HomeMy WebLinkAboutMiscellaneous - 570 BOSTON STREET 4/30/2018 (2) / 570 BOSTON STREET
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Commonwealth of Massachusetts
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City/Town of No Andover t� .-'-dSystem Pumping Record 1 2013
Form 4 of Noj jT! ANDCVER
HEALTH I)EPARTIM-MT 6
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 withour
local Board of Health to determine the form they use. The System Pumping Record must be submitted
the local Board of Health or other approving authority within 14 days from the pumping date in to
accordance with 310 CMR 15.351.
A. Facility information
Important:When
filling out forms I. System Location:
on the computer, _7D
use the tab
key to
move your Address F�
cursor-do not
use the return No andover
key. CltylTown Ma
State Zip Code
2. System Owner.
Name
Address(if different from location)
City/Town
State Zip Code
B. Pumping Record Telephone Number
1. Date of Pumping * vatsZ )Sd®
- Z. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspooi(s) ap tic Tank
❑ Tight Tank ❑ Grease Trap
E3 Other(describe): '
i
4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned?
❑ Yes ❑ No
5. Condition of System:
ao
6. System Pumped By:
Name
Stewart's Septic Service Vehicle License Number
Company
7. Location where contents were disposed: '
Ste"rKs Pre-treatment Plant 20 So. Mill Bradford Ma 01835
Signature of Hauler
Date
Signature of Receiving Fac lity Date
t5form4.doc•03/06
System Pumping Record•Page.
, 1
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t
Commonwealth of Massachusetts
CiTY.t. own of NORTH ANDOVER MASSA-CHUSETTS.'
Sy..stem Pumping Record
Form 4 OCT 1 2 2006
DEP has provided this form for use by local Boards of Health. the System Pump 15n Record mu:
be submitted to the local Board of Health or other approving authority: I
A. Facility Information
Important:
When filling out 1. System Location:
fomes the
computer, use ,� �� 610j--/-� /J
only the tab key Address .._. ' _ ------.... ._._....._.to move your
cursor-do not - _
use the return City/Town -- State — �-- ---'-'
Zip Code
key.
2. System Owner:
Name
Address(if different from location) -
City/Town - --__------- - ----------- __—.._
State Zip Code
Telephone Number -
B. Pumping Record
1. Date of Pumping Date -- 2• Quantity Pumped: —
Gallons
I Type of system: ❑ Cesspool(s) OoSeptic Tank ❑ Tight Tank
❑ Qther(describe): --
4. Effluent Tee Filter present? E] Yes L —�o If es was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Sy em Pumped By:
ame -- - ...._�
vehicle License Number ---
.
Company -
7. Location where contents were disposed:
�
SI ature of Hsu --_.-.__
Date
http://www.mas�gov//dep/water/ provals/t5forms.htm#inspect
t5form4.doc-06/03
�`�- System Pumping Record -Page 1 of
Address 7o 130 Title of File Page of
Date File Open: Date fele closed:
Doc Document/Action Title Date of Refer to other Purpose of Documen-t—/4ction and notes
action Document/ document/
Num. Action Department
S�
6�
Z�
Board of Appeals - Board of Health - Planning Board Conservation Commission - Building Department
�l
S \
� (J
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i
I
j Address Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department
Gy
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
12/16/98
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by Ben Osgood Jr. North Andover Licensed Installer
at Lot 2 Windkist Road (570 Boston Road Street),North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit# 905 dated 3/3/97 .
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board-of Health Agent
�f
}
Memorandum ....... .. .....
To: File
From: Susan Ford,Health Inspector
Date: December 23, 1998
Re: Lot#2 Windkist(Boston Road)
Per a conversation with the Chairman of the BOH, Gayton Osgood, the following actions were taken
concerning Lot#2 Windkist on December 16, 1998. Please see the Installation Certification form,
and the notes of exception provided by the professional engineer.
