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HomeMy WebLinkAboutMiscellaneous - 58 APPLETON STREET 4/30/2018 (3) f i � (� y c� J ,� SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items.1,2,and 3.Also complete A. Received by(Please Print Clearly) B.�gate of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse C. ature so that we can return the card to you. �ent ■ Attach this card to the back of the mailpiece, X Y`A, El Addressee or on the front if space permits. D. delivery address different item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3. Service Type i Certified Mail ❑ Express Mail ❑ Registered eturn Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 (Transfer from service label) ��O f 3lOQ doaa. �c 4 / .,F/7 PS Perri 3811, March O?+++I I I++I++ + it++I++k I I 102595-01-M-1424 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Lx� �V 6/t-ck SAr q Sh_olp ro A0 126tx 9 yo-_ &'b>7, 114,4- az %Cs^ 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 G � NORTH 1 p i�w t txwt r �,• 4r 0 �9SSA41 CHUSES 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