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Miscellaneous - 572 FOREST STREET 4/30/2018
572 FOREST STREET 27D/ID5.D-0025-0000.0 ns r E c North Andover Board of Assessors Public Access Page 1 of 1 JV - _ NORTM rth Andover Board of Assessors Ofit�eu e��0 a F �9S a+reo•�;�.�9 SACHUSO � roperty Record Card Parcel ID :210/105.D-0025-0000.0 FY:2011 Community:North Andover 0 � Click on Sketch to Enlarge Click on Photo to Enlarge • w 572 FOR ST STREET- Location: `_ '572 FOREST STREET, Owner Named MAYE,BRIDGET M Owner Address: 572 FOREST STREET �- City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 2.09 acres Use Code: 101-SNGL FAM RES ,Total Finished Area: ;*2-43-8—s gft CURRENT VEAR o ' Total Value: _ 494,900 Building Value: 279,700 297,900 w 4 __-- Land Value: �s 215,200 1� 215,200 Market Land Value: 215,200 Chapter Land Value: LATESTSALE Sale Price:. _ 250,000 Sale Dater 01/08/1993 Arms Length Sale Code: Y-YES-VALID Grantor: GAUDET,PAUL CertDoc: 1 `Book: - 003639 'Page: 0273 httn://csc-ma.us/PROPAPP/diSDIay.do?linkld=1707559&town=NandoverPubAcc 12/12/9.01 1 Residential Property Record Card PARCEL ID:210/105.D-0025-0000.0 MAP:105.13 BLOCK:0025 LOT:0000.0 PARCEL ADDRESS:572 FOREST STREET FY:2011 PARCEL INFORMATION Use-Code: 101 - Sale Price: 250,000 Book: 03639 Road Type: _T Inspect Date: 09/22/2003 , Tax Class: T Sale Date: 01/08/93 Pa e: 0273 Rd Condition: P Meas Date: 09/22/2003 Owner: - ._ ______. .. .�.r._ _ _ - 9 -- -- _ - - - ---••- ------ MAYE, BRIDGET M Tot Fin Area 2438 Sale Type: P Cert/Doc: Traffic: M Entrance: R Tot Land Area. 2.09 Sale Valid: Y Water-:-- Collect I& RRC Address: _ -- G'rantor: GAUDET, PAUL . `Sewer: Inspect Rea s-: S 572 FOREST STREET - - NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 1196 Attic: N13 HD CODE: 6 NBHD CLASS: 6 ZONE: R1 StoryHeight_: 2.00 Bedrooms: 4 Up Fn Area: 1242 Bsmt Area: 1196_ Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Baths: __. _.. __- - Bs-_ 1 P 101 S 43560 1.000 - 206,910. Roof: G Ful!Baths: 2 Add Fn Area: Fn Bs--t Area: 400 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grader 2 R 101 A 0 1.090 8,284 Masonry Trim: 46 Ext Bath Fix: 0 Tot Fin Area: 2438 DETACHED STRUCTURE INFORMATION Foundation CN _Bath Qual T RC- , _ 277626 Str "Unit Msr-1 Ms-r-2 E-YR-BIt Grade Cond%Good P/F/E/R Cost Class' Foundation: Kitch Qual: T - EffYr Built: 1983Vu-Mkt Ad - 1 -__ - __ _._.__. w _ _ _ -- �. PT S 400 0.00 1981"'— A A __///82 _ 2,100 Heat Type: HW Ext Kitch: Year Built: 1977 Sound Value: Fuel Type: O Grade G Cost Bldg: 277,600 VALUATION INFORMATION Fireplace: 2 Bsmt Gar Cap: Condition: A Aft Str Val1: _ _ Current Total: 494,900 Bldg: 279,700 Land: 215,200 MktLnd: 215,200 Central AC- N_ Birnt Gar SF: -Pct Complete: - Aft Str Val2: Prior Total: 513,100 Bldg: 297,900 Land: 215,200 MktLnd: 215,200 Aft Gar SF: 576%Good P/F/E/R: /100/100/85 Porch Tvue Porch Area Porch Grade Factor P 184 S 240 T 576 SKETCH PHOTO 576 Sq.F 24 24 .r 46 Fav 150 240 Sq.Fi 10 �¢ F 26 27 a 20 576 Sq.F 24 a. 1 184 Sq.Ft 24 572 FOREST STREET Parcel ID:210/105.D-0025-0000.0 as of 12/12/11 Page 1 of 1 Lot & Street Map/Parcel i CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Approved by: Designer: Plan Date: Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: • SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit# Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Certificate o f Compliance As of December 20, 2011 This is to cert that a SA IIS ACTORT IAVS1PECT[OAr Was completed for the: Construction o f a New On-site Sewage ggTosaCsstetn Todd Bateson at: 572 Forest Street 9Kap-105.(D-%Parce�-0025 9VorthAndoven wA 01845 The Issuance of this certificate shafrnot be construed as a guarantee that the On Site Sewage IDisposaCSystem wiCCfunction satisfactorily. 4Sus `Y. Savvy , 1�EXSIQU (Pu6Cic JTeaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com 40R1k F p i � '"f y•� - i ��SSwCMUs t� PUBLIC HEALTH DEPARTMENT � �1 Community Development Division TOWS �AL�WND�pAH 1'MEp NT�� —.... TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;( )repaired; By: ` or>D (Print Name) Located at: `77 7— 9—t'rLz E 1 (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated =L-(p— I I and last revised on &--Z-7- 11 ,with a design flow of "f gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 1 V �? Engineer Representative(Signature) V 1 L L V1,1 /I\) And—Print Name Final Construction Inspection Date: Engineer Representative(Signature) And—Print Name Installer: (Signature) Date: n An —Print Name Enginer: woo/,OR N���1f�� (Signature) Date: _ J I-A)1 1-1 1 gr, And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Commonwealth of Massachusetts RECEIVED City/Town of . System Pumping.Record MAY 112015 Form 4 TOWN OF NORTH ANDOVER s.•• HEALTH DEPARTMENT DEP has provided this form for use,by local Boards of Health.Other forms may be'used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/ o t of Nous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/rown State Zip Code 2. System Owner. C� Name Address Cd different from location) Citylrown ' StateZp de Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity.Pumped: Gallons 3. Type of system: ElCesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? 3Ves ❑ No If yes,was it cleaned? es No 5. Condition of System:` cD -�A C` v\_n e , 6: System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Lo ca' ere contents were disposed: Lowell Waste Water op_ J �ks- Sign Haul Date 06=4.doc•06/03 System Pumping Record•Page 1 of 1 n SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. 97.60 BLDG. CORNER A B C NOTE. THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.17 SEPTIC TANK OUT 39.6 28.6 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 96.91 DIST. BOX 53.5 87.5 SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.28 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 96.12 COMPONENTS. INV. IN CRAM. 96.05 BOTT. CHAM. 95.78 "I CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS—.BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." VLADIMIR NEMCHENOK DATE r r r LOT 5 (209 AC.) f . 1 8 •gip DIST.4rJgT e,,:i57,a 9JrtA, . you.W, '+ *BM.T.F.-IMO i t 4 1800 GAL SEM TANK 0—BWf I8'* r } � f t0 VENT LEACH EtO w i 40 WFlTRAT& I CHAMBERS Ne. PORT 129.1 30.88' w. 0%A OF MAS FORMT MEU p VLADIMIR L �yG NEMCHENOK o � /STER`����� AS BUILT PLAN- NA_ EN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./572 FOREST STREET AS PREPARED FOR BILL MAS' TM: 105D DATE: 11-1-11 TL: 25 SCALE: 1"=40' 0 20 40 80 s MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 FINAL G DE INSPECTION Date: f Address: V/LOAMED? a SEEDED? @- COVER PER PLAN? 3 Other: Driving Directions from 1,600 Osgood St, North Andover, Massachusetts 01845 to 572 Fo... Page 1 of 2 Notes mapquest' m 0 572 Forest Street-Michele-Final Grade-Monday- #`Y 12/12/2011 Trip to: 572 Forest St North Andover, MA 01845-3216 7.78 miles 16 minutes i V �_ Miles Per Miles N( Section Driven 1. Go 3.1 Mi 3.1 mi Rd 2. l v� v Go 0.5 Mi 3.7 mi Ma; Ess If yc t - 3. E - 1 Go 2.6 Mi 6.2 mi 4. S 0.2 Mi 6.4 mi 5.T, io1.4Mi 7.8 mi If you 6. 57 � 7.8 mi Your c If youGw 572 ` �� 8 mi 7.8 mi Nortl http://www.mapquest.com/print?a--app.core.e7f7fb7e1 ad5c498c78638f8 12/12/2011 Driving Directions from 1.600 Osgood St, North Andover, Massachusetts 01845 to 572 Fo... Page 1 of 2 Notes mapquest• ❑ 572 Forest Street-Michele-Final Grade-Monday- 12/12/2011 Trip to: 572 Forest St North Andover, MA 01845-3216 7.78 miles 16 minutes 1600 Osgood St Miles Per_ Miles y North Andover, MA 01845-1048 Section Driven • 1. Start out going south on Osgood St/RT-125 toward Orchard Hill Go 3.1 Mi 3.1 mi Rd. Continue to follow RT-125. 2.Turn left onto Massachusetts Ave. Go 0.5 Mi 3.7 mi Massachusetts Ave is 0.1 miles past Bay State Rd Essex Enrichment Center is on the corner If you reach Fernview Ave you've gone a little too far t - 3. Enter next roundabout and take the 2nd exit onto Salem St. Go 2.6 Mi 6.2 mi 4. Stay straight to go onto Boxford St. Go 0.2 Mi 6.4 mi 5.Take the 1 st right onto Forest St. Go 1.4 Mi 7.8 mi If you reach Candlestick Rd you've gone a little too far 6. 