Gayton Osgood was contacted by the builder,Mark Rea, on Tuesday 12/15/98,to explain the
mistake.of placing a stonewall of the driveway within the breakout of the newly constructed septic
.......asystem on. The wall was shown on the original plan in a non-obtrusive location. He
stated that:the septic installer,Ben Osgood Jr., installed a mylar barrier behind the wall as a
response to the mistake. Due to extenuating circumstances the board members agreed through a
photic call that a variance to the required 3:1 slope would be granted and formally voted on at the
next B. ..meeting. This variance should also address the use of a mylar barrier instead of a
concrete retaining wall as required by local regulation.
Afket Ws decision had been determined,the Health Inspector was instructed to issue a Certificate of
-C lance. The Health Agent was not available for consult on this action due to personal leave.
Tfe COC was issued as directed.
.:<;: : ::::
1
.............................
a
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( } constructed; ( )repaired;
by (��'n1 r/�✓�-i :its C u �� �/ v
located ati `
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit# datedLwith an approved design flow of—
--gallons per day. The materials use wee in conformance with those specified on the approved
-plan;the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and
local regulations, and the final grading agrees substantially with the approved plan. All work is
accurately represented on the As-built which has been submitted to the Board of Health.
Installer: Lic. #: Date: /lo
Design Engineer. Date:
r
Exceptions:
1. The final grading does not comply with the design or the requirements of 310
CMR 15.255;the required 3:1 slope after a 15 foot separation is not met in all
areas around the system.
2. A mylar barrier was installed at the retaining wall and the retaining wall is closer
to the system than provided for on the plan.
3. The system was installed 12 feet closer to the southerly property line than
specified in the design.
I
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„ DEC 15 ' S8 13:44
F. ti1
NEW ENGLAND EN
GINEERING SERVICES
INC
M'ORTANT FAX
FAX TO : D4_v,
DATE: 2 j j� J q
FAX FROM: Ben Osgood, Jr., New England Engineering Services Inc.
OPERATOR BCO JR
PAGES IN FAX INCLUDING THIS SHEET:
IF TMS TRANSMISSION IS UNCLEAR, CAIN, SENDER AT (508-686-1768)
MESSAGE:
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33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508
� ) 686-1768
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Town of North Andover F „ORTk
OFFICE OF 32 O e11 to 'e 4,0 L
COMMUNITY DEVELOPMENT AND SERVICES p
27 Charles Street
WILLIAM J. SCOTT North Andover, Massachusetts 01845 sgc,HusE��y
Director
(978)688-9531 Fax (978)688-9542
May 28, 1999
Mark Rae
Colonial Village Development Corp.
1049 Turnpike Street
North Andover, MA 01845
RE: Lot 2 Windkist Farms
Dear Mr. Rae:
This is to confirm that at their regularly scheduled meeting on May 28, 1999, the North
Andover Board of Health voted unanimously to grant a waiver to the Town of North Andover
Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, Section 9.0 1, to allow
the construction of a stone retaining wall with a poly barrier to achieve breakout protection at Lot
2 Windkist Farms, 570 Boston Street.
Sincerely,
i
Sandra Starr, R.S.
Health Administrator
Cc: File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
NEW ENGLAND ENGINEERING SERVICES
INC
April 27, 1999
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: Lot 2 Boston Street
Dear Sandra:
Please accept this letter as a response to your request to attend the Board of Health
meeting later tonight. I can not attend the meeting because of a previously scheduled
commitment to attend a function for my daughters hockey team.
I believe the issue you have with the installation of the septic system at lot 2 is the
proximity of the stone retaining wall to the septic system. Specifically the issue is the
breakout requirements are not met as per the design plans.
When I was at the site installing the system it was evident that the stone retaining wall
being installed along the proposed driveway would cut into the slope for the septic
system. As a precaution we obtained a roll of 20 mill pond liner from A H Harris and
installed it vertically in the ground ten feet from the end of the system from the top grade
of the system extending six feet in the ground. At the time I was under the impression
that Title 5 allowed reduction of the slope with the use of a suitable impervious barrier.
My experience has been that a 20 mill poly barrier met that condition.
