HomeMy WebLinkAboutMiscellaneous - 58 APPLETON STREET 4/30/2018 (3) f
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PS Perri 3811, March O?+++I I I++I++ + it++I++k I I 102595-01-M-1424
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NEW ENGLAND ENGINEERING SERVICES
INC
1
.L
June 12, 2002
North Andover Board of Health
Town Hall Annex
27 Charles Street
North Andover, MA 01845
RE: TITLE V REPORT: 58 Appleton Street,North Andover, MA
Dear Sirs:
Enclosed is a copy of the Title V report for the above referenced property. The system PASSED
our inspection.
If there are any questions please call me at my office, 686-1768.
Sincerely
f9-2 C (0--).
Benjamin C. Osgood, Jr
60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01M-(978)686-1768-(888)359-7645-FAX(978)685-1099
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:�jb Rppt c f(D N 5`J(2E r %=JJ6RT' H AI'JDO1' /
_Mo 01-t Aiu flOv 2 MA _-C_.!qD OF HEALTH
Owner's Name:_ C L E�vt'-./y-j-7.v t 1-)9 44!3b_/?1
Owner's Address: 63g R PPP C--17D N 2aZjfe7 I A10Ju� ( �
/0 2 7Z/ .4nJ Dv�2 iia
Date of Inspection: .. 4)L(?lo i
Name of Inspector:(please print)- SNS ftivl c.v QSCsao J 2
Company Name:_N&(Al Civ Env(1_/W L C-
Mading Address: 6,n l�r�eft c,J�on Pa'()e-
A/0 2Tl f kAl9� i�2 i(it o i 8 5!S
Telephone Number: 7g - 6 P G-/7C_�
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and.complete as of the time of the inspection.The inspection was performed based on my
training and e"erience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000). The system:
asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Q Date: & o v Z
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The-original should be sent to the system owner and copies sent to the buyer,if
ceP yer, applicable,and thea approving
pPr g
Notes and Comments
V-A e; has o�� �ee.n occv ��e> �� one. Pees�r � 2 tmG�
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of mv-
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: v5-6 )J-pp I-e-1-b" S?2 EC
NO R �/ AN DouC/2 AtA
Owner:
Date of Inspection: r) d Z
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Panes:
�I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR:15:304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
(tor more system components as described in the"Conditional Pass"section need to be replaced or
r ed The system,upon completion of the'replacement or repair,as approved by the Board of Health,will pass.
Answer yes, o or not determined(Y,N,ND)in the for the following statements.If"not det ' ed"please
explain.
The septic s metal and over 20 years old*or the septic tank(whether m or not)is structurally
unsound,exhibits;su tial infiltration or exfiltration or tank failure is imminent ystem will pass inspection if the
existing tank is.replaced wi a complying septic tank as approved by the Boar of Health.
*A metal septic tank will pass' 'on if it is structurally sound,not 1 ' g and if a Certificate of Compliance
indicating that the tank is less 20 years old is available.
ND explain:
Observation of sewage backup or br out or static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled o distribution box.System will pass inspection if(with
approval of Board of Health):
brok ipe(s) replaced
o on is rem ved
'bution box is le led or replaced
ND explain:
The cyst equired pumping more than 4 times a year due broken or obstructed pipe(s).The system will
pass inspecti f(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
+ Page 3 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_;5-16
00 -E(Z AAjq
Owner: r M 9�N T)At 0 LAS 3 2T
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass.unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the
sys is not functioning in a manner which will protect public health,safety and the environment:
— Cesspoo privy is within 50 feet of a surface water
Cesspool or ivy is within 50 feet of a bordering vegetated wetland or a salt m
2. System will fail unless the Boa f Health(and Public Water'Su liek,-if an determines that the
system is functioning in a manner that acts the public h tti,safety and environment:
The system has a septic tank and soil a tion em(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface er s}tpply.
The system has a septic tank and AS and e S is within a Zone 1 of a public water supply.
The system has a septic tank and Sand the SAS is 'thin 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less 100 feet but 50 feet or more from a
private water supply well".M od used to determine distance
"This system passes if well water analysis,performed at a DEP ed laboratory,for coliform
bacteria and volatilo:or 'c compounds indicates that the well is free from llution from that facility sad
the presence of 'a nitrogen and nitrate nitrogen is equal to or less than Sppm,provided that no other
failure criteria are 'ggered.A copy of the analysis must be attached to this form.
