The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 64 FOREST STREET 4/30/2018 64 FOREST STREET .�.{ 29O/906A-0006-0000.0 cr 4 c� C f� i Sl _ SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. PRE—EXIST BLDG. CORNER A I B C D �• THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 161.49 SEPTIC TANK OUT 14.0 36.7 — — A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 161.14 DIST. BOX 18.4 30.2 - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 161.00 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 160.84 COMPONENTS. INV. IN CHAMBER 160.78 BOTT. CHAMBER 160.50 "1 HEREBY 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." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER ATE I� 365,31' LEACH I IELD W/40 SOT 28 INFlLTR TOR CHAMBERS INSPECTION (46,291 S.F.) PORT O ' O� � 40• 28 N i5. 10, s I� VENT D—BOX 9�1, / R 1500 GAL. SEPTIC TANK I a 1 94 � 1 � jH OF M4ss9c VLADIMIR L yG Z NEMCHENOK 84 A�or�9F /S7ER`�G��`�� S�ONAI EN AS BUILT PLAN A OF NOV 1 g 2015 SUBSURFACE DISPOSAL SYSTEM TC N OF IN0.t7HANDOVER LOCATED IN DEPART„'ENT 0 NORTH ANDOVER, MASS./84 FOREST STREET z AS PREPARED FOR DON GUNES TM: 106A DATE: 9-11-15 TL: 6 � SCALE: I"=40' 0 20 40 so MERRIMACK ENGINEERING SERVICES 66 PARK STREET A ANDOVER, MASSACHUSETTS 01810 -Lot oc ap-Blk Commonwealth of Massachusetts Map-Block k BOARD OF HEALTH - -- • Permit No North Andover BHP-2015-0342 P.I. FEE F.I. $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd_Bateson to(Construct)an Individual Sewage Disposal System. at No 64 FOREST STREET - -- -- ----------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2015-034 Dated --August 12,2015- - ----- - ---- COPY--- -- -RtE -------------------- Issued On:Aug-12-2015 BOARD OF HEALTH --------------------------------------------------------------------------------- • °jam` , Commonwealth of Massachusetts Map-Block-Lot �� • 106.A0006 BOARD OF HEALTH North Andover �'. TIFICATE OF MPLIANCE THIS IS TO CERTIFY,That t ual Sewage Disposal System (Construct) by Todd Bateson ---------------------------------------- - - ----- Installer at No _-6-4-F-0-REST-STREET - - -- -- -- -- - ----- ----- --------------------------------------------------------------- ---------------------------------------- ------ has been installed in accord ith the provisions of TITLE 5 of the State Environm t Code as described in the I application for Dis sa Works Construction Permit No. BHP-2015-034- Dated---August_12,2015----- Printed On:Aug-12-2015 BOARD OF HEALTH • • S�TLED' PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 11/18/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On-Site Sewage Disposal System By: Todd Bateson At: 64 Forest Street Map 106A Lot 6 orth Andover, MA 01845 T e'Issuance oft s ce i 'cate sha not be construed as a guarantee that the system will function satisfactorily. OV is ele Gran — Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ode.. • 5��;,.F°� ' , NOV 16 2015 • ' TC'r."q OF NO'ZIII ANDOVER HEAL; i DEPART.ENT PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed;( )repaired; By: I V 7 (Print Name) Located at: 674 Imo/dv�rr 45 ;r- (Installation ; . (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated L2— !2--157 and last revised on �'�j�j 1'�j- ,with a design flow of 440 6�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 31.0.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: Engineer Representati a(Signature) And—Print Name Final Construction Inspection Date: Engineer Representative(Signature) And—Print Name Installer: gnature) Date: / And—Print Name Engineer: //ll r�( / l�( � (Signature) Date: �-►v And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) /All changes to the design plan have been reflected and noted on the as-built plan 2) 7As-built plan has a suitable scale; 0 inch = 40 feet or fewer for plot plans) 3) Street Address,Assessor's Map and Lot Number 4) Lot Lines and Location of Dwellings served by the system 5) J,Locations,Elevations and Dimensions of As-built system components,inclu 