It is my understanding that the main issue is your feeling that any other method for slope
reduction other than a concrete wall as described in Title 5 requires a variance to Title 5. I
have designed and installed at least twenty alternative slope designs using poly barriers
and have not had to obtain a variance. In addition, I have had plans approved by DEP for
variances other than slope variances that incorporated the use of poly barriers and I have
not been required to obtain a variance for the slope waiver. It is my opinion that this
alternative slope method does not require a DEP variance but it does require a local
bylaw variance.
33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
3
l
I understand this issue is rather complicated and I regret not being able to attend your
meeting. I would be glad to attend your next meeting to try and resolve this matter. I
would also be happy to meet with you prior to the meeting to discuss this matter.
I have enclosed a sketch of the wall relative to the septic system with three spot
elevations.
If you have any questions or need additional information please do not hesitate to contact
this office.
Sincerely,
A
Benjamin C. Osgood, Jr., EIT
President
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MAP # LOT # L
PARCEL # STREET
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID?l� / YES N�JO ,�
PLAN APPROVAL: DATE V� Nl � 7 APP. BY
DESIGNER: P/ �l S T'll4�U� PLAN DATE --� -
e
CONDITIONS
W,ITER SUPPLY TOWN WELL
WELL PERMIT DRILLER
WELL TESTS:' CHEMICAL DATE APPROVED
BA RIA I DATE APPROVED
BACTERIA DATE APPROVED
PLUMBING SIGNOFF A WIR DATE
COMMENTS:
y
FORM U APPROVAL: APPROVAL TO ISSUE YES NO
DATE ISSUED ��3/GJ-7 BY
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: BY:
a'
• "* r 1► :�
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4
SEPTIC SYSTEM INSTALLATION
IS THE INSTALLER LICENSED? YES NO
TYPE OF CONSTRUCTION: y NEW REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW /-YES-- NO
CONDITIONS OF APPROVAL YESN0)
(FROM FORM U)
ISSUANCE OF DWC PERMIT YES') NO
DWC PERMIT PAID? yE NO
DWC PERMIT NO. /��.� S INSTALLER: -, aa1
BEGIN INSPECTION S NO:
EXCAVATION INSPECTIO NEEDED:
/19
PASSED 7 BY
CONSTRUCTION NSPECTION: DED4,-
AS BUILT PLAN SATISFACTORY: YES:
APPROVAL fiO BACKFILL: DATE: /2,�' BY —
FINAL GRADING APPROVAL: DATE BY
FINAL CONSTRUCTION APPROVAL: DATE: BY
NEW ENGLAND ENGINEERING SERVICES
INC
April 27, 1999
Sandra Starr,Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: Lot 2 Boston Street
Dear Sandra:
Please accept this letter as a response to your request to attend the Board of Health
meeting later tonight. I can not attend the meeting because of a previously scheduled
commitment to attend a function for my daughters hockey team
I believe the issue you have with the installation of the septic system at lot 2 is the
proximity of the stone retaining wall to the septic system. Specifically the issue is the
breakout requirements are not met as per the design plans.
When I was at the site installing the system it was evident that the stone retaining wall
being installed along the proposed driveway would cut into the slope for the septic
system. As a precaution we obtained a roll of 20 mill pond liner from A H Harris and
installed it vertically in the ground ten feet from the end of the system from the top grade
of the system extending six feet in the ground. At the time I was under the impression
that Title 5 allowed reduction of the slope with the use of a suitable impervious barrier.
My experience has been that a 20 mill poly barrier met that condition.
It is my understanding that the main issue is your feeling that any other method for slope
reduction other than a concrete wall as described in Title 5 requires a variance to Title 5. 1
have designed and installed at least twenty alternative slope designs using poly barriers
and have not had to obtain a variance. In addition, I have had plans approved by DEP for
variances other than slope variances that incorporated the use of poly barriers and I have
not been required to obtain a variance for the slope waiver. It is my opinion that this
alternative slope method does not require a DEP variance but it does require a local
bylaw variance.