3. Othe .
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: v j4r P?i C i b N S7rZ U-i�_7
ly cy 27N ft��fl t�u�2 M R
Owner. ti VA) E M,3 €2T
Date of Inspection:_ w/r o v
D. System Failure Criteria applicable to all systems:
You mast indicate"yes"or"no"to each of the following for all inspections:
Yes No
V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool 0.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than%:day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
/ Any portion of the SAS,cesspool or privy is below high ground water elevation.
V Any portion of cesspool.or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ ! Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water'supply well.
— r Any portion of a cesspool or privy is less.than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed ata DEP.certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen:and nitrate.nitcogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be nsidered a_large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indica ither`yes"or"nor to each of the following:
(The following criteria ly to large systems in addition to the criteria above) .
yes no
— _ the system is within 400 fe \ce drinking water sup
— _ the system is within 200 feet of a tribe to a ce drinking water supply
_ the system is located in a nitrog sitive area terim Wellhead Protection Area–IWPA)or a mapped
Zone H of a public water s y well
If you have answered" to any question in Section E the system is co dered a significant threat,or answered
"yes"in Section ve the large system has failed.The owner or operator o y large system considered a
significan eat under Section.E or failed under Section D shall upgrade the"tin accordance with 310 CMR
15.3 .The system owner should contact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: !�-v A-(7(?LE–(b U S t R Et?
,),z, f2-n-c I)A 41 A
Owner:
Date of Inspection:
Check if the following have been done.You mast indicate`yes"or"no"as to each of the following:
Yes No
—11Lo_ Pumping inf
rmation was provided by the owner,occupant,or Board of Health
_. Were any of the system components pumped out in the previous two weeks?
- V Has.the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_ Was the facility or dwelling inspected for signs of sewage back up?
— Was the site inspected for signs of break out?
N/ _ Were all system components,excluding the SAS,located on site?
V _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the bales br tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
_y_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and-location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
�/
/Existingag information.
For example,p ,a plan at the Board of Health.
_ Determined in the field(if any of the failure criteria related W.Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3xb)]
Page 6 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: P? L.ETb N s 7 Ec
1�7 o fLT11 /kN n o�E2 /vt R
Owner:
Date of Inspection: /20/o �
RESIDENTIAL FLOW CONDITIONS
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: /
Does residence have a garbage grinder(yes or no): &0
Is laundry on a separate:sewage system(yes or no):eva[if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no):_ZLro
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):jV0
Last date of occupancy:��CE K S
COMMERCIALIINDUMM L
Type of establishment:
Design flow(based on 310 CMR 15.203): nd
Basis of design flow(se►tslpe'sonstsgketd.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):—
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancytuse:
OTHER(describe):
Pumping Records GENERAL INFORMATION
Sauce of information:_ �l �Ci9/15 !q�10 pe---2
Was system pumped as part of the inspection(yes or no): n o
If yes,volume pumped:—____gallons—How was quantity pumped determined?
Reason for pumping:.
TYPE OF SYSTEM'
Septic tank,distribution box,soil absorption system
—Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative(Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank —Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: - t,-e 01-0pL�=t b I j S'YL EC-7
two 2�1-( A,,-j Q noap
Owner.
_C.M _NTIA/T I-AAL(6C i21—
Date of Inspection: 6,1101D 2,
BUELDING SEWER(locate on site plan)
E�
Depth below grade: c9
Materials of construction:— iron _40 PVC other(explain):
Distance from private water supply well or suction line: Nil
Comments(on condition of joints,venting,evidence of leakage,etc.):
P, .0 &-&CDp Como 1'n0 Al
SEPTIC TANK:—(locate on site plan)
Depth below grade: 2 y_
Material of construction: t Xconcrete metal fiberglass__polyethylene
other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: �c7 (a,-q uc,tj (Lo,)ND `T7+A X
Sludge depth: y'�
Distance from top of sludge to bottom of outlet tee or baffle: Z 8
Scum thickness: 1-1
Distance from top of scum to top of outlet tee or baffle: 7 '�
Distance from bottom of scum to bottom of outlet tee or baffle:�B"
How were dimensions determined: Su fzF
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
, o /:7CCQ 144CA/a -7-&-4,1C c.v
—/c�ASF 2s 77---) �, c t l iTJ.li.ff �' o�_
®�LL% O PEA//.t/(rS.