572 FOREST ST is on the left. 7.8 mi Your destination is just past Ingalls St If you reach Scott Cir you've gone a little too far 572 Forest St 7.8 mi 7.8 mi North Andover, MA 01845-3216 http://www.mapquest.com/print?a--app.core.e7f7fb7el ad5c498c78638f8 12/12/2011 Driving Directions from 1600 Osgood St,North Andover, Massachusetts 01845 to 572 Fo... Page 2 of 2 Total Travel Estimate: 7.78 miles -about 16 minutes 1 f s 213 * Y t �y r - 97 Methuen t ti;"r, �6 orgeto' 110 1 E e 0. Byers Hill-N., ill- . Hillusi3st 3 f F J Willow Rd � renil: , 3� Osgood� - �� Hill Me xt Boxf©rd 97�� �t" a tor ` rA over-, SOu I Lawn [F .' Si t s rr w qtt �''�Y � } �A; •��,�.,,,.- 1 M y ,C - yy � •" � �tr c ' ..a'9'Y k �y r�-, Fa 'Hill ID 7r� . ` j .,�J�Ds125 133 Ht11 - � hills"Hi o h m 133 off,;r Carr�ael r1 y'� . ' `,, spq"' = ., ��... Rci ..rte"�SFps I r' G1ayaitHi1li / r! ' -a+Sh�wa 6.t B®xFord utie Andever3 c Pin Hill 114 4_ f R r li L_l 11 7 ` { � � 5000ft C i ��` z .r`�,. , p ��. 6 IN 11 Hvtt HiJJ kl Y-J Olt L2000m rll�� rf`: ia,eeG,_,. : ii_pa�3 02011 MapQuest - Portions©2011,NYlVTE'Gt,lnterrnap9T ©2011 MapQuest,Inc.Use of directions and maps is subject to the MapQuest Terms of Use.We make no guarantee of the accuracy of their content,road conditions or route usability.You assume all risk of use.View Terms of Use http://www.mapquest.com/print?a=app.core.e7f7fb7el ad5c498c78638f8 12/12/2011 • S�,KxtiF.D lis • � I North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: S'7 .7— mar��-- S`� MAP: l z>,- jD LOT: -2 s INSTALLER: J� �� C'Z �--- DESIGNER: PLAN DATE: - /W`j I 7 BOH APPROVAL DATE ON PLAtV: l6 /ff INSPECTIONS TANK INSPECTION: d-D c f DATE OF BED BOTTOM INS ECTION: 1 DATE OF FINAL CONSTRUCTION INSPECTION: DATE .OF FINAL GRADE INSPECTION: SITE CONDITIONS E;;r Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: /° ti�cd ^ ���Lt<: - / ,-.� vee. • �avr�-s �✓C-1� v� i-. ���� SEPTIC Building sewer in continuous grade, on mpacted firm base ❑ Cleanouts per plan Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ T gallon tank has been installed t� loading Monolithic tank construction ❑ Water tightness of tank has been achieved by testing ❑ Inlet tee installed, centered under access port 1d1 -71 � y c>L^--ti� Dom/ �-✓`�— E�'� (J �-`��-S rte►''' �`-�'� ���--�'-- �" � ,�� 100 ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading Monolithic tank construction ❑ et tee installed, centered under access port ❑ Pum installed on stable base ❑ Alarm floc orking ❑ Pump On/Off is working ❑ Separate on/off flo ❑ Drain hole in pressure li ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYS T (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 ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = -�t BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral INVERT Top of Chamber Bottom of Bed/Chamber, SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 'Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 5 (rte i('�i ('J� KI V V 2 1 �O = Town of North Andover �. .•' HEALTH DEPARTMENT ARTMENT CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ S tic-Design Approval $ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer . woRT Application for Septic Disposal System �f,•••• No TODAY'S DATE `A Construction Permit TOWN OF ORTH ANDOVER. MA. 01845 $255.00—Fall Repair •f' $125.00-Component 1SSACIW'S" Important: A licatio ' ereby made fora permit to: When fiffing out UConstruct a new on-site sewage disposal system* ' forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal syste only the tab key to move your ❑Repair or replace an existing system component—What? cursor-do not �IZEYNALYH OF WATN ANDOVER use the return A. Facility/Infonnation _ 01 ARTMENT key. Address or Lot# �eao Cffyrrown O- ay ez-- 2.-*TYPE OF SEPTIC SYSTEM*: ❑Pump CKravity(choose one) \ ***If pump system,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) ❑Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information Name t7 �� ��,c�� S�• , Address(if different from tabove) Cityrrown state Zip Code Telephone Number 3. Installer Information ® SATPcnN�. Name Name of Company11 ARG�OINC. 11A ANDOVER MA nt a$a8 A Address Cityfrown state Zip Code q7t- Y16-- X-7o3 Telephone Number(Cell Phone#If possible please) 4. _Designer Information Name Name of Company �— G& -P4d-k 51- Address AnL ytr M,4 CSS(��D Citylfown State Zip Code 97? 17,5-- 3s'6-6— Telephone Number(Best#to Reach) Appticatimi for.Disposal System Construction Permit•Page t of 2 r4`°;Tyo Application for Septic Disposal System ..:. cTODAY'S DATE pConstruction Permit - TOWN OF *`��' •F' ORTH ANDOVER MA 01845 $.250.00-Full Repair ,,�e,r"r, + $125.00-Component SSACHUS PAGE 2 OF 2 A. FadilitOnformation continued.... 5. Type of Building: Residential Dwelling or[)Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place the system in operation until a Certificate of Compliance has been issufl#by this Board of Health. Name Date Application pp ed By: (Board of Health Representative) _qA Z / - MS Name Date M Application Disap roved for the following reasons: For Mice Use Only: 1 Fee Attached. Yes_// No 2. Project Manager Obli tion Form Attached. Yes " I g• � _ No / 3.: Pump S s�tem? Ifsot Attach copy ofElectrical Permit . Yes_ No V 4. FoundadonAs Bu&?(new construction ronly). Yes. No (Same scale as approved plan) Fl r - 5. oo Plans. (new construction only): Yes No Application forpisposal System Construction Permit-Page 2 of 2 SEPTIC SYSTEM.INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for•the septic system for the property at: 377 &1A. s4r - (Address of septic system) For plans by >"/��/t �t .�/✓�ic�-�e/e,Le� (Engineer) Relative to the application of ��pZ�� �iQ -eSdre/ (installer's name) And dated '4/– v G—/ t ngma ate . Dated I—?�—/( o ay s dateT With revisions dated (Last revised date) I understand the following obligations for management of this project: I. 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. 3.0 As the installer,I am-required to,have the necessary work completed prior to the applicable in as indicated below. I understand that reduesting an inspection,without comliletion of the items in.accordance with Title 5 and the Board of Health Remulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom:of =Generally,this is the first(15 'inspection unless there is a retaining wall,which should be done.:first The installermust 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:heald dept(2ttownofnorthandcver corn) from the engineer must be submitted to the Board of.Health,after which installer.cails for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and 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:rimple 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 b .others unlicensed to install se tics stems in North Andover can constitute reasons for denial of the system and/or revocation orsuspension 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 thatI must be on-site during the performance of the following construction steps: a. Determination that.the proper elevation of the excavation has been reached. A Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staffor consultant. d. Installation,of tm*D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely res12onsibla for the installation of the system as ner the approved plans. No instructions by the homeowner general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) /d� f•-Q Sac/ -� ame— nute . r, AS-BUILT CHECKLIST All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number,Street Name,Assessors Map and Parcel Number Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,inc)l06_r,5's< >q applicable) Ties to dwelling or Permanent Structure&Wells a.From Septic Tank b.From Leach Area Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System Top of