33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099
I understand this issue is rather complicated and I regret not being able to attend your
meeting. I would be glad to attend your next meeting to try and resolve this matter. I
would also be happy to meet with you prior to the meeting to discuss this matter.
I have enclosed a sketch of the wall relative to the septic system with three spot
elevations.
If you have any questions or need additional information please do not hesitate to contact
this office.
Sincerely,
Benjamin C. Osgood, Jr., EIT
President
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Town of North Andover, Massachusetts Form No.2
• MORTN BOARD OF HEALTH
19 'I
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DESIGN APPROVAL FOR
,SSACHUS Et� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
•
Applicant w Test No,
Site Location Lai 7 a lei nt A
Reference Plans and Specs. &YZ
DESIGN DATE
Permission is granted f( sorption sewage disposal system to be installed
In accordance with regul 4 th.
C AIRMAN,BOARD OF HEALTH
Fee Y p Site System Permit No. �y�
�L ��.t .,
�3 Y+l" / -
p �fY 6 a,-r �
-for'
Town of North Andover, Massachusetts Form No,s
Of NORTH, BOARD OF HEALTH
2-11 (4 19 _
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DESIGN APPROVAL FOR
• ;,SSACHUS Et� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
• Applicant Test No.
Site Location UZ-5 il l�i
Reference Plans and Specs. (3
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
-NAI RMAN,BOARD OF HEALTH
Fee Site System Permit No. vS
No................_....... F$s............................
..
THE COMMONWEALTH OF MASSACV;USE_TTS
BOARD 44 ,A14ii
o _.�
........ : oW ........OF.. NURTN...r�Nc.Vf�.......I�... _
- v ;
>� Appliralitut for Ih-upowd Hfur1w Tuttnttudintt pu99�
Application is hereby made for a Permit to Construct Off) or Repair ( ) an Individual,5ew�ge Disposal
System at:
..............................r- 5� ..5 --..:..........._...........
Location-Address or Lot No.
L ........--
owner Address
f4
• •••....................................................•-•:.................-•-••-•---............ ..............•-•--••-••-•......_.........•----•-----...................... ..................
Installer Address
Type of Building Size Lot
....�7-�15W.....Sq. feet
Dwelling— No. of Bedrooms............ ...........................Exc'pansion Attic ( ) Garbage Grinder ( )
per,
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ............................... . . ��/�,
W Design Flow.............. . .... gallons per person per day. Total daily flow.._.............`x-`�0............. gallons.
WSeptic Tank—Liquid capacity� U.galfons Length.�U-.-6._._ �Vidth.{!.r9 Diameter......_—.... Depth.S—.:S
IV Disposal Trench—No. ......Z............ Width......4......_.. T'otal Length..... Total leaching area......144....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................:.. Total leaching area..................sq. ft.
z Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed b �Z.H){?St•.ArYS_6_,1V....4... tff—G(a.1:--l ... Date...
S,�L/��v
.a �3S Test Pit No. 1..... .z...minutes per inch DepthAof "fest Pit..../. _....... Depth to ground water...A9 I...............
r4 %.-ZTest Pit No. 2.........I....minutes per inch Depth of Test Pit----- .i...... Depth to ground water....1,6................
C4 ....•••.... ........................................................•••--•••••-•••........--•-.........................._.......:...........................
O Description of Soil......?,.tSY4........j!/ir....6f9-n!IV... .
x
I
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
..............• --....................................................................................._........__....----...........--•............•----•---•--._._._..._...._.........---•-•------....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE, 5 of the State Sanitary Code -- The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed....................•----........................................__................... ................................
Date
Application Approved By.........................................................
........................................
Date
Application Disapproved far the following reasons:................................................................................................................
.......................•--••••-••--••••-•--•••----..................................•--•••-•--•-...._..._._._.._..._............-••-••-••--•••••••••--••....._.........•-••.......---......•-•••--•......
Date
PermitNo......................................................... Issued.......................................................
4 Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.............................
........................................................