GREASE TRAP:4L�iocate on site plan)
Depth below grade:_
Material of construction:—concrete metal_fiberglass
(explain): _polyethylene other
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping.
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
ZZ IF
Page 8 of 11r:
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: -*I9f'J-C D,V S i/1 Epi
Owner: L�-✓1����/!> L R/►'!gC 2r
Date of Inspection:
TIGHT or HOLDING TANK:&A(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: Gallons
Design Flow: Qallonstday
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DLSTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Q
Comments(note if box is level and:distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
gioa w ot( c =nom ihiyilodt �0�9AL no c✓� ✓�e .vLL
H�1 v� a R 'ni AH ci4fv U?
PUMP CHAMBER:/J. (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: -,5-9 A?Pl-zi3y
A2 or
Owner: C�6441 VV v E I-tI MOCOF
Date of Inspection:
SOII.ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why.
Type ISI
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
1/leaching trenches,number,length:z �/LE'�Kc's f1�P/Lt)1C So
leaching fields,number,dimensions:
overflow cesspool,number:
innovativdaltemative system Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
ff b� LFA[/ TIZ�.ucNc�syc 10
CESSPOOIS: {cesspool must be pumped as pact of inspectionxlocate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY�(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
a � "
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ,�Q r9,�p ibAJ s�2ce.
Owner: c(-f A4EA-1P )E
Date of Inspection: 6 fT
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
1
CA iZ PORI �
1
381.3'
ti
�2wE
Y _
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_ 6 F-
D buC tz
Owner: I.v C- I— ✓h 3 21
Date of Inspection:
SITE EXAM
Slope
Surface water .v
Check cellar
Shallow wells
C
Estimated depth to groundwater feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
a l}S Fy e''N t G` B EW
h}R C�9 0 F cos 7 e W-rsca X?go uc '+-v 3✓P c�'�i �v C�.4N ps
vi
a
ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the North Andover
computer, use Conservation Commission
only the tab
key to move To: Applicant
your cursor- Property Owner(if different from applicant):
do not use the David J. Bradbu Same
return key. Name
Name
58 Appleton Street
rQ Mailing Address
Mailing Address
North Andover MA. 01845
City/Town State Zip Code Cityr own State Zip Code
renin
1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents:
RDA 3/15/07
Title
Date
Plan of Land 3/1/07
Title
Date
Title
Date
2. Date Request Filed:
3/15/07
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
construction of an addition with a concrete foundation to an existing single-family dwelling within the
Buffer Zone to a Bordering Vegetated Wetland
Project Location:
58 Appleton Street North Andover
Street Address Cityrrown
Map 37B Parcel 20
Assessors Map/Plat Number Parcel/Lot Number
wpaform2.doc•rev.3/1/05
Page 1 of 5
T '
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of
Resource Area Delineation (issued following submittal of Simplified Review ANRAD)has been received
from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act.
Removing,filling,dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s)are
confirmed as accurate. Therefore,the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
❑ 3. The work described on referenced plan(s)and document(s) is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s)and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone).
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
wpaform2.doc•rev.3/1/05
Page 2 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability,work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
See attached conditions
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
wpaform2.doc•rev.3/1/05
Page 3 of 5
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CONSERVATION DEPARTMENT
Community Development Division
NEGATIVE DETERMINATION OF APPLICABILITY
SPECIAL CONDITIONS
58 Appleton Street, North Andover
At the March 28,2007 public hearing the North Andover Conservation Commission (NACC)
voted to issue a Negative Determination of Applicability for the razing of an existing 10'x15'
sunroom on sonotubes, in order to construct an addition on a full foundation in kind. Work
will take place within the Buffer Zone to a jurisdictional Bordering Vegetated Wetland
(BVW) located off property within the National Grid easement.
Applicant: David J. Bradbury
58 Appleton Street
North Andover,MA 01845
Record Documents: Request for Determination of Applicability received March 15,2007.