3fig reserve (if applicable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins Property lines Dwellings or other structures Private water supply or irrigation wells / Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) ALocation of water,has;electri�ines,cal5'le,controlfp�el (if applicable) 10) JLocation of Structures within 6 Inches of Finished Grade 11) v Original Stamp&Signature 12) cation and holder of any easements which could impact the system 13) A/Impervious Areas;Driveways,etc 14) North Arrow 15 Location &Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "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 breakout elevations,if applicable,ha ve been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a 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:Tuesday,November 17,2015 • North Andover Health Department [ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 64 Forest Street MAP: 106A LOT: 6 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering PLAN DATE: 6/5/15, rev. 6/25/15 BOH APPROVAL DATE ON PLAN: 06/30/2015 INSPECTIONS TANK INSPECTION: 9/9/15 DATE OF BED BOTTOM INSPECTION:9/9/15 DATE OF FINAL CONSTRUCTION INSPECTION: 9/11/15 DATE OF FINAL GRADE INSPECTION:10/27/15 SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ® 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 visual testing ® Inlet tee installed, centered under access port Z Outlet tee installed, centered under access port (gas baffle/effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 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 N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Low Profile Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 10 ® Number of rows (trenches): 4 Comments: Total Chambers = 40 FINAL GRADE X Loamed X Seeded X Cover per plan Comments: DOCUMENTS NEEDED X Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer X As-Built Plan BM = 164.90 HR = 2.55 HI = 167.45 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Existing Building Sewer 5.46 161.74 162.0 OUT Septic Tank IN 5.62 161.48 161.40 Septic Tank OUT 5.98 161.12 161.15 Distribution Box IN 6.10 161.00 161.00 Distribution Box OUT 6.27 160.83 160.83 Lateral 1 TOP 6.34 Lateral 1 INVERT 160.76 160.78 Lateral 2 TOP 6.32 Lateral 2 INVERT 160.78 160.78 Lateral 3 TOP 6.32 Lateral 3 INVERT 160.78 160.78 Lateral 4 TOP 6.32 Lateral 4 INVERT 160.78 160.78 Top of Chamber 6.30 161.15 161.17 Bottom of Bed/Chamber 160.48 160.50 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 Application for Septic Disposal System OD/ Q, TODAY'S DATE DATE__.. Construction Permit - TOWN OF 25"l.Repalr NORTH ANDOVER, MA 01845 $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use FRWepaIr or replace an existing on-site sewage disposal system* only the tab key to move your ❑Repair or replace an existing system component–what? cursor-do not use the return A. Facility Information key. & Address or Lot# as Cdyirown i 'A I t.M r v rM ` 2.-*TYPE OF SEPTIC SYSTEM*: `'` ➢ ❑Pump ❑Gravity(choose one) AUG ***If pump system,attach copy of electrical permit to application— � �� ➢ ❑Sp1riventional System (pipe and stone system) ..A,, pe�ry ➢ [Dnfiltrator or Biodiffuser(Grave!-Less)(Attach a copy of your certi y.;t on.to'install,fhis tyof system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of friter before DWC issuance) What is the Make? What is theModehl' 2. Owner Information bAa G�-e-s Name �y fel2sf ��_ Address(if different from above) _ f City/Town State Zip Code Telephone Number 3. Installer Information o _TS4 Name Name of Company //,/ BATMON ENTERPRISES,INC. 111 ARG I MA h0AD Address y� L ANDOVER,MA 01810 Cityrrown State Zip Code Telephone Number(Cell Phone#It possible please) 4. Designer Information �e1'r�rutac�` �NcP�N.ce2�'�-cp Name Name of Company Address CityiTown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 oRTM APplicati-on..for Septic Disposal :SSystem �► TODAY'S DATE Construction Pyr= - T0" OF -ORTH ANDOVER, mA 01845 $•250.00-Full Repair $125.00.