(9rdif iratr of Tnutpliatt e
THIS IS 7'0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by..............................................................................•-•-•---•-•--•----- --•---•---.....-•---............................---...---•--........................••---•......_.
Installer
at.....................•-•---......_....................................._............................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........•-•............................•••-•..................••---•......I...... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................................... ..................----..............................................................
r �......................... O F � FEE........................
�Ai,�.�t�.��t! �nrlt.� (�ntin�rttr#inti �r��Burt
Permissionis hereby granted...::........•••--•-•----.............----•---------------•-•---.......•••-••....•••-••••-•-•-•---...-••----•••-•......••......••-••...•••••-
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo......................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..................... ....................
.........................................................................................................
Board of Ireattt,
DA-TE..................••----•---_............._.............._....__._............•-
FORM 1255 HOODS & WARREN. INC., PUBLISHERS
I
�V. Location and elevation of soil tests.
Foundation drain outfall shown.
3. Desi an/C"alculat ions and Notes
A. . Percolation rate used for design.
Soil log results - designate various strata depths
and description, depth to ledge and/or groundwater
if encountered.
Date of percolation and deep hole tests.
✓� Number of bedrooms.
E. Elevation of test
pits.
4. Profile of System (Suggested Scale: 1" = 41 )
A.. Finished floor of house.
B. Invert elevations at house, septic tank (inlet &
outlet), and distribution box. If applicable for
pump systems, inlet and outlet of pump chamber and
pump bloat switch settings with supporting
/ calculations.
C. Length, type and grade of pipe and length of
leaching facility.
r Elevation of ledge and/or groundwater.
E. Elevation of bottom of leaching facility.
Existing and proposed grades.
G. Slope (breakout) requirement and calculations.
Scale.
I. Topsoil & subsoil removal shown. (If applicable)
5. Cross-Section of System (Suggested Scale: 1" = 41 )
_A. Elevations of various components.
'�. Existing and proposed grades.
C. Type, dimensions and stone and system components
Specifications.
-W D. Elevation of ledge and/or groundwater.
_ r _E Elevation of -bottom leaching facility.
✓F. Dimensions.
G. Slope (breakout) requirements and calculations.
-_,te _H• Scale.
-Y I. Top soil and subsoil removal shown. (If applicable)
S£f✓ PRAM(�
6. Additional Notes and Other Details
A. Owner' s name, address and phone number.
B. Applicant's name, address and phon_enumber.
- `�_C• Engineer's name, address and phone number.
The designer should indicate any notes or special
conditions peculiar to the site of interest to the
Board, Installer or
Owner.
E. Plans should be dated. Any revised plans after the
initial submission should show a revision is on date and
abbreviated explanation of the revision.
Ali" F. If a pump system, type, make, model, operation
.head, performance curve, and pump rates should be
provided. All required alarm, power and float switch
data should be provided for review and approval.
�a. System components (septic tank, D-box, etc. )
details should be provided if other than standard
as required from local suppliers. Component spec.
should be indicated somewhere on the plans for
standard items.
�H. Material to replace the topsoil & subsoil shall be
specified. (If applicable. )
Reviewed and recommended by:
Date
SEPTIC PLAN SUBMITTALS
LOCATION: �-
NEW PLANS: S $60.00/Plan
REVISED PLANS: S $25.00/Plan
DATE: �—
DESIGN ENGINEER:_,
When the submission is all in place, route to the Health Secretary
.
Town of North Andover, Massachusetts Form No.3
o< ,+ooTPI BOARD OF HEALTH
•
• •+
9
CMUSE�•CH••'�� DISPOSAL WORKS CONSTRUCTION PERMIT
`SA
Applicant
NAME
ADg E55 `� TELEPHONE
Site Location-
Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No. ��'h�-�
• ��--.— Lig
�CHAIRMAN, BOARDOF HEALTH
- 75)`
l �
Fee _ / ) D.W.C. No.
u0',I^u91Ir.M
N011VAI II;NO2A
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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
12/16/98
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by Ben Osgood Jr. North Andover Licensed Installer
at Lot 2 Windkist Road(570 Boston Road Street),North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit# 905 dated 3/3/97 .
