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HomeMy WebLinkAboutMiscellaneous - 659 FOREST STREET 4/30/2018 (2) 659 FOREST STREET 21-0/105.D 0038-0000.0 9 a ,a Lot & Street Map/Parcel / 3 CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Approved by:,h, AO) Designer: Plan Date: ll Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemica��% te Approved Bacteria Ite Approved Bacteria IIto Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? Y NO Well Construction Approval? --- NO Septic System Construction Approval? ACES NO Certification? NO Other? NO Any Variance Needed? YES NO s7 fa Lo e � FINAL BOAR OFrA/L.TH APPROVAL: DATE: / APPROVED BY: • SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? Y�� N0 Type of Construction: NEW _ CREPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: Y_ NO DWC Permit Paid? ( NO DWC Permit# Installer: Begin Inspection: YES NO Excavation Inspection: � -- Needed: -- L % C�I�/�%/O �, P0/` ok rl Passed: By: ; Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: 7 � By: Final Grading Approval: Date: / By: zd� Final Construction Approval: Date: /J ®L By: Certificate of Compliance: Approval: / Date: I� Commonwealth of Massachusetts = City/Town of System Pumping Record ,!;; � v 2U12 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forif is nl0yT"M, 1313f Me information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck fo 5°ik Ted-esl S�- Address y� Ci !Town State tY Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 1 t2. Quantity Pumped: C O Date Gallons 3. Type of system: ❑ Cesspool(s) K4eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locattomhere contents were disposed: ACS.zl Lowell Waste Water 10 Sign t e I Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record ► Y ' 1? Form 4 T1MMQFMMMRA 14MWi QEF1A'i'i1691MT DEP has provided this form for use-by local Boards of Health. Other forms may be used, but t e information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, rig s e f house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under dec c Address �Dcl 1 +` ' Cityrrown T NNSvtate Zip Code 2. System Owner. Name q Address(if different from location) Cityrrown Stat Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditin of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio re contents were disposed: G.L S. Lowell Waste Water k4 �-�cr c3 SignAtufe cfHaulev Date t5form4.doc•06103 System Pumping Record•Page 1 of 1 TOWN OF SYSTEM PUMPING RECORD RECEIVED DEC 0 2 2005 DATE. TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM OWNER&ADDRESS SYSTEM LOCATION (example:left front of hoose) DATE OF PUMPING: QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record SEPI 6 2008 Form 4 TOWN OW OFH NORTH DEPAAM OVER DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front, left rea left side of house Right front, right rear, right side of house. forms on the computer,use only the tab key Address to move your (Q cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Q� Name Address(if different from location) City/Town StateDQ-3 [ O �ICode Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: 0 Cesspool(s) eptic Tank [I Tight Tank Other(describe): 4. Effluent Tee Filter present? Yes Lei'No If yes,was it cleaned? Q Yes L] No 5. Condition ofQSSste�m: V\' 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: Aure Lowell Waste Water r Date t5forrn4.doc•06/03 System Pumping Record•Page 1 of 1 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired by IN TALLER at C SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 11325 dated&0---! , The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. AR OFHEALTH- AS BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC / TESTS V ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE _- DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK& D-BOX ORIGINAL STAMP & SIGNATURE ✓ IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED Town of North Andover, Massachusetts Form No.2 "ORTh BOARD OF HEALTH 117 �, ... . oL D Y p i •'�°-"-'-�-�*- ' DESIGN APPROVAL FOR ss,C"°SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location Reference Plans and Specs. ENGINEEV DEdIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. r CHAIRMAN,BOARD OF HEALTH .s Fee ���` Site System Permit No. / 93.3 ✓ J ,, 5,;{`'1��j:::: <SG5:�2: moi:<•_ 2 i f l ' t t . TOWN Or NORTH AiNBOVEIZ Sr�V..kCri: DISPOSAI: I_STALLA-rioN CERTIFICATION f The undersismed here'-,y ceriiv that the Se%vase Disposal Systent (k) re^airzd: by--�VI�—LCc� located at -.-69Es_t_ QC' ISN• Nib was installed in cOnrcrtnance with the �1,).-th A,n.over Board of He:ith a-zproved plan, Svstern Desig,n Pe Mit = , dated _, with an arcroved+ desi-n [low of `ailons per day The mate ais;used were in conformarct :vI.-h those specined oh the app-roved plan; the system A.as 'nstallcd in accordant;, .•.nth the previsions of 3110 CNdR 15.000, Title 5 and local repalatiors, and the final grading a,rees substantially with the approved plan. kil ,vork is accurate, v represented :fir. the As-built ,vhich has been submitted to the Board e:i-italch. Bed inspection date: Engiriecr Rcprese_::ltive. Final inspect:en tate _-_— i E-ngireer Represe::mt:%e Iristal:er: Date: Lesi<T�1 Engineer',, ,� _ Date: f C.. TANGA RD � RL Address cl 53 Title of File Page of Date File Open: Date fele closed:,T Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes; T action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: c-.�_��- cE3 A-, LICENSED INSTALLER: SIGNATURE: .=a TELEPHONE#cy--)g-�}-)S_ID,a CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yesy No Foundation As-Built? Yes No Floor Plans? Yes No Approval `' Date: / aP7 • j/ INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the.North Andover licensed installer for the construction of the septic system for the property S atd - relative to the application of -Q Re')w k t -1'Z— dated Fes- for plans by nsceeA and dated 1pg-c)(5 with revisions dated I i—5,tc) I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH;after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my.license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer T Date: -©d Town of North Andover, Massachusetts Form Nc.3 BOARD OF HEALTH f gORT1 H p 3 '°�,;.;:•�`� DISPOSAL WORKS CONSTRUCTION PERMIT 9SSACHUS�S "Pi P . a Applicant 2fr 3r'—`O73 AWE ADP,W5 TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. f/ -• CHAIRMAN,IBOARD OF HEALTH Fee ` D.W.C. No. � e May-27-99 12 -64SP North Andover Com. Dev . S08 : 688 9542 P . 01 SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES .. 125.00/1"Ian REVISED PLANS: ` , S 60.00/Plan_ SITE EVALUATION FORMS INCLUDED: YES NO DATE: .1�1 -1 00 -- -- DESIGN ENGINEER:;, _EN cs-t-A/JD DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped en�-elope with the correct amount of postage to mail plans to Port Engineering. When the submission is all.in place, route to the Health Secretary. i pORTh q Town Of North Andover 3? "� Community Development & Services wr i J. Scott Directtoo r 27 Charles Street (978)688-9531 •''�* North Andover, Massachusetts 01845 � pOgwnn d*�49 9SSACHUSEt Fax 978-688-9542 Board of November 7, 2000 Appeals (978) 688-9541 Building Ben Osgood, Jr. Department New England Engineering (978) 688-9545 60 Beechwood Drive No. Andover, MA 01845 Conservation Department (978) 688-9530 Re: 659 Forest Street Health Department Dear Ben: (978)688-9540 This is to notify you that a variance to the distance to wetland from a leach area Public Health has been granted for 659 Forest Street. The variance is for no less than 79 feet Nurse with the granting of this waiver, the septic plans dated 11/5/00 are approved.688-9543 If you have any questions,please do not hesitate to call the Board of Health Planning Department Office at 978-688-9540. (978) 688-9535 Sincerely, A Sandra Starr, R.S., C.H.O. Health Director SS/smc cc: Tangard File NEW ENGLAND ENGINEERING SERVICES INC November 7, 2000 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 659 Forest Street,North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of revised design plans, 2 with original signatures. 