Evaluator Exam Isaac Rowe North Andover Board of Health 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 a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet for field diagrams: Lor u a SW DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 7 Commonwealth of Massachusetts City/Town of North Andover W Percolation Test Form 12 �N Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer, use Frank Peluso only the tab key Owner Name to move your 545 Johnson Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code (978)683-0048 Contact Person(if different from Owner) Telephone Number B. Test Results 7/22/10 Date Time Date Time Observation Hole# P-1 Depth of Perc 24"- 12" Start Pre-Soak 10:34 End Pre-Soak 10:49 Time at 12" 10:49 Time at 9" 11:10 Time at 6" 11:39 Time(9"-6") 29 minutes Rate Min./Inch 10 min/inch Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ James Scanlan Test Performed By: Isaac Rowe- North Andover Board of Health Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 R TOWN OF NORTH ANDOVER o� .�ao,•'40 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ~ " i _ ` j • 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 'ss,C,,,,5e` Susan V.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthde t a,townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: �] J (Z) 10 MAP&PARCEL: (()/q0A 13 LOCATION OF SOIL TESTS: 54-':� I© H 1`150�,1 %I- OWNER: TOWNER: 159—A 1A)�, Vi a 61 t l 1 A PEE t-.USO Contact#: APPLICANT: SAME Contact#: ADDRESS: j ' (�^ ENGINEER: CAN L(�t-� E►.�G�I t.?1=E12�1 ti1C�1 4�—`f'ontact#: g.-n -m- 3444 CERTIFIED SOIL EVALUATOR: j i m Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: �3 �2L I- (S I/(,-/ Signature of Conservation Agent:" Date back to Health Department: (stamp in): R r _ Z.: m 1 = i IA o,P�c /'L<?f'V CFEll s Ir i> Foe 5 A b 6rY00,9 IIOIWZ 37 �/IfC •� 300' b-� .1G'dP iY N— '� ✓!»-1� ij ` ryo� ?c•-`v F. Pct ��s y`S firms y 'u � � `� P � Girl/Er14!rreerS E Sur•v�ya S San' { t•1 P, V t=l 4 j --700- h Xt+l7f(4t eJf Uf10rE/' ��Sf/,riG�'Y1S/O arif •-:--J. i ifs - �4 1 �a sf � �. � • 1 E SOcI' `3 i - b"J%r3'09:07Y•— � �_s.s srin' S' TL g a � =� dfaav vscov daG�J [ v5cao �Q.9ra z3} ° 19 20 21 22 � 23 21- 25 2f L • �All, rte � /�, �x,• .lnsfnrsc3tr Residential Property Record Card PARCEL_ID:210/098.A-0013-0000.0 MAP:098.A BLOCK:0013 LOT:0000.0 PARCEL ADDRESS:545 JOHNSON STREET FY:2010 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 06050 Road Type: T Inspect Date: 09/29/2003 Tax Class: T Sale Date: 03/15/01 Page: 0192 Rd Condition: P Meas Date: 09/29/2003 Owner: Tot Fin Area: 1050 Sale Type: P Cert/Doc: Traffic: M Entrance: X PELUSO,FRANK J Tot Land Area: 1.02 Sale Valid: F Water: Collect Id: RRC VIRGINIA M PELUSO Address: Grantor: FRANK PERRY PELUSO Sewer: Inspect Reas: M 545 JOHNSON STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RN Tot Rooms: 6 Main Fn Area: 1050 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R3 Story Height: 1.00 Bedrooms: 3 