Foundation Elevation ✓ Locations of Wells,Drains,Watercourses within 150 feet of system Location of water,gas,electric lines,cable Distances from Corners of House to Center of Tank&D-Box / Location of Structures within 6 Inches of Finished Grade t/ Original Stamp&Signature Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc North Arrow Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "I certify the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 DelleChiaie, Pamela / From: Sawyer, Susan Sent: Friday, December 02, 20112:04 PM To: DelleChiaie, Pamela Subject: RE: 44 Marian Drive- Follow-Up information needed to complete file Perfect. It will be good to close them From: DelleChiaie, Pamela Sent: Friday, December 02, 2011 1:58 PM To: 'wrdufresne@comcast.net' Cc: Sawyer, Susan Subject: RE: 44 Marian Drive - Follow-Up information needed to complete file Importance: High Yes,thank you Bill,if you would just send all those other As Builts and Certification forms over,I can close out those files for this year and issue the COC's to the homeowners once we have all the paperwork to review for accuracy against the approved plans. I will scan and send you copies of the final COC's as well once complete. With regard to 44 Marian Drive,for whatever reason,I do not have copies of the paperwork I indicated. If you and Susan agreed about not including the notes,that is fine. I included that notation ih my email,as it was raised as a concern previously according to what I read in the file. Thank you. Viet Rgau*, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA oi845 2 Office-978-688-9540 Fax-978-688-8476 Email-ndellechiaiePtownofnorthandover.com �l Website http//www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net] Sent: Friday, December 02, 2011 1:41 PM To: DelleChiaie, Pamela Cc: Sawyer, Susan Subject: Re: 44 Marian Drive - Follow-Up information needed to complete file Hi Pam The as-built plan and certification have been completed since September 30, 2010 and were submitted to your office. I just pulled the job file from our archived files which is where the jobs are stored once all final paperwork has been submitted. The issue regarding the depth of the force main is one which was never brought to my attention at the time of construction. It was raised on the plan review and I argued to Susan that the force main is not subject to any requirement regarding the water table. Susan sought the opinion of DEP on this matter 1 r and was informed by Claire Golden that the requirement of being 1.0 ft. above the watrer table pertains to gravity inlet and outlet tees associated with the septic tank and not the force main or pump tank so I am unsure as to why this is any concern and I professionally disagree with your opinion. It certainly should not be holding up issuance of a Certificate of Compliance for my client. I have a copy of the e-mail and correspondence from DEP to your office dated July 30, 2010 substantiating this. Please check your files for the same. I have as-built plans and certifications for 196 Summer Street, 572 Forest Street, 2009 Salem Street and 143 Dunacn Drive that I need to send over so I will include a copy of 44 Marian Drive as well if you want. Bill From: "Pamela DelleChiaie" <pdellech@townofnorthandover.com> To: "Bill Dufresne (wrd ufres ne@com cast.net)" <wrd ufres ne@com cast.net> Sent: Friday, December 2, 2011 9:43:36 AM Subject: FW: 44 Marian Drive - Follow-Up information needed to complete file Hi Bill, Upon review of the file for 44 Marian Drive,it appears that we still do not have the final certification form signed by both you and Todd,and we also do not have the final as built. Please submit the required paperwork asap,and include the as-built elevations of the PC outlet on the plan, as was determined at the Final Construction Inspection that the pump chamber outlet for the force main is below the ESHWT. I am unable to issue a final COC for the homeowner from our department until we have all of this information. Thank you. Also, Mr. Bowab, the homeowner, is looking for a certified survey plot plan of his property for a deck addition on the back of his house, and needs to show the deck in relation to the septic tank and leaching area. Do you perhaps have that on file as well? Thank you. fiat Rgssda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 Fax-978-688-8476 Email-ndellechiaieotownofnorthandover.com S Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: DelleChiaie, Pamela Sent: Tuesday, September 28, 2010 4:08 PM To: mpeters@millriverconsulting.com Subject: FW: 44 Marian Drive 2 From: brdufresne@comcast.net [brdufresne@comcast.net] Sent: Tuesday, September 28, 2010 2:35 PM To: DelleChiaie, Pamela Subject: 44 Marian Drive Pam, The above site is ready for an as-built inspection by the Town. The contractor is Todd Bateson Thanks, Bill Dufresne Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 3 f DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Monday, October 24, 2011 12:49 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 572 Forest St Const. Inspection Attachments: Construction Inspection Form 10-24-11.doc Please find attached the results from the inspection this morning with Todd Bateson. All was per plan except the relocation of the tank which they said was fine with you. The tank to the d-box still had 1% slope so all is well. Sincerely, Randy Burley Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930 Ph 978-282-0014 Fx 978-282-1318 www.millriverconsultiniz.com rburleygmillriverconsulting com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:htto://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 572 Forest St. MAP: 105 D LOT: 25 INSTALLER: Todd Bateson, Bateson Enterprises DESIGNER: Merrimac Engineering PLAN DATE: 4-26-11 BOH APPROVAL DATE ON PLAN: 7-24-11 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/24/11 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Contractor reported the tank location moved due to some buried steps. Also the invert at the foundation was able to be raised. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan N/A ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ❑ Water tightness of tank has been achieved by testing Z Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Could not verify tank water-tightness. Only had a foot or so of liquid in tank at time of inspection. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) NIA ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: None 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 ❑ Retaining wall (boulder/ concrete /timber/ block) N/A ❑ Final cover as per plan Comments: None SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers LP ® Number of chambers per row: 10 ® Number of rows : 4 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 97.60 97.30 Septic Tank IN 97.19 97.10 Septic Tank OUT 96.95 96.85 Distribution Box IN 96.32 96.30 Distribution Box OUT 96.16 96.13 Lateral 1 INVERT 96.11 96.08 Lateral 2 INVERT 96.10 96.08 Lateral 3 INVERT 96.10 96.08 Lateral 4 INVERT 96.09 96.08 Top of Chamber 96.49 96.47 Bottom of Bed/Chamber 95.82 95.80 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, October 21, 2011 11:19 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: Septic-572 Forest Street- Final Construction Inspection Request Importance: High Hello, " Bill Dufresne called and stated that 572 Forest Street is ready for a Final Construction Inspection. Todd Bateson concurred. Thank you. Fiat, qou a, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 " North Andover,MA o1845 1 Office-978-688-9540 2 Fax-978-688-8476 El Email-pdellechiaie(@townofnorthandoNer.co er.Com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: Sawyer, Susan Sent: Monday, September 12, 20113:53 PM To: DelleChiaie, Pamela; Grant, Michele Subject: FW: 572 Forest perc test " Looks like it won't be this week. See Bill's email below. S From: wrdufresne0comcast.net [mailto:wrdufresne( comcast.net] Sent: Monday, September 12, 20113:49 PM To: Sawyer, Susan Subject: Re: 572 Forest Susan I just called Todd Bateson, although he pulled the permit, he is not starting that job for a couple weeks. He said He will keep us in the loop as his start date gets nearer. From: "Susan Sawyer" <ssawyer townofnorthandover.com> To. wrdufresne(cD-comcast.net" <wrd ufres nea-com cast.net> Cc: Pamela DelleChiaie <pdellech D-townofnorthandover.com> Sent: Monday, September 12, 2011 3:40:56 PM Subject: 572 Forest Hi Bill 1 Todd Bateson will probably be calling you. I just left him a message telling him that we need to schedule a perc test at 572 Forest before approving the Bottom of Bed. I just don't know when Todd was looking to start. If you two come up with a time, please let us know and we will try to accommodate.This is a fairly flexible week for us but we need some notice. Thank you, Susan Stmatt Sawyn J ub&31eaef Dked" 16CO Odgead Stud XWg.2U,unit 2-36 .Nadi Qndam,Na 01845 mice 978 68S-9540 fax 978 688-8476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, Y Jul 11, 20119:52 AM To: Bill Dufresne(wrdufresne@comcast.net) Cc: Sawyer, Susan Subject: Septic-572 Forest Street- Plan Approval-REVISED LETTER Attachments: 20110711093334676 Importance: High Follow Up Flag: Follow up Flag Status: Flagged Hi Bill, Please note that there was an error on the original e-mail/letter that was sent to you for this property. Please discard the prior version of this letter referencing 752 Forest St.,and take this as the final approval letter- dated July 6,2011 for 572 Forest Street. We apologize for the confusion. Thank you. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 0 Fax-978-688-8476 0 Email-udellechiaie(@townofnorthandover.com `6 Website http://www.townofnorthando-,,er.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous i '�`-'rte •• North Andover health Department Community Development Division July 6,2011 William Maye 572 Forest Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 572 Forest Street,Map 105D,lot 25,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property,submitted on your behalf by Merrimack Engineering Services, dated April 26,2011, last revised June 20,2011, The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total)design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time,a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover.In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits.Please retain the included form 9B for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street,Building 20,Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 572 Forest Street July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed, Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Conshuction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer , S san Y. Sawyer,RE Public Health Director cc: Vladimir Nemchenok,Merrimack Engineering file encl: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street,Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab William Maye key to move your Name cursor-do not 572 Forest Street use the return key. Street Address North Andover MA 01845 ®Ir--v City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok. Name ® PE ❑ RS 66 Park Street Andover MA, 01810 Address Clty/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 672 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval•Page 1 of 2 ' Commonwealth of Massachusetts Cityrrown of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min.nnch Depth to groundwater ti ❑ 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: Health Department Approving Authority Susan Sawyer, Health Dir July 5,2011 Print or Type Name and Title Signature Date 572 Forest Street fonn9b 7.6.11.doc•rev.7/06 Local Upgrade Approval*Page 2 of 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, June 10, 20114:19 PM To: Bill Dufresne(wrdufresne@comcast.net) Subject: Septic-572 Forest Street- Plan Review- Disapproved Attachments: 20110610155937538 Importance: High Follow Up Flag: Follow up Flag Status: Flagged Hi Bill, Attached is the septic plan review for 572 Forest Street. This plan was disapproved. Please submit the items as requested so that we may be able to issue an approved septic plan approval. Thank you. b"iat�?cganala, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 0 Fax-978-688-8476 Eil Email-pdellechiaieRtownofnorthandover.com -�l Website bM://www.townoftiorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Friday, June 03, 2011 10:07 AM DelleChiaie, m To: Pamela el a Subject: RE: Septic-572 Forest Street-Plan Review Application Rec'd today From: DelleChiaie, Pamela [maiIto:pdellech@townofnorthandover.com] Sent: Tuesday, May 31, 20114:02 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan Subject: Septic - 572 Forest Street- Plan Review Application Importance: High Hello, I am sending the application for a septic plan review for 572 Forest Street in the mail for review today. Please confirm when you receive it. Thank you. O VW Ref m a, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 ( Fax-978-688-8476 ( Email-pdellechiaie(@townofnorthandover.com 2�1 Website http://www.townofnorthandover.com/Pages/index "We can never see the pati:of our life if we are too busy focusing on the pebbles under our feet."--Anonymous Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 �DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, July 06, 20114:43 PM To: DelleChiaie, Pamela Subject: 572 Forest St approval Attachments: 20110706155948474.pdf Here is the scanned approved document to send to Bill and the owner.I will put the file into your box.Also please enclose a list of installers even though I did not remember to reference it in the letter. 52 Olympic is ready too,but waiting for a couple of things from Bill and also for Heidi to say ok to a question I asked her. Thanks, S -----Original Message----- From:noreply@townofnorthandover.com Lmailto:noreply@townofnorthandover.coml Sent:Wednesday,July 06,20114:00 PM Lmaflto:norZly@townofnorthandover.com Sawyer,Susan Subject: This E-mail was sent from"RNPOA428C" (Aficio MP C5000). Scan Date:07.06.201115:59:48 (-0400) Queries to:noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. i e North Andover Health Department Community Development Division July 6,2011 William Maye 572 Forest Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 752 Forest Street,Map 105D,lot 25,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, . for the above referenced property,submitted on your behalf by Merrimack Engineering Services, dated April 26, 2011,last revised June 20,2011.The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total)design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time,a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover.In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits.Please retain the included form 9B for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street,Building 20,Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r . 52 Olympic July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed. Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerel , Susan Y. Sawyer,REH S Public Health Director cc: Vladimir Nemchenok,Merrimack Engineering file enol: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street,Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts Cityfrown of NEW Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab William Maye key to move your Name cursor-do not 372 Forest Street use the return key. Street Address North Andover MA 01845 Q Cityrrown State Zip Code 2. Owner Name and Address(if different from above): Name Street Address Cityrrown State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok. ® PE ❑ RS Name 66 Park Street Andover MA, 01810 Address Citylrown 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 672 Forest Street form9b 7.6.11.doe•rev.7106 Local Upgrade Approval@ Page 1 of 2 c�L\ commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 8B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction f< Percolation rate min,nnch Depth to groundwater 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: Health Department Approving Authority Susan Sawyer, Health Dir July 5,2011 Print or Type Name and Title Signature Date s" 572 Forest Street formOb 7.5.11.doc•rev.7106 Local Upgrade Approval*Page 2 of 2 DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, September 12, 20113:41 PM To: 'wrdufresne@comcast.net' Cc: DelleChiaie, Pamela Subject: 572 Forest Hi Bill -o -B will probably be calling you. I just left him a message telling him that we need to schedule a perc test at 572 Forest be,or approving the Bottom of Bed. ` iks ow when Todd was looking to start. If you two come up with a time, please let us know and we will try to accommodate.This is a fairly flexible week for us but we need some notice. Thank you, Susan Swan Sawyex Yubhe.7ieaPtfi;Omd" 1600 Uo Sued IN4 20,unit 2-36 .Nox&Qndvm,.MQ MS45 agiee 978 6SS-9540 fax 978 6SS-5476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 North Andover Health Department Community Development Division July 6, 2011 William Maye 572 Forest Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 572 Forest Street, Map 105D, lot 25,North Andover, Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated April 26, 2011, last revised June 20, 2011. The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total) design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits. Please retain the included form 9B for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 572 Forest Street July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed. Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer , i�- S san Y. Sawyer, RE Public Health Director cc: Vladimir Nemchenok, Merrimack Engineering file encl: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ` Commonwealth of Massachusetts City/Town of Local Upgrade Approval 7M SV'y`� Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab William Maye key to move your Name cursor-do not 572 Forest Street use the return key. Street Address North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address Citylrown State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok. ® Name PE ❑ RS 66 Park Street Andover MA, 01810 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 572 Forest Street form9b 7.5.11.doc•rev.7106 Local Upgrade Approval*Page 1 of 2 Commonwealth of Massachusetts City/Town of : a Local Upgrade Approval Form 9B M y•v B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate min./inch Depth to groundwater 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: Health Department �J Approving Authority Susan Sawyer, Health Dir //� July 5, 2011 Print or Type Name and Title i f JSignature Date j f (� 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval,Page 2 of 2 D" $4 - North Andover Health Department Community Development Division x July 6, 2011 William Maye 572 Forest Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 572 Forest Street, Map 105D, lot 25,North Andover, Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated April 26, 2011, last revised June 20, 2011. The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total)design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer,designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits. Please retain the included form 9B for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 572 Forest Street July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed. Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer , S san Y. Sawyer,1; Public Health Director cc: Vladimir Nemchenok, Merrimack Engineering file encl: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of Local Upgrade Approval s Form 913 6,M SVov 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 William Maye key to move your Name cursor-do not 572 Forest Street use the return key. Street Address 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: 440 gpd 5. System Designer: Vladimir Nemchenok. ® PE El RS Name 66 Park Street Andover MA, 01810 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%' sas size,sq.fr. %reduction 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval*Page 1 of 2 s Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B i M SVy B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate mm./inch Depth to groundwater ❑ 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: Health Department Approving Authority Susan Sawyer, Health Dir July 5,2011 Print or Type Name and Title ,.�/Signature Date G 572 Forest Street form9b 7.5.11.doc•rev.7/06. Local Upgrade Approval*Page 2 of 2 i North Andover Health Department Community Development Division July 6,2011 William Maye 572 Forest Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 572 Forest Street, Map 105D, lot 25,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated April 26, 2011, last revised June 20,2011. The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total)design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits. Please retain the included form 913 for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 y 572 Forest Street July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed. Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer , S san Y. Sawyer,RE /S Public Health Director cc: Vladimir Nemchenok, Merrimack Engineering file encl: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab William Maye key to move your Name cursor-do not 572 Forest Street use the return key. Street Address North Andover MA 01845 Q Cityrrown State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok. Name ® PE ❑ RS 66 Park Street Andover MA, 01810 Address Cityrrown State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. a q /o reduction 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval*Page 1 of 2 Commonwealth of Massachusetts City/Town of z u : a Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft. Percolation rate min./inch Depth to groundwater 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: Health Department Approving Authority Susan Sawyer, Health Dir July 5, 2011 Print or Type Name and Title ''Signature Date i 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval,Page 2 of 2 • SF'TTL�D76ye North Andover Health Department Community Development Division July 6, 2011 William Maye 572 Forest Street North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 572 Forest Street, Map 105D, lot 25,North Andover,Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated April 26,2011, last revised June 20,2011. The design has been approved for use in the construction of a replacement onsite septic system for a four bedroom(seven room total) design at 440 gallons per day. Generally this plan would be good for 3-years from the date of approval, however since this repair is the result of a Title V report failure,this system must be completed within two years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This includes the approval of local upgrades 1) This plan includes a local upgrade approval allowing a single test pit within the system area rather than two test pits. Please retain the included form 9B for your records. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 572 Forest Street July 6, 2011 This approval is also subject to the following conditions: 1. A perc test must be conducted with the Health Department at the time of construction, prior to excavation of the bottom of bed. Results will be compared with the information noted on the submitted sieve analysis. The sieve analysis alone cannot be used for the design criteria as the DEP protocol was not followed for the collection of the sample. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(l)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincer , S 'san Y. Sawyer, RE/ Public Health Director cc: Vladimir Nemchenok, Merrimack Engineering file encl: DEP form 9b Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab William Maye key to move your Name cursor-do not 572 Forest Street use the return Street Address key. North Andover MA 01845 VQ City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip p Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok.Name ® PE F1RS 66 Park Street Andover MA, 01810 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is ranted for: P9 pp 9 ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater 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: Health Department Approving Authority Susan Sawyer, Health Dir JJuly 5, 2011 Print or Type Name and Title Signature Date 572 Forest Street form9b 7.5.11.doc•rev.7/06 Local Upgrade Approval* Page 2 of 2 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET-ANDOVER,MASSACHUSETTS 01810-TEL(978)475-3555,373-5721 -FAX(978)475-1448-E-MAIL:merreng@aol.com 8 FANEUIL HALL MARKETPLACE-THIRD FLOOR- BOSTON,MASSACHUSETTS 02109-TEL(617)973-6462-FAX(617)973-6406 June 28, 2011 Susan Sawyer Public Health Director Al 1600 Osgood Street Building 20, Suite 2-36 € �j North Andover, MA 01845 ToWN f9 RE: 572 Forest Street Dear Ms. Sawyer, We are in receipt of your review letter dated 6-20-11 for the above referenced site. We have revised the plan with regards to the 7 comments in your letter. Enclosed are 3 copies of the revised plan. On behalf of our client,we respectfully request that the plan be approved as re-submitted so they may move forward with the upgrade of their septic system. Yours``truly, William Dufresne Merrimack Engineering Commonwealth of Massachusetts City/Town of North Andover a 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. 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 William Maye Residence only the tab key Name to move your 572 Forest Street cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): SAME Name Street Address Citylrown State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval wM DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): 0 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: Total Replacement (see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25W SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well(explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: 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: Existing physical features 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 f • 9 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval ��M 5DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete pians 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." 6-27-11 Facility Owner's Signature Date William Maye Print Name Bill Dufresne/Merrimack Engineering 6-27-11 Name of Preparer Date 66 park street Andover Preparer's address Cityrrown MA/01810 (978)475-3555 State/ZIP Code Telephone LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 20, 20113:54 PM To: 'Bill Dufresne' Cc: DelleChiaie, Pamela Subject: 572 Forest Attachments: 20110620153827190.pdf Us too.Here's the 2nd one.Note one of the last comments on the letter is just a correction.Your soil log was one number off,but Sandy luckily logged the correct number.Otherwise we wouldn't have the 4 feet on this one. Thx S -----Original Message----- From:noreply@townofnorthandover.com Lmailto:noreply@townofnorthandover.com� Sent:Monday,June 20,20113:38 PM To: Sawyer,Susan Subject: This E-mail was sent from"RNPOA428C" (Aficio MP C5000). Scan Date:06.20.201115:38:27(0400) Queries to:noreply@townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 VV North Andover Health Department (ommunity Development Division June 20, 2011 Vladimir Nemchenok c/o:Bill Dufresne Merrimack Engineering Sei vices 66 Park Street Andover,MA 01810 Re: Subsurface Sewaze Disposal System Plan for 572 Forest Street,Mau 1051),Lot 24 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated April 26,2011 and received on May 31,2011 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000,or North Andover regulation that is not met by this design follows each item. 1. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested. Please submit the Form 9A and note the Local Upgrade Approval request on the design plan(3 10 CMR 15.405(1)(k)). 2. Sieve analysis does not follow state guidelines.The BOH file has no information regarding the use of a sieve or a passing perc test. The BOH must be in concurrence with the soil evaluation and present for any soil collection for analysis.Please determine process preferred.You may request to conduct a perc test as needed just prior to construction,conduct a perc test now or pull a sample per the guidance.(my concern would be if the perc went 2 min. an inch,which will dramatically change the plan with a 5 foot separation) httn://ivivw.mass.gov/den/water/laws/t5sieve.pdf 3. On sheet 1 of 2, please provide existing spot elevations to the south and southwest of the proposed leaching facility to verify the existing grades in this location. 4. On sheet 1 of 2,note#15 indicates no wetlands within 50 feet of the proposed system. NA BOH regulations require wetlands within 150 feet be shown. Please modify this Page 1 of 2 North Andover Health Department, 1600 Osgood Street,Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i note accordingly or show the location of any wef land,,esource area within 150 feet of the proposed system(NA BOH 3.2). 5. On sheet i of 2,the site plan appears to sho w the new building sewer line connecting to the existing building-sewer line. However, on sheet 2 the building sewer line is proposed to be raised. Please modify plan accordir,;ly. 6. On sheet 2 of 2,the septic tank detail indic,,:tes a gas baffle or effluent filter. Please indicate the required maintenance for the effluent filter if this option is chosen(3 10 CMR 15.227(7)). 7. On sheet 2 of 2,the soil log for T-1 indicates 46 inches of Cl soil. The BOH file actually shows T—1 38 inches to 86 inches rather than 84. Please change on the plan or there will be less than 48 inches of parent soil requiring alternative tech. (3 10 CMR 15.415(2)). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y, Siawyer,R V SIRS Public Health Director cc: Bill and Bridget Maye File Page 2 of 2 North Andover Health Department, 1600 Osgood Street,Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 •^SF'T�L'ED'j� • • North Andover Health Department (ommunity Development Division June 20, 2011 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 572 Forest Street,Map 1051),Lot 24 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated April 26, 2011 and received on May 31, 2011 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested. Please submit the Form 9A and note the Local Upgrade Approval request on the design plan(3 10 CMR 15.405(1) (k)). 2. Sieve analysis does not follow state guidelines. The BOH file has no information regarding the use of a sieve or a passing perc test. The BOH must be in concurrence with the soil evaluation and present for any soil collection for analysis. Please determine process preferred.You may request to conduct a perc test as needed just prior to construction, conduct.a perc test now or pull a sample per the guidance. (my concern would be if the perc went 2 min. an inch, which will dramatically change the plan with a 5 foot separation) http://www.mass.gov/dep/water/laws/t5sieve.pdf 3. On sheet 1 of 2, please provide existing spot elevations to the south and southwest of the proposed leaching facility to verify the existing grades in this location. 4. On sheet 1 of 2,note#15 indicates no wetlands within 50 feet of the proposed system. NA BOH regulations require wetlands within 150 feet be shown. Please modify this Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 note accordingly or show the location of aay wet Rand resource area within 150 feet of the proposed system (NA BOH 3.2). 