2. Submittal form for revised plans. 3. Check to cover the fee. The following changes have been made to the plan. 1. The note regarding the required local variance has been added to the plans. If you have any questions please do not hesitate to contact this office. Sincerely, 1 C 0 .i � Beni C. Osgoo Jr.,EIT _ President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 � NORTH R TOWN /�OFNORTH ANDOVER BOARD OF HEALTH � • ' V A i ► 27 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845 ' SS CHUS� SANDRA STARR,R.S., C.H.O. Telephone(978)688-9540 Health Director FAX(978)688-9542 November 1, 2000 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, MA 01845 Re: 659 Forest Street Dear Ben: This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: 1. Setback distance to wetland is less than the required minimum of 100 feet. Request for local upgrade approval is not shown on plan as required by 310 CMR 15.220 (4)(p)• If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Reed file Oct-10-00 02: 11P Paul D. Turbide, PE/PLS 978-465-0313 P.02 I October 10,2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover,MA 01845 "51 ��5-r Sf RE: Title V review for SDS upgrade at 42 er Street Dear Sandra, Enclosed find our review of the"Checklist for North Andover Septic System Plans" for the septicsystem stem uPgr ade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. o Setback distance to wetland is less than the required minimum of 100 feet. Request for Local Upgrade Approval is not shown on plan as required by 310 CMR 15.224 (4)(P). If you have any questions or comments please feel free to contact me. Sincerely Paul D. Turbide,PE/PLS OPTit I ENGINEERING, Civil Engineers& Land Surveyors One Harris Street Newburyport,.LMA 01950 (978)465-8594 i app 'SMGND XDOC Oct-10-00 01 : 58P Paul D. Turbide, PE/PLS 978-465-0313 P.01 Facsimile Cover Sheet To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9640 Fax: 978-688-9542 From: Paul D. Turbide, P.E./P.L.S., President Company: Port Engineering Associates, Inc. Phone: (978) 465-8594 Fax: (978) 465-0313 Date October 10, 2000 Pages Including This Cover Page: 2 Comments: Sandy, I have attached our review of the SDS upgrade at 659 Forest Street. Thanks, Paul D. Turbide,P.E./P.L.S. PoiFT ENGI�EEflING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 50,i V l I N S E. L__COL i ICON IA �0 I i Gill I Ifvl� �.'�' �'r.f\.. ___. � �'� •� _._ �r.i Icc_t , � ,"Ir'...=_ ICS`, -. I I I\,'i C7 .i I c' S 0 I IIVI IV •\ i r. ter.. .. -.t .�__. ... .,�� ._ I J .l t t J ���'��� . 111!11 111111111111NIIIN111111 1111111" Ii1111N11111111111111111 MINN s 11 IIIIIIIIIIIINIIIIII MINN e 11 1e1111111111n1111111 11111111 . � Crl� ;=, � . II�I�III�IIIIIIIINIIIIIINIIIIIN 11111111111 MINN 1111111 MINN lIIIIIIIIINIIIIIIIIMINN pop , MEIN �1�r111 Oi�l'iis IIIIIIIIIIIi1111Bl11�1111111.. . w 11111111111n11L!1i111111111111i 111111111 ELI! IIIIIIIIIIe11111N1111111111111111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIe1e11 Ie'leeeleeee1e11neeeleeleeeell�e� IIIIIe1NINE INI IIN111111111 N d. 111 NIIINIIIIIN111111111111111 ■ IIIIIIIIIIIIIINII 1111111111 IIIIIIIIIIIIN11111 11111111111 Ie11IIMM I11e11 IIIIeee,111 � ( IIIIIIIINIIIIIIINIII MINN 111 11 IN111111111111111111111111 l 1111 IIIIIIIIIIIIIN1111111111111 IIIIIIIIINIIIIIN1111111111111111 . t FORM 11 • SOIL EVALUATOR FORINT Page 1 of 3 No. �` Date- AV Com onmrgth of Massachusetts /d. ' � ,� D�' Massachusetts M1 Suitability Assessment for On-site Sewage Di :WqLaj Performed By: ...... « z�..... C.`-..