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Agent
i
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law, j
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: ��ic� �5��,�C z zL- Phone AZ
•LOCATION: Assessor's Map Number Parcel
Subdivision _ � �i j S 7, Lot (s)
Street
- "' C` St. Number �O
•��- cS'�D� S`�L��
************************OfficialUse *******
0 ******
my ***********
RECOMMENDATIO S O TO AGENTS:
Date Approved _
l� I
l
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date. Rejected
Comments
Date Approved
Food Inspe�-Health Date Rejected
Date Approved
ptic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections
-
- driveway permit
Fire Department 4"ej 1 I' -a", rd
Received by Building Inspectfor Date
�.
5 /
1
. n
Co 7- Z
CHECKLIST FOR
PLAN REQUIREMENTS
FOR
SUBSURFACE SEWAGE DISPOSAL SYSTEMS
TOWN OF NO. ANDOVER BOARD OF HEALTH
MARCH, 1990
1. Locus Map (Suggested- Scale: 1" = 20009 )
✓ A. Locus identified.
. B. Streets and names within 1/2 mile.
V_C. North arrow and scale
2. Site Plan (Suggested Scale: 1" = 20' )
A. Lot to be served, its dimensions and area.
�✓ B. Fronting street.
C. North arrow and scale.
D. Assessor' s designation. (Map & Lot Number)
E. Abutters names and lot numbers.
_A.,,/*r F. Easements.
z✓G. Property lines.
✓H. Footprint of proposed house to be served showing
garage (attached, detached, or garage under house. )
Where applicable setbacks to house.
1. Where
Number ofro osed' bedrooms.
P P
✓K. Location and elevation of driveway in vicinity of
the leaching facility & dwelling.
:
- L. Water service line from main in street or well.
4//V M. Location of existing or proposed well.
N. Locationof deep observation holes and percolation
tests.
�.0. Existing and proposed contours.
✓ P. Location of bench matk in the vicinity of the
leeching facility.
s/
Q. Location and dimensions of system (septic tank,
pipes and leaching facility) including the reserve
area.
�✓ Profile and section arrows. PP 0f t tL IS Th"u 6K rh"c_"
/ Z
cS. Location of any streams, water bodies, surface and
subsurface drains, known sources of water supply
within 200-feet, and wetlands within 100-feet
(locate wetlands, specify type of resource and show
100-foot buffer zone line if applicable) .
_ ,.X T. Erosion control devices as required by Con. Comm. ,
ooard of Health or Planning Board with detail and
/ description of device proposed.
U. Limits of topsoil and subsoil excavations shall be
dimensioned clearly on site plan.
r.
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F f® o {tAndlr®vl�
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* � z- -
over, Mass.,
o _
LAKE y: A
{ w COCNICKEWICK L �• �w
9 Oq�TEO-APP`y SCJ
S BOARD OF HEALTH
PERM. IT T D Food/Kitchen
Septic System ��
THIS CERTIFIES THAT.................................Ee. Q.is.0.................co.&O..S: BiJ DING INSPECTOR................................
n ation
has permission to erect.................... ......... buildings on ........ I ..........e a ..
to be occupied as....................... a /�j ��imney���
provided that the person accepting this permit shall in every respect conform to ?te�s of the application on file in
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
a Buildings in the Town of North Andover. PL BIN EXPIRES IN. 6 MONTHS
V ECAOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. ?PERMIT � � --
UNLESS CONSTRUCTION ST T ELECTRIC SPEC"R
................................ ............................. sern
.... . ... . .. ..