5. On sheet 1 of 2,the site plan appears to she w the new building sewer line connecting to the existing building-sewer line. However, z)n sheet 2 the building sewer line is proposed to be raised. Please modify plan accordir cr . Ily 6. On sheet 2 of 2,the septic tank detail india.tes a gas baffle or effluent filter. Please indicate the required maintenance for the effluent filter if this option is chosen (3 10 CMR 15.227(7)). 7. On sheet 2 of 2,the soil log for T-1 indicates 46 inches of Cl soil. The BOH file actually shows T— 13 8 inches to 86 inches rather than 84. Please change on the plan or there will be less than 48 inches of parent soil requiring alternative tech. (3 10 CMR 15.415(2)). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, XASusan Y. Sawyer, "S/RS Public Health Director cc: Bill and Bridget Maye File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 North Andover Health Department Community Development Division June 20, 2011 Vladimir Nemchenok c/o: Bill Dufresne Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 572 Forest Street,Map 1051),Lot 24 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated April 26, 2011 and received on May 31, 2011 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested. Please submit the Form 9A and note the Local Upgrade Approval request on the design plan(3 10 CMR 15.405(1) (k)). 2. Sieve analysis does not follow state guidelines. The BOH file has no information regarding the use of a sieve or a passing perc test. The BOH must be in concurrence with the soil evaluation and present for any soil collection for analysis. Please determine process preferred.You may request to conduct a perc test as needed just prior to construction, conduct,a perc test now or pull a sample per the guidance. (my concern would be if the perc went 2 min. an inch, which will dramatically change the plan with a 5 foot separation) http://www.mass.gov/dep/water/laws/t5sieve.pdf 3. On sheet 1 of 2, please provide existing spot elevations to the south and southwest of the proposed leaching facility to verify the existing grades in this location. 4. On sheet 1 of 2,note#15 indicates no wetlands within 50 feet of the proposed system. NA BOH regulations require wetlands within 150 feet be shown. Please modify this Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 note accordingly or show the location of airy wet land resource area within 150 feet of the proposed system (NA BOH 3.2). 5. On sheet 1 of 2,the site plan appears to she w the new building sewer line connecting to the existing building sewer line. However, 3n sheet 2 the building sewer line is proposed to be raised. Please modify plan accordir ;ly. 6. On sheet 2 of 2,the septic tank detail indic�.tes a gas baffle or effluent filter. Please indicate the required maintenance for the effluent filter if this option is chosen (3 10 CMR 15.227(7)). 7. On sheet 2 of 2,the soil log for T-1 indicates 46 inches of C1 soil. The BOH file actually shows T— 1 38 inches to 86 inches rather than 84. Please change on the plan or there will be less than 48 inches of parent soil requiring alternative tech. (3 10 CMR 15.415(2)). Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, S/RS Public Health Director cc: Bill and Bridget Maye File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r ' DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Wednesday, June 08, 2011 11:03 AM To: 'Susan Sawyer(ssawyer@townofnorthandover.com)' Cc: DelleChiaie, Pamela; 'Marianne Peters'; 'Dan Ottenheimer'; 'Randy Burley' Subject: 572 Forest Street Attachments: 572 Forest Street Disapproval Letter 6-8-11.doc Susan, Attached is the disapproval letter for the above referenced property. I did not put this in the letter but I have a couple additional concerns: 1. The soil testing was conducted with Sandy Starr in 2000 and the sieve analysis report was dated 4/20/11. Did he save the soil sample for 11 yrs? 2. The test pit he is using (T-1) only shows 46 inches of soil. They probably stopped digging and did not realize it was not 48 inches. I would recommend conducting a confirmatory test pit during construction. If there is not 48 inches then an I/A system would have to be used. Let me know if you have any questions. Thanks, Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 of�oRT:,y 5455 aidiidgh 9 Town of North Andover `+,'•;;; :: ,+ HEALTH DEPARTMENT ,SSACNU`+tt CHECK#: L �, DATE: �� � LOCATION: H/O NAME: CONTRACTOR NA E: ! Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: S,s�: ❑ Septic-Soil Testing Q--`Septic $ Qc-Design Approval $ � ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ � Y ealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer f NORT#1 5455 O , V e • 4a 'll Town of North Andover HEALTH DEPARTMENT SACMUSE CHECK#: �„7�O�w DATE: oZO LOCATION: t H/O NAME: ¢,"LiLl, CONTRACTOR NA E: lyl - i Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ w ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ A_Septic-Design Approval $ V" ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ i v ealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER raR*1+ OF tao a.�� Office of COMMUNITY DEVELOPMENT AND SERVICES °x HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ' °R •----•� • NORTH ANDOVER,MASSACHUSETTS 01845C;;,;g t� 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townoffiorthandover.com WEBSITE:http://www,townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Site Location: '5 7Z f/)r �/�; )Tw Engineer: & N New Plans? Yes ✓ $225/Plan Check#(includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes ✓ No ' Ljo tryT�V- Local Upgrade Form Included? Yes No UA- Telephone#: M10) 475—2�� Fax#: t70) y 7�2 J E-mail: Homeowner Name: OFFICE USE ONLY When the submission is complete(including check): ➢ ✓ Date stamp plans and letter Complete and attach Receipt ➢ ,/ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Location Address: Owner's Name: aiLA-,, LAAY5 Date: C5-Z-oo 4 Address: 5' Time: I1 ! !2&1, ` Or Lot #: 9 0y�?® Weather*AM&+/A° Telephone #: Deep Hole Number: . Location (Identify on site plan) nth Soil Soil Matrix Soil Redoximorphic Features Coarse Fragments Depth Horizon Color—moist Texture %by volume Soil Soil Consistence (inches) or layer (Munsell) Depth Color Percent (USDA) Gravel Cobbles Structure (moist) Other Additional Notes: Unsuitable Materials Present: No _ Yes If yes: Disturbed soil Fill Material Impervious layer(s) Weathered or Fractured Bedrock Bedrock Groundwater Observed : No _Yes If yes: Depth Weeping from Pit Face: Standing Water in the Hole Estimated Depth to Seasonal High Ground Water _ Location Address: '5177., I'0 � !4M66-r - Owner's Name: 93I LL, Date: t;;2. -00 Address: 5-7 Time: I Or Lot #: ® Weather: Telephone #: - Deep Hole Number: =7i Location (Identify on site plan) Soil Soil Matrix Soil Redoximorphic Features Coarse Fragments Depth Horizon Color—moist Texture %by volume Soil Soil Consistence (inches) or layer (Munsell) Depth Color Percent (USDA) Gravel Cobbles Structure (moist) Other »fe` ' r4 z kr,5t., t.lic. V,FWOPLO Additional Notes: Unsuitable Materials Present: No Yes If yes: Disturbed soil Fill Material Impervious layer(s) Weathered or Fractured Bedrock Bedrock Groundwater Observed : No _ Yes If yes: Depth Weeping from Pit Face: 4719 '{ Standing Water in the Hole Estimated Depth to Seasonal High Ground Water ` TerraFilter,LLC. P.O.Box 117 10 Main St. Sturbridge,MA 01566 Terr �a� Tel: (508)347-5508 a �� (877)347-7163 (� Fax:(508)347-9857 4 April 20,2011 Bill Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 RE: Particle Size Analysis (Alternative to Pere Test) 572 Forest Street, N.Andover, Mass. Dear Bill: Below are the results of the particle size analysis from the sample submitted for the above referenced property. The analysis was performed utilizing the hydrometer method of Gee & Bauder (1986) in Methods of Soil Analysis, Part 1. Physical and Mineralogical