�,0 Date: �ll4 ......... WitnessedB .i� -5, .. .......................... ................ ........... .... .................................... . NMI Nam / Lo`' TdoOAd4ress. 11 ��- X57•- �7- ew construction ❑ Repair Oftiq Review Published Soil Survey Available: No ❑ Yes � ........... Publication Scale � . c� Year Published Soil M Unit . ......... . Drainage Class .............. Soil Limitations ��! r � ,�v 7:.2 ..............................................................................._...__ _... Surficial Geologic Report Available: No 91 Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) ...................................................................................................................................... ....... ....� Landform ............................................I..................................... ......................._.. Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ " Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ..........:..:.......,.................................................................._.'....._....... Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month ,44Z Range :Above Normal El Normal EJBelc w Normal Other References Reviewed: V DEP APMOVED FOKM•12/0719S , . � ` 3 r- s FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. CO� � r �`� A k On-site Review, Deep Hale Number Date: .. ®`/ Time{�� ��� Weather 7�1T0-' 7�- Location Wefy on site plan) 4G,�'��.�. N..... Land Use �� � ��- Slope M . H. Sur!ace Stones Vegetation .. . ..... -�,.....:...... . .....� .....: �.... . .............:..�....�...,._.:..:... ... . ..... : Landform ... ....: . . Position on landscape (sketch on the back) Distances from: Open Water Body,'10-'� feet Drainage wa� 2Oo feet Possible Wet Area ���. feet Property Line..t: ! feet Drinking Water Well ./0-0- feet Other DEEP OBSERVATION HOLE LOGS Depth from Soil Horizon Soil Texture Soil Color S it Other Surface(Inches) (USDA) (Munsell) Mo ling (Structure,Stones, Boulders,Consistency, % Gravel Yk l�Tv G t� L -KLA Parent Material(geologic) J7f04 :5! T L Depthtoaedrock: Depth to Groun�ater: Standing Water in the Hole: '� Weeping from Pit Face: © ii — Es(imated Seasonal High Ground Water: r DEP APPROVED FORM-tlre7/95 ! j ' f FORM 11 - SOIL EVALUATOR FORM Pagc2of3 Location Address or Lot No. On-sit iew Deep Hole Number Date: Time':. •• Weather Location fide ify on site plan) Land Use ,% ?� �4� Slope (9'0) .3 Surface Stones . �..`,......:.....:...... Vegetation ,. Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way Z feet Possible Wet Area feet Property Line .. feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOGS Depth from Soil Horizon : Soil Texture Soil Color Soil OtherSurface(inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders;Consistency, % Gravel) zo amu, s� L°✓�,� ��� �o,��� o Parent Materiel(geologic)_ �� � f r / 'LL' Oepthtoaedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: r 6 r — Fstirriated Seasonal High Ground Water: DEP APPROVED FORM•12to7r9s FORM 11 - SOIL ISVALUATOR FORD Page 3of3 Location Address or Lot No. 65;?-C7gV 70 � DUeteMination for Seasonal m;.e WaterTable Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side gf observation hole........:......... inches °❑C Depth to soil mottles ..r.w,:..., inches / -- -&z ❑ Ground water adjustment ................. feet s Z _ &'Z� " Index Well Number .................. Reading Date .................. Index well level .................. Adjustment factor ................... Adjusted ground water level Depth of Naturally Occurring pervious M terial Does at least four feet of naturally occurring pervious material exist in a are observed throughout the area proposed as g p posed for the sail absorption system? �� If not, what is the depth of naturally occurring pervious material? -" Certification I certify that on (date) I have passed the soil evaluator examination approved by theWepr—t —of Environmental Protection and that the above analysis was performed by me consistent with the require described in 310 CM d training, expertise and experience R 15.09 7. Signatur � / C Date / oo i DEP APPROVED FORM-12!07/95 1l f May-27-99 12 : 45P North Andover Com. Dev . 