-Component PAGE 2 OF 2 A. Facility.Information continued.... 5. Type*of Building: esidential Dwelling or❑Eommercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Title.5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place the system In operation until a Certificate of Compliance has been Issue y this Board of Health. Name Date Application Approved By: (Board of Health Representative) Name Date Application Dlsapproved.for the following reasons: For Office Use Only: Y Fee Attached. Yes No 2.- PtojectMatiaper Obligation Form Attached? Yes No ' 3.: Puma Svs=? If'so)Attach copy ofElectrical Permit` Yes No 4. FbundatlbnAs Built.?(new construction-ronl (Same scale as approvedp&v) �>. YeS—' No A F1oorMins?(hew constructiononly). No Applfc tion for-pisposal 5ysterii:tronstructloh Permit.Page 2 of 2 SEPTIC SYS'�I +tI -PWP=MA .W:QBLIGATIaM AsdW.NqAAncloverSmsedbutallafobCWistMcftf0t.•t6.aepticay8taWf0ttheV.pexty=e s4 Re7ativa m tt�.appifeadon of e 1�1 ��-2��' `�'`) . (imudwg alma Abd doted Dared I' Lr : • w ttt rewdow dated, {ue,t rinsed due) I uadct�tannd the f0Unv ng ObUgations far rt> ragement of•4his projects As:&e fnmd*I ams.oblfgat+eti iv obtsia allpenpft' and Board ofHealth approved plans q t to ►performing any:Wc ca a mite. wa due, 2. At$ieia3taltM.I ibatse�I[ ,any and a$ adoau: I£Lome�vse��i��gw or any otherparacm not oc�ated my 'm bgtc ec t and the apatenn is notsrady,then flan t1mx•sbavl bi a�plfcatble. x I" Ast6b have s stoic ry�voaqddapt bo to the ap riled b ` r . ahoro�d be A21- :tlseac fs satsaio ug liiclr • a 'veib3t�.OIC"(ot ell ttx .the be • ttibniittied txt hc.BnrttdofHeakshoi . ��+pectipn tae.`I�atslterrnust heprat fc�r tl ,fstmpex:dost, ftb at dtettgtk; b�' mhte us Ora C. miter . . �� 3omag�a•�►s��tll�d�a��eosz�pltte: Ipsmitei iioe,, tot 4. As*e km&r um d&a a*'my mMwW*s attd At i• ed yea epiete thenatIsttiost cf the isr tti�;a #edir f ifoa nt MOAAndho 5.. A�ti�e.#nadlller;.I e�derat�si:� •I �� ' ce•af� ;• . a DeQ�omt t�we.Bieprmpertksatadara aiftlre qri�,bserr s�e�cbed<- - . ' . b� .TuvpeL'�eaQ aftht'�mrd ntrdst�etb he eraed ' : ', - .. P�illaapea�olrbp8aa�tat. TeAlt�retA`'orcuosulmrt >r,1 F ber &ftWVwallgatfOther . Gxwd . �b wa mmilin_g bz. .,rws�n.t►.+. n . lam: Rz }� .+ 71 - 'ram eF3Mr ebr*ba.�„_ - - �•�� Undete dUnnudSgnic.I e .. 13t V � • Zl North Andover Health Department Community Development Division June 30, 2015 Dogan Gunes 64 Forest Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 64 Forest Street(Map 106A,Lot 61 Dear Mr. Gunes: The proposed wastewater system design plan for the above site dated June 5, 2015 with a final revision date of Jun 25, 201 grid received on June 26, 2015 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4-bedroom (max 9-room)home utilizing a Quick 4 High Capacity Infiltrator Chamber system. This design plan approval is valid until June 25, 2017. 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 approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 454 Forest Street June 30, 2015 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 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, Michele Grant Health Inspector Encl. Installers list cc: Vladimir Nemchenok File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 • swrctED' • • North Andover Health Department Community and Economic Development Division June 22,2015 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 64 Forest Street(Map 106A,Lot 6) Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 5,2015 and received on June 11,2015 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. The loading rate used is incorrect based on the soil texture of the Bw2 layer(3 10 CMR 15.242). The percolation test was conducted in the Bw2 layer. 2. Since the Infiltrator Chambers system is proposed as an alternative soil absorption system the"Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use"will apply. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable ofproviding equivalent environmental protection; Please feel free to contact the office or Mill River Consulting at 978-282-0014 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, Michele Grant Health Inspector cc: Dogan Gunes File Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(a)townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: 40-1(11 JUN 1 1 2015 Site Location: u l rv"'�Ff_ d�l pl�_f TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Engineer: New Plans? Yes $225/Plan Check# ?/` (includes l st submission and one re- review only) Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yesy No Local Upgrade Form Included? Yes V No Telephone#: ( 2p ) Fax#:_6 �'1 E-mail: W-�f zt_W _6.0#4 el&!i .,�42r Homeowner Name: D26M 64Y& OFFICE USE ONLY When the sub ission is complete(including check): ➢ Date stamp plans and letter ➢ ✓ Complete and attach Receipt ➢ ✓ Copy File; Forward to Consultant ➢ /Enter on Log Sheet and Database Infiltrator Chamber I/A technology Certifij9L"D ,1UN 1 1 2015 OF NfORTH ANDOVER ARTWIENT I hereby certify that I have been given a copy of the Title 5 I/A technology approval letter, and the Owner's Manual for the above technology and I agree to comply with all terms and conditions. I further certify that I am aware that this design does not allow use of a garbage grinder in the dwelling and that I understand my requirement to repair, replace or modify or take any other action required by the Department or the LAA if the Department or the LAA determines the system to be failing to protect public health and safety and the environment. r'�Lqy� —10-,2&fS signa date: DEAN 61-itice7 certified by: (please print) MERRIMACK ENGINEERING SERVICES,INC. 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with 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 RECEIVED Important: JUN 1 1 2015 When filling out 1. Facility Name and Address: forms on theh TOWN OF NORTH ANDOVER computer,use Gunes Residence HEALTH DEPARTMENT only the tab key Name to move your 64 Forest Street cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code Z�Q 2. Owner Name and Address (if different from above): SAME Name Street Address City/Town State (978)688-6962 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 BDRM 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): Unknown t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover 4 o Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: 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): ® 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: Complete System, see plans 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 • Commonwealth of Massachusetts City/Town of North Andover a o 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: NA 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts - City/Town of North Andover a a Form 9A — Application for Local Upgrade Approval G 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. 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 plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." 411�ytt4� 6-10-15 �OFacility Tdners ature Date jaw, Gunes Print Name Bill Dufresne 6-10-15 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 Commonwealth of Massachusetts RECEIVED City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal JUN 1 1 2015 TOWN OF NORTH ANDOVER A. Facility Information HEALTH DEPARTMENT Gunes Owner Name 106A/6 Street Address Map/Lot# 64 Forest Street MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Published Soil Survey Available? ❑ Yes ❑ No If yes: 9-19-14 vers. 10 1:15,800 421 Year Published Publication Scale Soil Map Unit Canton Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): 4/2015 Range: ❑ Above Normal ❑ Normal ® Below Normal Month/Year 7. Other references reviewed: Soil Evaluation Forms.