Up Fn Area: Bsmt Area: 1050 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 225,640 Ext Wall: WS Half Baths: Unfin Area: Bsmt Grade: 2 R 101 A 0 0.020 152 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1050 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: T RCNLD: 110936 Kitch Qual: T Eff Yr Built: 1965 Mkt Adj: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class SE S 1 0.00 1988 A A ///88 0 Heat Type: HW Ext Kitch: Year Built: 1960 Sound Value: PA S 1 0.00 1988 A A 50/8 3,700 Fuel Type: G Grade: A Cost Bldg: 110,900 SE C 144 0.00 1988 A A 50/// 3,0 Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Vail: N88 Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12: VALUATION INFORMATION Aft Gar SF: 582%Good P/F/E/R: /1001100/73 Current Total: 340,800 Bldg: 115,000 Land: 225,800 MktLnd: 225,800 Porch Type Porch Area Porch Grade Factor Prior Total: 352,400 Bldg: 127,500 Land: 224,900 MktLnd: 224,900 E 192 P 20 SKETCH PHOTO 12 192 Sq.Pt 12 12 '12 4216 inf .. 288 SqJ tG FDI 4 294 5 21 g 24 1050 SgFt all 24 26 �a 545 JOHNSON STREET �•tti*� . -u� Parcel ID:210/098.A-0013-0000.0 as of 7/9/10 Page 1 of 1 on overdue payments from the due date until """"" ' 04RE ACT payment is made. THE COMMONWEALTH—OF MASSACHUSETTS Town of North Andover Make Checks Payable To: Fiscal Year 2010 4th Quarter Town of North Andover Actual Real Estate Tax Bill Collector of Taxes _- P.O. Box 184 Office of Collector of Taxes Medford, MA 02155-0002 Jennifer Yarid, Treasurer/Collector Office Hours: PAV/MtN-f M-F 8:30am - 4:30pm PELUSO, FRANK J TAX COLLECTOR: 978-688-9550 VIRGINIA M PELUSO ASSESSOR: 978-688-9566 545 JOHNSON STREET NORTH ANDOVER, MA APR 0 5 2010 Please use the enclosed lockbox envelope to NOR NORexpedite your payment.This will assist us in 01845 NORTH ANDOVER processing your payments more efficiently.The Tax TREASURER-COLLECTOR Collector's Office is located at 120 Main Street. 206413-000001 Based on assessments as of January 1,2009, Town of North Andover 4th Quarter Receipt your Real Estate Tax for the fiscal year beginning July 1,2009 and ending June 30, Fiscal Year 2010 4th Quarter Keep This Portion For Your Receipt 2010 on the parcel of real estate described Actual Real Estate Tax Bill Bill No. 15110 below is as follows: PROPERTY DESCRIPTION Jennifer Yarid,Collector of Taxes Real Estate Tax $4,341.79 545 JOHNSON STREET SPECIAL ASSESSMENTS CPA $91.50 Class Code 101 Special Assessments $0.00 Land Area 1.02 Exempt/Abatement $0.00 Map-Lot-Plot 210-098.A-0013-0000.0 Subtotal $4,433.29 Book/Page 6050/192 Land $225,800 Building $115,000 Payments Made ($3,274.79) Tax Rate Per$1,000 Total Value $340,800 Past Due $0.00 1 Res. 2OpenSp 3Comm 4Indust *418782004* Interest$12.74 $0.00 $17.69 $17.69 11111111111111111111111111111111111111111111111111111 - 4th Quarter Tax $1,158.50 Assessed owner as of January 1,2009: PELUSO, FRANK J Interest at the rate of 14%per annum will Amount Due VIRGINIA M PELUSO accrue on overdue payments from the due $1,158.50 545 JOHNSON STREET date until payment is made. 5/3r 2010 NORTH ANDOVER, MA 01845 0418782004201000000000(00000��0�000000001,000051,100000001,15850049 i � I /I I I I 1 'I r i - � I -77 r f ii i f I / I j err► i I� i i '�- I i I- t''T I i I it L Ll iGr i L )prPil IbI-Aft !