5O8 688 9542 P._ O1 i f SEPTIC PLAN SU13MITTAL FORM LOCATION: NLW PLANS: $125.00/1'lan zr REVISED I'LANS: YES SITE EVALUATION FORMS INCLUDI D:. YES NO DATE: DESIGN ENGINEER: ./J&w EN(a-i=h DATE TO CONSLrL.TANT: l _ --- *`Ifyou want your plans expedited, please submit three plans and included a stamped enF-elope with, the correct amount of postage to mail plans to Port Engineering. g €, When the submission is all in place, route to the Health Secretary. { j q S S f NEW ENGLAND ENGINEERING SERVICES INC October 3 2000 Sandra Starr,Administrator North Andover Health Department Town Hail Annex 27 Charles Street North Andover, MA 01845 Re: 559 Forest Street,North Andover, Septic system design Dear Sandra: Enclosed are five copies of design plans for the above referenced property. Also enclosed are the following documents. 1. Soil evaluator sheets. 2. Plan submittal form. 3. Check to cover review fee. If you have any questions please do not hesitate to contact this office. Sincerely, [3? Osgood, r`,/,T Benjami President s�\lpS�fy3'.37, u;40 9 , r}rn[ T S''� CJ S9P,�N dl . 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 I Town of NorthAndover � MORTH q 3 a2 4`t�� n ks6�G`� �- Office of the Conservation Department Community Development and Services Division William J. Scott Division Director 27 Charles Street �S3 CHU North Andover,Massachusetts 01845 Telephone 978 688-9530 Interim Conservation Brian LaGrasse Fax{978)688-9542 Administrator November 16, 2000 To: Robert Nicetta, Building Commissioner Alison Lescarbeau, Chairman, Planning Board William Sullivan, Chairman, ZBA From: Brian LaGrasse;Interim Conservation Administrator At our Conservation Commission meeting held on November 15,2000 the following decisions were approved: 242-1044 428 Winter Street This NOI was for the construction of a replacement septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. 242-1046 314 Rea Street This NOI was also for the construction of a replacement septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. 242-1049659 Forest Street The Order of Conditions was approved as drafted for this NOI which was for the construction of a septic system and associated grading within the Buffer Zone of a BVW. 242-1047 212 Haymeadow Road This NOI was for the construction of a replacement of a failing septic system and associated grading within the Buffer Zone of a BVW. The Order of Conditions was approved as drafted for this project. If you would like a copy of the Order of Conditions please contact the Conservation Department. CC: Scott Masse, Chairman, Conservation Commission eidi Griffin, Town Planner ,/Sandra Starr, Board of Health Administrator BOARD OF APPEALS 688-.9541 BUILDING 688-9545 CONSERVATIOit 688-9530 HEALTH 688-9540 PLANING 688-9535 Town of North Andover, Massachusetts Form No. i NORTH ♦ BOARD OF HEALTH 19 O '�A°� <°° Ew°•� APPLICATION FOR SITE TESTING/INSPECTION . 7 Q�RATE D..PpR '`y �SSACHUS�� Applicant NAME DDRES TELEPHONE Site Location' ti Engineer NAME ADDRES TELEPHONE Test/Inspection Date and Time- CHAIRMAN,BOARD OF HEALTH Fee- 76 .. Test No. 11 S.S. Permit No. D.W.C. No. C.C.`Date - -Plbg. Permit No. 2jigtufla2sM -iovobnA djioM to nolo� b2 H T_IA3H 90 O gAO8 �Tsic; Qv ♦j� ]3�_ d Q r i AOlT7392Vil\Ji,/ilT23T 3T12 3903 AOITA31J99A i ! f i 3Vioii93J3T 2�2351UGA 3trIAVI ; noil5:)o-1 532 23,900A 9mi i bns elf;(] noiis5g2nl\.izs'1" , d , s iI"iJA3E1 U—(['AG7,Sl�tlSilAia") t �. _.�_ �,_..�•CrV1 it9T t.-�� 99-I � i i i rr:'( lit-139 . cil9 si�Cl . r.� opt . .'fJ.(J obi iim739 .2.