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: T-1 5-19-15 9 am rain, clouds 60 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 161.8 Location (identify on plan): See Plan 2. Land Use Rersidential None 3-8 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Ground Moraine top slope Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body feet>100 Drainage Way feet>100 Possible Wet Area >100 feet Property Line 0 Drinking Water Well >1fee00 Other feet 4. Parent Material: Till Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ® Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 64 156.5 inches elevation Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent Gravel Cobbles&Stones (Moist) 0-14 Fill 14-28 A 7.5YR4/6 FSL Wk Gran Friable 28-48 B 10YR5/6 FSL Massive Friable 48-96 C 2.5Y5/4 64" 5Y6/2 >5 LS 35 Massive Friable Additional Notes: Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 5-19-15 9 am clouds, rain 60 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 163.2 Location (identify on plan): See Plam 2. Land Use Resdiential None 3-8 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Lawn Ground Moraine Top Slope Vegetation landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100 Drainage Way >100 possible Wet Area >100 feet feet feet Property Line 45 feet Drinking Water Well >1fee00 Other feet 4. Parent Material: Till Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ® Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 70 157.3 inches elevation Soil Evaluation Forrns.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 8 <CI\I Commonwealth of Massachusetts MaXEM City/Town of North Andover F - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T-2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent ravel Cobbles& (Moist) Stones 0-18 Fill 18-22 A 10YR4/6 FSL Wk Gran Friable 22-58 B 2.5Y5/4 FSL Massive Friable 58-96 C 2.5Y4/4 70" 5Y6/2 >5 LS 30 Massive Friable Additional Notes: Soil Evaluation Forms.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 8 Commonwealth of Massachusetts =- City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 64 B. 70 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches 2 Lower boundary: 96inc„96 Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. 5-19-15 Signature of Soil Evaluator Date William Dufresne SE#640 5-9-96 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Isaac Rowe (Mill River) North Andover Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. Soil Evaluation Forms.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 8 Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 �M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out A Site Information forms on the 'D094V1 computer,use 9m Gunes only the tab key Owner Name to move your 64 Forest Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 CitylTown State Zip Code (978)688-6962 Contact Person(if different from Owner) Telephone Number B. Test Results 5-19-15 Date Time Date Time Observation Hole# P-1 Depth of Perc 45" Start Pre-Soak 10:24 End Pre-Soak 10:39 Time at 12" 10:39 Time at 9" 10:47 Time at 6" 10:58 Time (9"-6") 11 Rate(Min./Inch) 4 Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ William Dufresne Test Performed By: Isaac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Grant, Michele From: Gaffney, Heidi Sent: Tuesday,June 23, 2015 4:38 PM To: Iwrdufresne@comcast.net' Cc: Grant, Michele; Hughes,Jennifer; Blackburn, Lisa Subject: RE: 64 Forest St - septic Hi Bill, I visited the property and agree that the system as proposed is outside of the 100' buffer zone. Heidi Gaffney Conservation Field Inspector Town of North Andover 1600 Osgood Street,Suite 2035 North Andover,MA 01845 Phone 978-688-9530 Fax 978-688-9542 Email hgaffnev@townofnorthandover.com Web www.TownofNorthAndover.com . �•iT1)tt� 1 Grant, Michele From: Gaffney, Heidi Sent: Tuesday,June 23, 2015 9:38 AM To: Iwrdufresne@comcast.net' Cc: Grant, Michele; Blackburn, Lisa Subject: 64 Forest St - septic Bill,are there wetland flags at 64 Forest St for me to confirm the location of the wetland? Heidi Gaffney Conservation Field Inspector Town of North Andover 1600 Osgood Street,Suite 2035 North Andover,MA 01845 Phone 978-688-9530 Fax 978-688-9542 Email hgaffnev@townofnorthandover.com Web www.TownofNorthAndover.com 