Site plan entitled, "Plan of Land",prepared by Scott L. Giles,
R.P.L.S., dated April 25,2006 revised through March 1, 2007.
Stamped&signed by Scott L. Giles, R.P.L.S.
Letter to Lincoln Daley,Town Planner,prepared by Arrow
Environment,LLC.,dated July 10, 2006.
Pre-Construction
❖ A row of staked hay bales backed by trenched siltation fence shall be placed between all
construction areas and wetlands as shown on the approved plan referenced herein. The
erosion control barrier will be properly installed and placed as shown on the plans approved and
referenced herein and shall be inspected and approved by the NACC prior to the start of
construction and shall remain intact until all disturbed areas have been permanently stabilized to
prevent erosion. All erosion prevention and sedimentation protection measures found necessary
during construction shall be implemented at the direction of the NACC. The NACC reserves
the right to impose additional conditions on portions of this project to mitigate any impacts
which could result from site erosion, or any noticeable degradation of surface water quality
discharging from the site. For example,installation of erosion control measures may be required
in areas not shown on the plan(s) referenced in this Order of Conditions. Should such
installation be required by the NACC they shall be installed within 48 hours of the
Commission's request.
1600 Osgood Street,Building 20 Suite 2-36 North Andover Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnortliandover.com/Pages/NAndoverNL-A—Conser%,ation/index
❖ Immediately following completion of the above-mentioned items,the applicant shall contact
the Conservation Department to schedule an on-site pre-construction meeting. The
applicant and contractor must be present at this meeting. This Determination shall be included
in all construction contracts, subcontracts, and specifications dealing with the work proposed
and shall supersede any conflicting contract requirements.The applicant shall assure that all
contractors, subcontractors and other personnel performing the permitted work are fully aware
of the permit's terms and conditions. A reasonable period of time shall be provided as
notice of the pre-construction meeting (e.g. 48 hours).
Post Construction
❖ Immediately following completion of the work, any disturbed areas shall be permanently
stabilized against erosion. Once the site is adequately stabilized, the Conservation Department
shall be contacted to conduct a final site inspection.
1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnorthandover.com/Pages/NAndover iA_Conservation/index
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5. The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Activity(site applicable statuatory/regulatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
North Andover Wetland Protection Bylaw Chapter 178
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as ollows:
F1 by hand delivery on �y certified mail, return receipt requested on
3
Date L-1 7
q
Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent
to the appropriate DEP Regional Office (see Attachment)and the property owner(if diff rom the
applicant).
Signatures:
`i �� z
,3A Y A 7
Date
wpaformMoc•rev.3/1/05
Page 4 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate Department of Environmental
Protection Regional Office (see Attachment)to issue a Superseding Determination of Applicability. The
request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee
and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in
310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. A copy of the
request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission
and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the
objections to the Determination which is being appealed. To the extent that the Determination is based on
a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the
Department of Environmental Protection has no appellate jurisdiction.