<.' I j Town of.North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH IO��i�Eo ib q�0 0 19- 0 �; A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUSE��y Applicant- NAME '--ADDRESS � TELEPHONE Site LocationG'a1 Engineer �`" j A1C-9t_et NAME ADDRESS TELEPHONE Test/Inspection Date and Time V CHAIRMAN,BOARD OF HEALTH Fee ��/ Test No. l S.S. Permit No. ' D.W.C. No. C.C. Date Plbg. Permit No. f (' i r t BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: �� 2 ro Cho r'�(Lesi LOCATION OF SOIL TESTS: ("5 sT2E E I Assessor's map & parcel number: Ion b3 OWNER: Ro7Ya ADDRESS: iu. A•v n ENGINEER: &-�u )FNGune Eg _ TEL. NO.: 68 CERTIFIED SOIL EVALUATOR: &ix zlv ' 5 izicFt Intended use of land: residential subdivision, single family home, commercial Repair testing X Undeveloped lot testing N. A. Conservation Commission Approval: it THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan ' 3. Fee of$275.00 per lot for new construction. this covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing... 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be.submitted.to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. } i SEE i .%T 2 7 A<., 4.G9 z 12 A .. .. F a t k } S .F i:.. .. .. J 3 p � f�.. � 1 �� , �• - 32 k 2 n r J d7 9.7 Am t' d . 4c IL 4� 1 W 43 as2 > 2 1tia 6 / �. \4. 1.17A� tl5 w t t.aoL►6. 1c 72 ?t t 9e. t•ee° 1 gid~ ` r 1 t%G '�i ..' u0 � ; \•��� / 1.05 A<. IA4 M. n, Ito y 4 n- fA / -fTt7310 c v rob � 1•> G9 23 � ?zraT y e5 I.o LA-5:4 e 70 t2t f-�Z�hZ 2ee t2-2 crgC (oA< 22 ?a M.c.?o we,a Co. r� Eisrwnewir 934 ne . rLL. 2< SEE PLAT 106 SCALE 1°= 2001 25 ,ro'' et az +�� �l �S��d sF as i i BOARD OF HEALTH TEL. 688-9540 a NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL.TESTS I DATE: i LOCATION OF SOIL TESTS: 6,5-q t Si 2E E i Assessor's map & parcel number: /g2,,5- n OWNER: TEL. NO.: r - � �o�E��; 2�;� � .� 7 y � ADDRESS: ��Sr12esi s7-rzc�i tel. / '-j 0 ENGINEER: &u to Fv&.,:._ TEL. NO.: 68 CERTIFIED SOIL EVALUATOR: P .� Q:SLPDc�cY �� � 21 c a2b C- -rAN&4Qa Intended use of land: residential subdivision, single family home, commercial Repair testing x Undeveloped lot testing N. A. Conservation Commission Approval: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of2$ 75.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing.. 6. Within 45 days of testing, a scaled plan (no smaller than V-100') shall be-submitted-to' the Board of Health showing the location of all tests (including aborted-tests). t 7. Within 60 days of testing soil evaluation forms shall be submitted. L !A.) VA6v9'-- S0' A4Crvo FIZOM /rv53'cG� 123 "0 H64LTH 2 - 5u IDA.) Ati1) t-- viSr�E� (30 ��I z F41t, - 17�,jjj5r5 Ai 1H�5 co2v� , � X33/335 ,Otis 3�3 E 13,15 . 7h X 5 rh L >O*T -otic. &rH ter,'-0 5 y ,Y' i�ao y T�c,5r 3 - (OS /J v i�j,v ME , zoar-S �/J 5�tj (-�iZ�c.E5T-(,)Fp- , _ 55 7 -- -- G 55 LI KC oc.J) DUGS ou T r',a�� . z- 13/J 5 OF TA5� ovT 5 ow&�� /u/OF /V uG H of ,6 H4Z/);r7 ©i HC� TtKn� THe- z 54 DF' —Pfps t1 ko�sE llc KOS 5 i'S ND U 6 LY c,J i-�v c�M p��rvEp le��� a�kk s,--oOUT w � Page -5- ORDER OF CONDITIONS DIGITAL CONSULTING HDQTRS D.E.Q.E. 4242-415 23. Continued. . . . . A good quality loam, and then be seeded or planted with compatible wetland species and mulched with hay. 24. No earthen embankment in the buffer zone shall have a slope steeper than 2: 1. Any slopes of steeper grade shall be rip-rapped to provide permanent stabilization. 25. All erosion prevention and sedimentation protection measures found necessary during construction by the NACC will be implemented at the direction of the NACC. . 