Methods,2nd Edition. Sand Silt Clay (2.00 to.05mm) (.05 to.002mm) (<.002mm) Portion Passing 81.8% 15.2% 3.0% #10 Sieve USDA Soil Textural Classification: Loamy Sand MA Section 15.243 Soil Classification: Class I Based upon the DEP's Title 5 Alternative to Percolation Testing Policy for System Upgrades,the following effluent loading rates apply: Un-compacted Soil 0.66gpd/sf Should you need additional information, or require further testing services, please do not hesitate to contact our office. Sincerely, Mark Farrell,Soil Scientist www . TerraFiIter. com Commonwealth of Massact USQIbEIVED 91 City/Town of ' System Pumping Record JUN 3 0 Zoos r� Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: � I^�� forms on the Y computer, use only the tab key Address to move your cursor-do not citylrown State Zip Code use the return key. 2. System Owner: YQ Name ISI Address(if different from location) City/Town State,,oiZip Code Telephone Number B. Pumping Record (0 r C���� 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): �,� 4. Effluent Tee Filter present? [I Yes Ej No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of S stem: \'j 6. SysteTPum fed By: ^ C� �v Namemoi\ ^l Vehicle License Number r � Company V 7. 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N I '{ e?i}CSrFT7r.•5;° '�+ tj^°f k'']<I a�_ S , 7 - ''7{��"`�� t rt[ lt�l.`aS����.t„!{ ,qy�'n •s !1.{' '�'�=n Y i i q �f-t p�° i� s.�'�u,F•e-t•-t Y� �I s i+ +. t1 = ',y`t -• '��3y�+�y,,.��FI� _s'{µ'6 � N=^jSyttt �4�2 1 {i t}i �,��`E Rat�5�7 .:t '" ,� t`q /* , {"S" 3 k ; t;1 rx [ t f t `�, z�E:. YE, "+"• - c Commonwealth of Massachusetts RECEIVED 2L/�O\ja M ssachusetts OCT 19 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT System Puhmn9a Record System Owner System Location 1 5j Date of Pumping: 10_S 0 �[ Quantity Pumped: ( 600 gallons Cesspool: No Yes [I Septic Tank: No [] Yes System Pumped by: &&4" License# Contents transferred to: Greater Lawrence Sanitary District Date: (�' S" Q Inspector: .. �, .h';w}Ltii�'•���af�.'}C::'7JR.'�::�S:iifi':.'�::1i." a�' �ii:�`[%;'� - 1�..,,� },,,:L�f. .,,r Jyy,;�..y�,f y,I ..rJ.', •r.ti;;'yp ;J,1 :,rr��iri'r' ,�r:.'..: . �'FS•. t l,J'� ��+ I��.'1� �•SAY ..l!eI. 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(ezum�'ie Icfr frons of nous-, .f r u V,T CY(�FQUANTITY f'UMI' r ? �nr�;�y�ivl��'y�'1111S�Jit 1�'•s'yly�•°, '>,5�,t�,. ` I, r YES r SEPTIC TANK, NO -Y �s V, , �aTUKE'O.F.:S-ER`:Y.l.'CE.i ROUTINE ✓' `' 'EM ERC6NCY ”" CU CIS• ""��itr•'' ;�'f +�r�:;�Y�;�RCf,Z�;�rt�S C:::�:";:;:;..�`:' A FF(:LS f� I'�l /'� � — , ',},. i:"v�'!'a,'(�t•' ;,I�:��tri:.� I rad.• �'r ;R;U OTS:��; : ,,,,•'. CA CH FI C LD i 'HRR. -EX .r — :. 1 1 ,I i;� !>i ��r 4:./ 11 "�"'^^^� iS .:L'• .� •�. 4A.1 N) ' ,``�:'Y�•.1, t:,rJ11 /` �, �1 )n.; 1•VJ:fIJ-khr�'fi�X1i•'j;�i \ f t ,y: `4 1J 1,•3y is?;;�,.. _—.__. .t'. 11. 5•y. r.r.:Sr,-,,::.,�, ;,., \\.s5'''�t''�P!tr:y.;,r.::k,,r:v,•"�t:;�;'rf:r%t:��,":,. , +/1 -8, b R Y`'i:::: .� 'i r•li,�•,1•,%;j:y;';,� ;\: 3• �.r;;;a j'•,t.;, . .,f;.,�:;•;:,. — :i 'e��'�{� 1 ir�t1��5` �4��,tt`(,t,�lt��,f ' `',i.• . .iii•! ?N:'•H"'(a:• ��t�"�'s',<<.%C�7�:�" r}Jli{':ally' .ti:,:�:,,:',^!.',., � 1511?aNSI�,CI��I��LD 1U; Town of North Andover, Massachusetts Form No. 1 NORTH d BOARD OF HEALTH a I- 0 4117 APPLICATION FOR SITE TESTING/INSPECTION Y 7 AERATED �SSACHUS�� ` Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRES TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee �� '� Test No. q& S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH f r' C OF�z�eD bgti0 / �/^ "•RADR4TED WPPp`y�\5* APPLICATION FOR SITE TESTING/INSPECTION 9SSACHUSE�� _ Applicant ',,�i "a f r�:_-•: �-� NAME ADDRESS TELEPHONE Site Location Engineer .; ,.. ��,',, t _ c .. ,t %: i•�� -- �.� NAME ADDRESS r TELEPHONE Test/I nspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Av Test No. S.S. Permit No. D.W.C. No.-C.C. Date Plbg. Permit No. to BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION OF SOIL TESTS: 5_7 Z Assessor's map& parcel number: j- v P,4,r�• Zs OWNER:lie(44*t w&&Ly&gr k#,4 o TEL. NO.: SAG—4 zr--/ ADDRESS:_ 722 ENGINEER: TEL. NO.: el- CERTIFIED SOIL EVALUATOR: Intended of I nd: sidential subdivision, single family home, commercial Repair sting Ur lot testing N. A. Conservation Commission Approval: � -- THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of J2Z6,QQ per lot forear construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of 75 0 per lot for repairs or upgrade GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic 6 9 5 8 1e tics stem WILLIAM F. MAYS oz�ssssaso p y BRIDGET M. MAYS 572 FOREST ST. at the NORTH ANDOVER, MA 01845 DATE .3 le-ti- PAY TO THE /n 7 lig ��/ o /� /� eating. ORDER OF / tJ"� Q I� T� t��6 .ti $, 1. t � s submitted to J i ($ta). —DOLLARS � Fle t 56460 Mattapan Office Mattapan, Massachusetts 02116 MEMO 1:0 1 LOOO L 3134 0 2 L 5 6 5 5 3 SOV 6 9 58 r .o G 3A / dip Sb 2.40!y " G9 Q3 'k- l•� ?r Ac. �f 7b ?-� ?? IJL bA A 3• Z�' 2��s SCALE _ 200 2� FIR. �,� st Az ss 2.09 Z1 7,46 AG.Vs v BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: oa LOCATION OF SOIL TESTS. - 5-7Z- Assessor's -7Z,Assessor's map & parcel number --z:f/ D Pte• 2� OWNER:I, 444 TEL. NO.: 666 -4 off/ ADDRESS: J72- ENGINEER: 72- ENGINEER: TEL. NO.: CERTIFIED SOIL EVALUATOR: At-L- 42ge7�e Intended of I nd: 'sidential subdivision, single family home, commercial Repair sting Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1'-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. APR - 6 commonwealth of Massachusetts ova" , Massachusetts System PwAiing Record System Owne" System Location Date of Pumping: Quantity Pumped: /10�1 gallons Cesspool: No Yes Septic Tank: No U Yes System Pumped by: aredert E�lererlgm d License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: 'tCvVN OF NIORTli Ali.. 7, BrIARD OF ig iiM 1 i a MAY 1 1 1999 { - ..,r wP.w•v- - —'. Tia - Commonwealth of Massachusetts City/Town of �s System Pumping Record 9 Form 4 "OWN WN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Healt . AITH ed, but the information must be substantially the same as that provided here. Before using this orm, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Le Right front Qf house,Left/Right rear of house, Left/right side of house, Left/ Right side of building, Leftfight front of building, Left/Right rear of building, Under deck Address — `J h City/Town State U" Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping pate 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 ol�gstem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G.LS.p Lowell Waste Water Sign t e Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, January 19, 2012 10:27 AM To: 'wmaye@verizon.net' Cc: 'nbateson@comcast.net' Subject: COC-572 Forest Street Attachments: 20120117103904163.pdf To: W. Maye 978-686-6261 Dear Mr. Maye, Attached is a scanned copy of your Certificate of Compliance(COC). The hard copy has been mailed. Please call with any questions. Best Regards, PameCa DeCCeChia.ie Departmental Assistant I Community Development Division (Health Department Town of North Andover-1600 Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover, MA 01845 m Office-978-688-9540 1 M Fax-978-688-8476 1 Website-http://www.townofnorthandover.com/Pages/index f 1 �LN Commonwealth of Massachusetts �t elv = City/Town of a a a° System Pumping Record pT20- p12 41M SVevev FOr111 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other form HEALTH DEPARTNT information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hous Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stateni � Zi ode C Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) D'S'eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? es ❑ No If yes, was it cleaned? P--Yes ❑ No 5. Condit'pn of Syste�, 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca ' contents were disposed: .LWHaul Lowell Waste Water g to Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1