wpaformldoc•rev.3/1/05 Page 5 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
DEP Regional Addresses
Massachusetts Wetlands Protection Act M.G.L. c 131, §40
Mail transmittal forms and DEP payments,payable to:
Commonwealth of Massachusetts
Department of Environmental Protection
Box 4062
Boston, MA 02211
DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham
Agawam Wales
436 Dwight Street 9 Conway Hancock Montague Plainfield
Suite 402 Alford Cummington Hatfield Monterey Richmond Ware
Amherst Dalton Hawley Montgomery Rowe Warwick
Springfield,MA 01103 Ashfield
�etd Deerfield Heath Monson Russell Washington
Phone:413-784-1100 Easthampton Hinsdale Mount Washington Sandisfield Wendell
Belchertown East Longmeadow Holland New Ashford Savoy Westfield
Fax:413-784-1149 Bemardston Egremonl Holyoke New Marlborough Sheffield
g Westhampton
Blandford Erving Huntington New Salem Shelburne West Springfield
�
Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge
Buckland Gill Lee Northampton Southampton Whately
Charlemont Goshen Lenox Northfield South Hadley Wilbraham
Cheshire Granby Leverett Orange Southwick Williamsburg
Granville Leyden Otis Springfield Williamstown
Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor
Chicopee Greenfield Ludlow Pelham Sunderland Worthin ton
Peru Tolland
Clarksburg Hadley Middlefield g
I
DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge
627 Main Street Ashbumham Clinton Hubbardston Millville Shirley Warren
Worcester,MA 01608 Ashby Douglas Hudson New Braintree Shrewsbury Webster
Athol Dudley Holliston Northborough Southborough Westborough
Phone:508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston
Fax:508-792-7621 AyerEast Brookfield Leicester North Brookfield Spencer West Brookfield
Barre Fitchburg Leominster Oakham Sterling Westford
TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster
Berlin Grafton Lunenburg Paxton Sturbridge Winchendon
Blackstone Groton Marlborough Pepperell Sutton Worcester
Bolton Harvard Maynard Petersham Templeton
Boxborough Hardwick Medway Phillipston Townsend
Boylston Holden Mendon Princeton Tyngsborough
Brookfield Hopedale Milford Royalston Upton
DEP Southeast Region Abington Dartmouth Freetown
g Mattapoisett Provincetown Tisbury
20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro
Lakeville,MA 02347 Attleboro Dighton Gosnold Nantucket Rehoboth Wareham
Avon Duxbury Halifax New Bedford Rochester Wellfleet
Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater
Fax:508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport
Bourne Easton Harwich Norwell Scituate West Tisbury
TDD:508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman
Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham
Brockton Fall River Mansfield Pembroke Somerset Yarmouth
Carver Falmouth Marion Plainville Stoughton
Chatham Foxborough Marshfield Plymouth Swansea
Chilmark Franklin Mashpee Plympton Taunton
DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield
1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole
Arlington Cohasset Hull Middleton Reading Waltham
Boston,MA 02108 Ashland Concord Ipswich Millis Revere Watertown
Phone:617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland
Fax: 617-5561049 Belmont Dedham Lexington Nahant Rowley Wellesley
Beverly Dover Lincoln Natick Salem Wenham
TDD:617-574-6868 BillericBoston Dracut Lowell Needham Salisbury West Newbury
Essex Lynn Newbury Saugus Weston
Boxford Everett Lynnfield Newburyport Sherbom Westwood
Braintree Framingham Malden Newton Somerville Weymouth
Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington
Burlington Gloucester Marblehead North Andover Sudbury Winchester
Cambridge Groveland Medfield North Reading Swampscott Winthrop
Canton Hamilton Medford Norwood Tewksbury Woburn
Carlisle Haverhill Melrose Peabody Topsfield
Wpafor m2.doc-DEP Addresses-rev.10/6/04
Page 1 o 1
i
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Request Information
Important:
When filling out 1. Person or party making request(if appropriate, name the citizen group's representative):
forms on the
computer, use Name
only the tab
key to move
your cursor- Mailing Address
do not use the
return key. City/Town State Zip Code
VQ Phone Number Fax Number(if applicable)
Project Location
Mailing Address
City/Town State Zip Code
2. Applicant(as shown on Notice of Intent(Form 3),Abbreviated Notice of Resource Area Delineation
(Form 4A); or Request for Determination of Applicability(Form 1)):
Name
Mailing Address
City/Town State Zip Code
Phone Number Fax Number(if applicable)
3. DEP File Number:
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding Order of Conditions ($100 for individual single family homes with associated
structures; $200 for all other projects)
❑ Superseding Determination of Applicability($100)
❑ Superseding Order of Resource Area Delineation ($100)
Send this form and check or money order for the appropriate amount, payable to the Commonwealth of
Massachusetts to:
Department of Environmental Protection
Box 4062
Boston, MA 02211
wpaforrn2.doc•Request for Departmental Action Fee Transmittal Form-rev.10/6/04 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Instructions (cont.)
2. On a separate sheet attached to this form, state clearly and concisely the objections to the
Determination or Order which is being appealed. To the extent that the Determination or Order is
based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,
the Department has no appellate jurisdiction.
3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding
Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office(see
Attachment A).
4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the
Conservation Commission and to the applicant, if he/she is not the appellant.
wpafonn2.doc•Request for Departmental Action Fee Transmittal Form•rev.1016104 Page 2 of 2