BUILD INSPECTOR
Fina
Occupancy Permit Required to Occupy Building GM INSPECTOR
Display in a Conspicuous Place"on the Premises - Do Not Remove
Rough r
n <
No 'Lathin or D Wall To Be Done`
Until Inspected, and A roved b the Building~ Inspector. FIRt-DEPARTMENT
PP Y
Burner
y Street No. �+
Smoke Det.
s
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
✓ TIES TO LOT LINES & DWELLING, WELLS
1. FROM SEPTIC TANK
b. FROM LEACH AREA
✓ LOCATIONS OF DEEP HOLES & PERC
TESTS
_ ELEVATIONS OF DISPOSAL SYSTEM
✓ TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
I/ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
✓ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D-BOX
�/- STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
r/ NORTH ARROW
✓ FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
✓ LOCUS PLAN
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
12/16/98
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by Ben Osgood Jr. North Andover Licensed Installer
at Lot 2 Windkist Road(570 Boston Road Street),North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit# 905 dated 3/3/97 .
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Agent
it
310 CMR:;-DEPARTMENT OF ENVIRONMENTAL PROTECTION
15.410: Variances - Standard of Review
(1) .Local approving authorities.and the Dep2rtment may vary the application of any
C provisions of 310 CMR 15.000 with respect to any particular case except those listed in 310
CMR 15.415. Variances shall be granted only when, in the opinion of the approving
authority:
(a) The person requesting a variance has established that enforcement of the provision
of 310 CMR 15.000 from which a variance is sought would be manifestly unjust,
considering all the relevant facts and circumstances of the individual case; and
(b) The person requesting a variance has established that a level of environmental
protection that is at least equivalent to that provided under 310 CMR 15.000 can be
achieved without strict application of the provision of 310 CMR 15.000 from which a
variance is sought.
(2) With regard to variances for new construction,enforcement of the provision from which
a variance is sought must be shown to deprive the applicant of substantially all beneficial use
of the subject propertyin order to be manifestly unjust.
15.411: Process for Seeking a Variance From Local Approving Authorities
(1) The local approving authority shall review requests for variances as follows.
(a) Every request for a variance shall be Jr, writing and shall make reference to the
specific provision of 310 CMR 15.000 for which a variance is sought and a statement in
compliance with 310'CMR 15.410..
(b) No application for a variance shall be complete until the applicant has notified all
abutters by certified mail at his/her own expense at least ten days before the Board of
Health meeting at which the variance request will be on the agenda. The notification
shall reference the specific provisions of 310 CMR 15.000 from which a variance is
sought,a statement of the standards set forth in 310 CMR 15.410 and the date, time and
place where the application will be discussed.
(2) Emergency repairs pursuant to 310 CMR 15.353 may be performed without seeking a
variance. The owner of the system must seek a variance within 30 calendar days after
performing the emergency repairs.
(3) Any variance allowed by the_local.approving authority shall be in writing. Any denial
of a variance shall also be in writing and shall contain a brief statement of the reasons for
the denial. A copy of each variance shall be conspicuously posted for 30 days following its
issuance; and shall be available to the public at all reasonable hours in the office of the city
or town clerk or the office of the Board of Health while it is in effect.
(4) A request for a variance for a residential facility with four units or less (as described
_in M.G.L. c. 111, § 31E) shall be deemed constructively approved by the local approving
authority if the local approving authority does not act upon it within 45 days of receipt of a
complete application. Such variances are still subject to review by the Department in
accordance with 310 CMR 15.412.
15.412: Review of Variances by the Department
(1) Except as provided in 310 CMR 15.412(4), the applicant shall file a copy of each
variance granted by the local approving authority with the Department together with the fee
specified at 310 CMR 4.00. The Department shall review all those issues raised before the
local approving authority and may review other issues raised by the application, all in
accordance with the standards set in 310 CMR 15.410.
(2) The Department shall approve,disapprove or modify the variance granted by the local
approving authority,or shall request additional information to be provided by the applicant,
within 30 calendar days of the Department's receipt of the request If the Department has
requested additional information,it shall approve,disapprove or modify the variance within
30 days of receiving the applicant's response.