/1/d 11) i r Init- { I+ I (Ft T I �{ { iI I � T�'. I 1I � ' i , 1 I i I i 1 �1 I71TITH H 1 i 1 I IilIli '�I II I ' il ; { ill + '� �LLLi�y1. SUBSURFACE SEWAGE DISPOSAL SYSTEM _.._. PUMP DESIGN RECEIVED 7 Zona 545 Johnson Street TOWN OF NORTH ANDOVER North Andover MA HEALTH DEPARTMENT (Tax Map 98.A Block 13 Lot 0) OWNER: Frank Peluso 545 Johnson Street North Andover MA AsS �n JAMES B �c SCANV�,N CIVIL No.4$2&9 j �o.9�GISTE �Q DATE: 7/30/2010 `Fss�aIVAL Scanlan Engineering LLC #0321 9 9 P.O.BOX 906 GEORGETOWN, MA 01833 978-372-3440 545 Johnson Street Frank Peluso North Andover MA 545 Johnson Street (Tax Map 98.A Block 13 Lot 0) North Andover MA 7/30/2010 PUMP CALCULATIONS: DAILY FLOW: 330 GALLONS/DAY SOIL PERC RATE: 10 MIN/IN SOIL TYPE: CLASS II 4 DOSES/DAY VOLUME/DOSE: DOSE 82.5 GALLONS PIPE 12.9 GALLONS TOTAL 95.4 GALLONS/DAY FORCE MAIN: 2 DIA, C-VALUE: 140 PUMP CHAMBER: (INSIDE DIMENTIONS) 1000 GALLON MONO TANK LENGTH 8.83 FT WIDTH 4.17 FT EFF. DEPTH 4.00 FT PUMP CHAMBER INLET 96.93 SUMP 92.93 OFF 93.43 ON 93.80 ALARM 94.30 STATIC HEAD: 93.43 PUMP OFF 100.74 DBOX Hs 7.31 FEET EQUIVALENT LENGTH: (2"SCH-40 PVC PIPE) PUMP CHAMBER 1 90 DEGREE BENDS 5 FT 1 GATE VALVE 1.2 FT 1 CHECK VALVE 14 FT TOTAL 20.2 FT USE: 21 FT PIPE RUN 1 90 DEDGREE BENDS 5 FT 2 45 DEGREE BENDS 5 FT 1 TEE 12 FT LENGTH OF PIPE 79 FT ADDITIONAL LENGTH 8 FT TOTAL 109 FT USE 109 FT TOTAL EQUIVALENT LENGTH 130 FT 545 Johnson Street Frank Peluso North Andover MA 545 Johnson Street (Tax Map 98.A Block 13 Lot 0) North Andover MA 7/30/2010 SYSTEM CURVE: Q V Hf/100 FT Hf Hs TDH GPM FT/SEC FT/100FT FT FT FT 50 4.51 3.96 5.15 7.31 12.46 52.5 4.73 4.34 5.64 7.31 12.95 55 4.96 4.73 6.14 7.31 13.45 57.5 5.19 5.13 6.67 7.31 13.98 60 5.41 5.55 7.22 7.31 14.53 62.5 5.64 5.99 7.78 7.31 15.09 65 5.86 6.44 8.37 7.31 15.68 PUMP SPECIFICATIONS: MANUFACTURER BARNES PUMPS MODEL# SE411 HP 0.4 VOLT 115 PHASE 1 RPM 1750 DISCHARGE 2 INCH IMPELLER DIAMETER 5.44 INCH OPERATING POINT: HEAD 15.6 FT FLOW RATE 65 GPM TIME ON 1.5 MINUTES Series SE Performance Curve www.cranepumps.corn AHP, 1750RPM, 60Hz 1% 2 3 Discharge TOTAL HEAD METERS FEET 30 9 ................ ... STANDARD IMPELLER SIZES Pump HP Impeller Dia. 0.4 5.44(138) 8 5.44(138} 25 7 5.12(130) 4.75(121) % - 6 20 4.50(114) ----------------------------- -------- ----- 4.25(108) _7 5 4 NN ----- ---------- -7 3 10 ------ N-, 2 ------ - ---------- _ V9674 EN ---- --------- .............. U.S.GALLONS 25 50 75 100 125 150 PER MINUTE LITERS2 3 4 5 6 7 8 9 PER SECOND Testing is performed with water,specific gravity 1,0 @ 68°F @(200C),other fluids may vary performance SECTION 1B PUMPS & SYSTEMS CRANE PAGE 3DATE 6104 A Crane Co.Company USA:(937)778-8947 - Canada: (905)457-6223 - International: (937)615-3598 _ = Series SE 2" Spherical Solids Handling www.cranepumps.com Manual &Automatic 9%", 2" & 3" Discharge DISCHARGE .......................2' NPT, Female,Vertical LIQUID TEMPERATURE SE411 ...........77°F(25°C)Continuous SE421 ...........104°F(40°C)Continuous VOLUTE...............................Cast Iron ASTM A-48, Class 30 MOTOR HOUSING..............Cast Iron ASTM A-48, Class 30 SEAL PLATE ......................Cast Iron ASTM A-48, Class 30 IMPELLER: Design.............2 Vane, Open with pump out vanes on back side: Dynamically Balanced, ISO G6.3 Material ..........Cast Iron ASTM A-48, Class 30 SHAFT ................................416 Stainless Steel SQUARE RINGS .................Buna-N HARDWARE........................300 Series Stainless Steel PAINT...................................Air Dry Enamel SEAL: Design ............Single Mechanical, Oil Filled Reservoir, Secondary Exclusion Seal �> Material...........Carbon/Ceramic/Buna-N o 0 Hardware-300 Series Stainless CORD ENTRY......................15 ft. (5m)Quick Disconnect Cord with plug On 115Volt, Pressure Gromment for sealing and strain relief SPEED.................................1750 RPM(Nominal) UPPER BEARING................Single Row, Ball, Oil Lubricated Load................Radial LOWER BEARING...............Single Row. Ball, Oil Lubricated Series: SE (SE411 & SE421) Load................Radial&Thrust 4HP 1750RPM 60HZ MOTOR: Design ............NEMA L Torque Curve, Oil Filled, Squirrel Cage Induction Insulation........Class B SINGLE PHASE...................Permanent Split Capacitor(PSC) Includes Overload Protection in Motor LEVEL CONTROL..............."A" -Wide Angle, PVC, Mechanical, 15 ft(5m) cord with Piggy-Back Plug, N/O "VF"-Vertical Float, PVC, Snap Action, 15 ft(5m)cord,with Piggy-Back plug. OFF point ONLY is adjustable OPTIONAL EQUIPMENT.....Seal Material,Additional Cord CI� us CSA 108 UL 778 LR16567 Sample Specifications:Section 1 Page 3. DESCRIPTION: SUBMERSIBLE NON-CLOG SEWAGE PUMP DESIGNED FOR TYPICAL RAW SEWAGE APPLICATIONS CRAN E PUMPS & SYSTEMS PAGEION 1e DATE 12/07 A Crane Co. Company USA: (937) 778-8947 • Canada: (905) 457-6223 • International: (937)615-3598 -"7' 7, Series SE S 2" Spherical Solids Handling Manual &Automatic www.cranepumps.com I Y2", 2" & 3" Discharge SE411VF SE411 & SE421 (Less Float) Inches SE411A 10.75 10.75 32 1.56 5.32'! 1.56 (273)I___(5. (273) 1 1: I 35) �-(40) r�-135F7(40) :3.86 z4 186 0 0 :(98) 7.75 7.75 (197) A (197) U UUMN::777111: 16.76 7777 116.76 8.75 (426) !(426) (22'2) cr= T 5.001 5.00 27) (127) 7 ADJUSTABLE (70)i f-'0b0) 1 STOP j MODEL NO PART NO HP VOLT/PH Hz RPM NEMA FULL ILOCKED CORD CORD CORD (Nom) START LOAD ROTOR SIZE TYPE O.D CODE AMPS AMPS inch(mm) SE411 096747 0.4 115/1 60 1750 C 12.0 19.0 14/3 SJTOW 0.375(9.5) SE411A 096748 0.4 11511 60 1 1750 C 12.0 19.0 14/3 1 SJTOW 0.375(9.5) SE411VF 1 100836 0.4 1 115,11 60 1=50 C 12.0 19.0 14/3 1 SJTOW 0.375(9.5) SE421 1 096750 0.4 1 230/1 60 1 1750 C 6.2 13.0 14/3 1 SJTOW 0.375(9.5) Mechanical Switch on SE-A:cord 16/2,SJOW Piggy-Back Plug Vertical Switch on SE-VF,cord 16/2,SJOW,0.320(8.1 mm)O.D.Piggy-Back Plug IMPORTANT 1.) PUMP MAY BE OPERATED"DRY"FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS. 2.) THIS PUMP IS APPROPRIATE FOR THOSE APPLICATIONS SPECIFIED AS CLASS I DIVISION 11 HAZARDOUS LOCATIONS. 