26. There- shall be no stockpiling of soil or other materials within 25 feet of any resource area. 27. During and after work on this project, there shall be no discharge or spillage of fuel, oil, or other pollutants into any resource area. 28. Any changes in the submitted plans, Notice of Intent, or resulting from the aforementioned conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds, by majority vote, said changes to be significant. and/or to deviate from the original plans, Notice of Intent or this Order of Conditions to such an extent that the interests of. the Wetlands Protection Act and Bylaw cannot be pro- tected by this Order of Conditions and would best be served by the issuance of additional conditions, then the NACC will call for anothhr public hearing within 21 days, at the expense of the applicant, in order to take testimony from all interested parties. Within 21 days of the close of said public hearing,the NACC will issue an amended or new Order of Conditions. 29. Any errors found in the plans or information submitted by the applicant shall be considered as changes, and procedures outlined above for changes shall be followed. 30. Members of the NACC shall have the right to enter upon and inspect the premises to evaluate compliance with this Order of Conditions. 31. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 32. The provisions of this Order shall apply to and be binding upon the applicant, its employees, general contractor, subcontractors, and all successors and assigns in interest or control. Of SNOFTF�9� /,/y/J - o ^` F P i � Y SA US A rR6^j CIO;rro 1'aiil [l. Sharon 120 Main St. Town Manager North Andover, MA. Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record AUG - 6 2007 r` Form 4 SV . TO\NN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health.Other fo ss it-^ Ij-Q t-ffh information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. Sym LOcatl � � forms on the computer,use only the tab key Address to move your cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name + Address(if different from location) City/Town Statee Telephone Number B. Pumping Record " 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes e'No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition System: V ` J 6. System um Jay: l � Name l Vehicle License Number Company 7. Location a cpntentse died: Sign a ler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i Commonwealth of Massachusetts City/Town of System Pumping Record RECEIVED Y p 9 Form 4 SEP 2 8 2009 DEP has provided this form for use by local Boards of Heal. Other forms may be e , but the information must be substantially the same as that provided hwe. Beforel I , check with your local Board of Health to determine the form they use. The S t be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location side of house, fight side of house, Left front of house, Right front of house, Left rear of house, Right rear hous Address �j . dv� City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code 7 lam!—H ( Telephone umber B. Pumping Record 1. Date of PumpingDate 2. uantity Pumped: 3. Type of system: ElCesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Vehicle License Number F5821 Bateson Enterprises Inc Company 7. Location where contents were disposed: L. .D Lowell Waste Water S' n ur of Haul rj Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts _ City/Town of System Pumping Record 41N ye`. Form 4 OCT 110 DEP has provided this form for use by local Boards of Health. Other 6r , information must be,substantially the same as that provided here. B Jwith your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health m-other approving authority. A. Facility Information 1. System Locatioeft side o Ouse ight side of house, Left front of house, Right front of house, Left rear of hous , ouse. Left rear of building. Right rear of building. Address Citylrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town St ,lip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes LSO If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio ere ntents were disposed: .L.S. Lo)#elyMpste Water S ig n#r H fu er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1