1 Grant, Michele From: Gaffney, Heidi Sent: Monday,June 22, 2015 12:53 PM To: Grant, Michele; Hughes,Jennifer Subject: RE: 64 Forest Street My comment recommended delineating the wetland, I took a quick look at the plan and it doesn't look like it was delineated, but"approximated" and I don't have any way to gauge the accuracy of the placement of the "approximate wetland" on the plan without going out and measuring which I don't have time for. Even if the system is outside of the BZ,the construction access looks like it would within the BZ? But no access point is shown on the plan. Heidi Gaffney Conservation Field Inspector Town of North Andover 1600 Osgood Street,Suite 2035 North Andover,MA 01845 Phone 978-688-9530 Fax 978-688-9542 Email hgaffney@townofnorthandover.com Web www.TownofNorthAndover.com From: Grant, Michele Sent: Monday, June 22, 2015 10:19 AM To: Gaffney, Heidi; Hughes, Jennifer Subject: FW: 64 Forest Street Hi Heidi, Heres another one Thx Michele From: Isaac Rowe [mailto:irowe@millriverconsulting.coml Sent: Monday, June 22, 2015 10:08 AM To: Blackburn, Lisa; 'Pam Lally' Cc: Grant, Michele; Isaac Rowe Subject: RE: 64 Forest Street Lisa/Michele, Based on Heidi's comments on the soil application (attached) I would recommend checking with her about the "approximate existing wetland" shown on the design plan. She probably has a better sense of the location. 1 Attached i's the disapproval letter for the initial plan review for the above referenced property. Do not send out until you confirm with Con Com. Please let me know if you have any questions. Thanks, Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax: 978-282-1318 irowe(a)millriverconsulting.com www.miliriverconsulting.com From: Blackburn, Lisa [mailto:LBlackburn(dtownofnorthandover.coml Sent: Thursday, June 11, 2015 11:49 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: FW: 64 Forest Street Septic plans for 64 Forest St. From: wrdufresne@comcast.net [mailto:wrdufresne@)comcast.net] Sent: Thursday, June 11, 2015 11:21 AM To: Blackburn, Lisa Subject: 64 Forest Street Lisa Attached are pdfs of 64 Forest Street Septic design plans. The owner should be submitting them to you sometime today. Thanks, Bill From: "Lisa Blackburn" <LBlackburn cDtownofnorthandover.com> To: "Bill Dufresne" <wrdufresne aC corn cast.net> Cc: "Michele Grant" <M G ra nt(o)-town ofnortha nd over.com>, "tat.boh(a-comcast.net" <tat.boh(@comcast.net> Sent: Wednesday, June 10, 2015 7:56:01 AM Subject: 70 Raleigh Tavern Lane Hi Bill, I noticed that there is a request for a variance and LUA. I will mail out the plans to Mill River today but since this is a first review, the plan will not be back in time to be on the June 25th BOH meeting. I will add the request to our July 23'd BOH meeting. Lisa Blackburn 2 Heialth'Dedartment Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com µ All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north andover www.facebook.com/northandoverma 3 0 COPY North Andover Health Department Community and Economic Development Division June 23,2015 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 64 Forest Street(Map 106A,Lot 61 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 5,2015 and received on June 11,2015 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. Although not a reason for disapproval,please explain the resources used to depict the approx. existing wetlands as shown on sheet 1 of the design plan. 2. The loading rate used is incorrect based on the soil texture of the Bw2 layer(3 10 CMR 15.242). The percolation test was conducted in the Bw2 layer. 3. Since the Infiltrator Chambers system is proposed as an alternative soil absorption system the"Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use"will apply. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable ofproviding equivalent environmental protection; Please feel free to contact the office or Mill River Consulting at 978-282-0014 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,` Q ichele Grant Health Inspector cc: Dogan Gunes File Page 1 of 1 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 1 S 1 auP�' : _ I _ V, JfAq I � I -. I ale li { — D L4 ! I 1 cy �� Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Friday, May 08, 2015 9:37 AM To: Blackburn, Lisa; 'Dan Ottenheimer'; 'Isaac Rowe' Subject: RE: 64 Forest St. Hi Lisa, We've scheduled this soil testing with Bill Dufresne for Tues. 5/19 in the morning. Let us know if you have any questions. Thanks,Pam -----Original Message----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent:Thursday, May 07, 2015 8:14 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: 64 Forest St. Good Morning, Soil testing application for 64 Forest St.Are you able to schedule 110 Farnum and 64 Forest on the same day? Bill Dufresne is the engineer on both of them.Thanks. -----Original Message----- From: noreply@townofnorthandover.com [ma iIto:noreply@townofnorthandover.com] Sent:Thursday, May 07, 2015 8:27 AM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date:05.07.2015 08:26:55(-0400) Queries to: noreply@townofnorthandover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north_andover www.facebook.com/northandoverma 1 P � + TOWN OF NORTH .ANDOVER t NT AND SERVICES Office of COMMUNITY DEVELOPME HEALTH IDEPARTNENT —� 1600 OSGOOD STREET;SUITE 2035 NORTH ANDOVER.MASSACHUSETTS 01845 978.688.9540–phone Susan Y.Sawyer,REHS,RS 978.688.8476–FAX Su heatthLet ownofoo'... veT-- mECE'VED Public Health Director ,,,�,.,V tflNVnofnorthandover.com 13 MAY 0 7 2015 �j APPLICATION FOR SOIL TESTS TOWN OF NORTH ANDOVER i MAP&PARCEL: A __ HEALTH DEPARTMENT S DATE: f h LOCATION OF SOIL TESTS: rJ Contact#: L �/� } v V OWNER: Contact#: APPLICANT:______-_ ADDRESS: Contact#: ENGINEER:�� e >�L CERTIFIED SOIL EVALUATOR: to le amily Ho Commercial CrJ Intended Use of Land. Residential Subdivision g g—moi ✓' Undeveloped Lot Testing: Upgrade for Addition: Is.,This: Repair Testing: P In the Lake Cochichewick Watershed'? Yes___-_____ rro ✓ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) Qom` ➢ 8 S"x Y 1"Plot plan 8 Location of Tnctinu(please indicate test it sites on the Alam 41 ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of 5360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. t ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans ➢ At least two deep holes and two vercolation tests are required for each septic system dtrga —y the dis DOGAN GUNES 9124 S AGNES GUNES 53-13iiiQMA 26512 64 FOREST ST NORTH ANDOVER,MA 01845-3204 s� nus r Pay roil,eToh 11/0Y'lA Order of 5..� "•• �{/.QQ Y�C/I.VILtt�-�./t 1 � O/ `vU i1l1iIC1 �R �eaiisen ,•••w•,• Bank of Bank of America Advantages d .S ACH W 01100013388^,, Lop L 1:0 1 1000 138ia 0000 S b4 b0 2 SOl°9 b 24 zN vp.e:rFi�Y rwec.rn eme -.� i �a T � I I 0 � nor �4 17 -9 I oz c , MORTGAGE INSPECTION�r{� LOCATED RI � LAW rJG� '��V tN G S FSAN�. I ITS Tin£R=�— AIASSACHUSETT wom AMT 1 1tAVE 0 LAYS 111E pAEMM )l1 1F11 11At WE, SI IW UO.( ) CCIlF01W 14 771E iOILR)LAYS Nm AIIEIIOL[lI15 L.6ROIiT.WE,k 1{EAR TAItU SEIUACIC '��-- OIiY.OF NOFZ'j'1-{ �lyDov�.='jZ 1dlEll COIISIRUCIEU. I,FWtTIIER CERUMATT AT UR:PROMTY 1S TSO' LOCATED YI 111E ESTADUSIIEU FLOW UCEU G , IMZAiIU mm -z 5,0og6a). -cel d 15 &• I Cj-1 453 ut"'. 2Sa /y CX4YU110R of 711E RECOIU'S 1S UAUE.010.Y SIASEWE11T 10 VIE RECORDED 4AIE OF 111E I•AOE: 15 rr �f LAITST L*M.NIU DOES IIOI UIcj.WE VEAIFIOtIC IC ACCUItACY UP 111E VELD UESOUP11W "YAWS IO 115 UAIC of KOHL CEItL 110. TIt<S CoWAliY IS HOT RESPUISWIE FOR AIIY munuRES 11AUE SUOSEoWIT l0 111E IECWU)EU CAIE OF WE tAIEST USED W RECORD. VaT A MORE PRECISE�iIEWjpjj*IcS AM Y� I 01 UE WAX TOYERY�tSE UEAStAMMIT FROU 119E Q Stix 13IIE,17 is AUNSEO I'WI J _ MIS j� 7PLS I o AfVEY LM1ERs OF 0111Us.ARU DOES 8100 11TT APROW SUR IIQS CER11FICATICII TO BE USLD FR MORTGAGE PURPOSES 0111-Y. SCALL- r- � OHSEIS AS SIIOW4ARE NOT TO BE USED FOR TILE ESTABUSIWJIT OF PROPERTY LINES DRADI<'ORD LNGINEi P.O. BOX 124 HAVERHILL MA. C �► .� Ata_ RES. J10307 1EL.Ceonl 173-:: ��yofl 11l