3.) THIS PUMP IS NOTAPPROPRIATE FOR THOSE APPLICATIONS SPECIFIED AS CLASS I DIVISION I HAZARDOUS LOCATIONS. 4-) INSTALLATIONS SUCH AS DECORATIVE FOUNTAINS OR WATER FEATURES PROVIDED FOR VISUAL ENJOYMENT MUST BE INSTALLED IN ACCORDANCE WITH THE NATIONAL ELECTRIC CODE ANSIINFPA 70 AND/OR THE AUTHORITY HAVING JURISDICTION.THIS PUMP IS NOT INTENDED FOR USE IN SWIMMING POOLS,RECREATIONAL WATER PARKS.OR INSTALLATIONS IN WHICH HUMAN CONTACT WITH PUMPED MEDIA IS A COMMON OCCURRENCE. SECTION 1B PAGE 2 CRANE PUMPS & SYSTEMS DATE 12/07 A Crane Co. Company USA: (937) 778-8947 Canada: (905)457-6223 - International: (937)615-3598 545 Johnson Street Frank Peluso North Andover MA 545 Johnson Street (Tax Map 98.A Block 13 Lot 0) North Andover MA 7/30/2010 BUOYANCY CALCULATIONS: STRUCTURE: 1500 GALLON MONOLITHIC 2-COMPARTMENT SEPIC TANK DIMENSIONS: (OUTSIDE) LENGTH 11.00 FT WIDTH 5.83 FT HEIGHT 5.83 FT INVERT-BOTTOM 4.58 FT WEIGHT: 13320 LBS MANHOLE DIAMETER 2 FT #MANHOLES 3 FOOTPRINT 64.1 SF ELEVATIONS: FINISH GRADE 99.60 MANHOLE GRADE 99.60 ESHGW 96.90 INLET INVERT 97.20 TOP 98.45 BOTTOM 92.62 SOILS INFORMATION: UNIT WEIGHT OF SOIL 115 LB/CUBIC FT WEIGHT OF SOIL" 7235 LBS FORCES: BALLAST WEIGHT 0 LBS WEIGHT OF SOILS 7235 LBS WEIGHT OF TANK 13320 LBS WEIGHT OF DISPLACED WATER 17127 LBS NET FORCES**: 3428 LBS (NEGATIVE INDICATES FLOATATION) FACTOR OF SAFETY: 1.20 *Neglect weight of soil over ballast. **Station assumed totally dry inside. Neglect weight of equipment inside and outside soil friction force. 545 Johnson Street Frank Peluso North Andover MA 545 Johnson Street (Tax Map 98.A Block 13 Lot 0) North Andover MA 7/30/2010 BUOYANCY CALCULATIONS: STRUCTURE: 1000 GALLON MONOLITHIC PUMP CHAMBER DIMENSIONS: (OUTSIDE) LENGTH 9.67 FT WIDTH 5.00 FT HEIGHT 5.83 FT INVERT-BOTTOM 4.67 FT WEIGHT: 14825 LBS MANHOLE DIAMETER 2 FT #MANHOLES 1 FOOTPRINT 48.4 SF ELEVATIONS: FINISH GRADE 99.50 MANHOLE GRADE 99.50 ESHGW 96.90 INLET INVERT 96.93 TOP 98.09 BOTTOM 92.26 SOILS INFORMATION: UNIT WEIGHT OF SOIL 115 LB/CUBIC FT WEIGHT OF SOIL* 7331 LBS FORCES: BALLAST WEIGHT 0 LBS WEIGHT OF SOILS 7331 LBS WEIGHT OF TANK 14825 LBS WEIGHT OF DISPLACED WATER 13999 LBS NET FORCES**: 8157 LBS (NEGATIVE INDICATES FLOATATION) FACTOR OF SAFETY: 1.58 *Neglect weight of soil over ballast. **Station assumed totally dry inside.Neglect weight of equipment inside and outside soil friction force. J� 41XJSTIt�G iy EkhA0s7"Fo f SrPTIC T/I k r A ys o Nri ST i � n Q/ t L , (1J LD Ic 41 � 1 ;° 0 m ti �L rem;. ..... � � ate• ..... ..... //3. 72' -�---5/G'-09'/D.,E- ��, ,,... ..-.