3/24/95 (Effective 3/31/95) 310 CMR - 555
310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION
15.402: Use of Local Uverade Avvrovals or Variances
(1) Local Upgrade Approvals may be granted by local approving authorities without review
by the Department for required or voluntary upgrade of failed or nonconforming systems with
design flows below 10,000 gpd in accordance with the terms and provisions of 310 CMR
15.402 through 15.405. Upgrade Approvals for required or voluntary upgrade of systems
-with design flows of 10,000 gpd or greater but less than 15,000 gpd which are failing to
protect or are a significant threat to public health and safety and the environment as set forth
in 310 CMR 15.304 shall be approved by the Department.
(2) Proposals for new construction or for increase in flow to an existing system other than in full compliance with 310 CMR 15.100 through 15.293 must seek and obtain a variance
from the local approving authority and the Department(with the exception of those variances
set forth at 310 CMR 15.412(4)for which the Department has no review)in accordance with
the terms and conditions of 310 CMR 15.410 through 15.417.
15.403: Local Upgrade Approvals
(1) The owner or operator may upgrade a failed or nonconforming system with design flows
below 10,000 gpd (systems which trigger failure criteria set forth at 310 CMR 15.303) or
systems with design flows of 10,000 gpd or greater but less than 15,000 gpd which fail to
protect public health and safety and the environment(large systems set forth at 310 CMR
15.304(l)) pursuant to a local upgrade approval in accordance with the standards and
requirements of 310 CMR 15.404 and 15.405 without obtaining variances. Local upgrade
approvals for any system serving a facility owned by an agency of the Commonwealth or the
federal government or systems with design flows of 10,000 gpd or greater but less than
15,000 shall be granted by the Department applying the same standards. The application for
a local upgrade approval shall be made using a form approved by the Department.
Notification to abutters shall be provided pursuant to 310 CMR 15.411(1)(b).
Y
(2) Local Upgrade approvals shall not be granted for upgrade proposals which include the
addition of new design flows to a cesspool or privy or for the addition of new design flows
above the existing approved capacity of a system constructed in accordance with the
provisions of 310 CMR 15.000 or the 1978 Code.
(3) System upgrades which cannot be performed in accordance with 310 CMR 15.404 and
15.405 require a variance from the provisions of 310 CMR 15.000,which shall be processed
in accordance with 310 CMR 15.410.through 15.417.
(4) The system owner or operator shall provide a copy of the local upgrade approval to the
Department upon issuance by the local approving authority and before commencement of
construction.
15.404: Maximum Feasible Compliance- Avvrovals for Upgrades and Lots Grandfathered Pursuant to
310 CMR 15.005(3). 15.005(4) and 15.005(5)
(1) Goal of full compliance. Wherever feasible, a failed or nonconforming system(other
than systems threatening public health and safety or the environment as described in 310
CMR 15.304(2))shall be brought into full compliance through installation of one or more of
the following:
(a) an upgraded system which is in full compliance with 310 CMR 15.100 through
15.293;
(b) an alternative system which has been approved for such use pursuant to 310 CMR
15.284 (remedial use), 15.285 (piloting), 15.286 (provisional approval), or 15.288
(certification for general use);
(c) where proposed by the owner or operator,a shared system which has been approved
for such use pursuant to 310 CMR 15.290 and 15.291; or
(d) connection to a sewer system.
r
11
3/24/95 (Effective 3/31/95) 310 CMR - 552
Commonwealth of Massachusetts -
wo
City/Town of NORTH ANDOVER MASSAC U SYR
r`
System Pumping Record
OCT - 5 Z010
Form a
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. The s ust
be submitted to the local Board of Health or other approving authority.
A. Facility Information
Important:
When filling out 1. System Location:
forms the
computer,usey J�
only the tab key Address
R
to move your
cursor-do not City/Town' - Bcdoyc--r State Zip Code
use the return
key. ,. 2. System Owner: 0 11, �ll
l�
Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record qljLll)lfU-,
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
i
6. S stem Pumped
ame Vehicle License Number
ompany
7. ovation here contents were disposed:
Signature of Haulier Date
http://www.mass.gov/deptwater/approvalstt5forms.htm#inspect
t5fonn4.doc-06/03
System Pumping Record-Page 1 of 1
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