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Miscellaneous - 72 PADDOCK LANE 4/30/2018 (2)
N O C � N N 00 N N U m Z U '� Q O gCoC3 CD CD o Y V Cl) D m ci m m m 0) a Ln CO U) U rn N ~ N co N a M in c o E Ua WUS O 00 O C T 00 C m Z U '� Q 3 gCoC3 �f��� Y V D c c Ln CO CD Ln o O rn N ~ Li m M in N O E Ua mdU Z U OG CD CD O O a W os CS Q c U CD 0 C Q r G p a N O d} H a 0 f6 C U +O•� p.M � C G i O -Op O O N O N N C :O N (n (D (n (n O J O O N p r r o no J J r L) m o 0 cn Q J m m _@ c O UVFf CLI E ON Quo ZLl- 00U. n �HHf- W O z CO I:t Z n v_ a z h +-'O o .. U. CD 0 MM cQ G ZCo CO� g o Z 0 0 U o m Q MM Q C2,CD 0 H m �cnQ co 0O r o Z aD 0 o D Z W W o J w Z� LU � � W Q W Q W J V- N 0' W CL 0 Vp o a � OQ JI Z- O2 W U)a� L) a. �g� CWa 2?N0 Q �OM n Z a O Q V 00 00 N rn O O) moo c c rn y� O CD 3 O Y Y CD C O CD CD O O NCO Z m rn o } Z �- �- 0 4w Q W J J 0 N 0 ON Quo ZLl- 00U. #fir z CO I:t Z n v_ z h +-'O o .. U. CD 0 MM ZCo CO� g a 3 U o m Q MM m �cnQ o0 Z aD 0 d p � � LO LO p p i• Uri W V O O c o H m tm a O 2 Z (%�N U a N O M O C14 co O N (D N r N r M f6 � � 7 M N N Q O m m 0 f0M ^ Q E c9 v 'O CO os ZQ C (n (n0 m LL r -I N U m (1) c U)i U Y o o: d QmLLm Q(nUQQ: R tn� C7 Z le 04 co t- C4 co ooN ti Z v OOiCD> r r N r r (D0 O y H a j,4 - N (C O Wn a 2 wy a� stn e `�Q EN cr CQQ m'7 O E.D LL c 00 " ° riv L� Z _ cU- }` ���U O mm co 0_ C w C`6 (� N V 2m<Z) w>C7Uao z W C nvNr FH d00L$cc y �N a.. w W X ) U) iri U)LL .. •• U�Li V V w aN N 0 0mmm�� C�C�� _ EEO_ �-amy=wru -2Y �M LL=WmYW mmQ N UNC)LmL U 20r� E rn Ho aim U � = ~~ m m nm> Wm� Lmlli w 5 Li 2 Li LL U a > Driving Directions from 400 {�ood St, North Andover, MA to 72 Pa�,&,ck Ln, North A... Page 1 of 3 �J start: 400 Osgood St North Andover, MA 01845-2909, us End: 72 Paddock Ln North Andover, MA 01845-6313, us Directions ® 1: Start out going SOUTHWEST on OSGOOD ST toward MILL POND. 2: Turn RIGHT onto BEACON HILL BLVD. 3: Turn LEFT onto MA-133/CHICKERING RD/MA-125. Continue to follow MA-133/MA-125. 4: Turn LEFT onto MA-114/MA-125/TURNPIKE ST/SALEM TURNPIKE. Continue to follow MA-114/TURNPIKE ST/SALEM TURNPIKE. 5: Turn SLIGHT RIGHT onto BOSTON ST. 6: Turn RIGHT onto PADDOCK LN. ® 7: End at 72 Paddock Ln North Andover, MA 01845-6313, US Total Est. Time: 14 minutes Total Est. Distance: 5.74 miles Distance 0.3 miles 0.1 miles 1.2 miles 2.6 miles 1.1 miles 0.1 miles http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& 1 gi=0&un=m&... 5/4/2005 Driving Directions from 400 ~'good St, North Andover, MA to 72 Pa .d1 ck Ln, North A.. w Page 2 of 3 Start: End: 400 Osgood St 72 Paddock Ln North Andover, MA 01845-2909, US North Andover, MA 01845-6313, US `09000 N `tet ft a .. o r-044, �anr sr �-- Stevens'crossingoi 133 " A t q 518 . d � Pand � 0 2005 MapQuest.com, Inc. 02005 NAVTEQ Notes: 300m 900ft & ,rGleY_R� o� "Y 0 2005 MapQuest.com, Inc. � 02005 NAVTEQ M AVTEGI All rights reserved. Use Subject to License/Copyright These directions are informational only. No representation is made or warranty given as to their content, road conditions or route usability or expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use. http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& 1 gi=0&un=m&... 5/4/2005 Commonwegith of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED ccT HIM TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use, by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using -this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, 42) righ I of hous Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Haaress City/Town 2. System Owner. Name Address (if different from location) Citylrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Telephone Number Zip Code Date 2. Quantity Pumped: Gallons i Cesspool(s)2-tieptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 5. Conditiqn f System: 6. System Pumped By. If yes, was it cleaned? ❑ Yes ❑ No, Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati a contents were disposed: �. S.j _ Lowell Waste Water Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, April 08, 2008 9:24 AM To: Ipunderwood@madrivergroup.com' Subject: 72 Paddock Lane Importance: High Hi Peggy, Here is your Certificate of Compliance, Certification from the installer/engineer, Title 5 info. re: sale of property, and your Septic As Built. I left you a voice mail message. I don't have any pumping records other than October of 2005 before you had the system repaired. I think, because the COC is November of 2005, that you would be at least all set until November of 2008 without having a pumping done, as that will be the three year mark. Call me if you have any additional questions, and I can have you speak with the Director. Pamela Message from Message from KMBT_600 KMBT_600 19-08! Ra0a1-d8, P.14votow A9000404M.1110 .1110 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 2978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com r10RTH q 0 SSL! D , 6' tiO i1?6���- h 6 0 O O�_ COCNIC KlWK• � 1' PUBLIC HEALTH DEPARTMENT Community Development Division CYFR7I�FICA�E OAF' CO�L�LIA�VC'�E As of: 5Vovember 10, 2005 ,This is to cert that the individuaCsu6surface disposal system received a SA'IS(FACTORT1-NSPEC 70Yof the: CompCete Septic System Repair/12ep(acement � y. Todd Oateson At: 72 PaddockStreet Wap 107.1D; Parce[100 North Andover, JKA 01845 'Cie Issuance of this certfiCcate shall not be construed as a guarantee that the system will function satisfactorily. Susan 2: Sawyer Pu6licIfealth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 00 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION T71ndersigned hereby certify that the Sewage Disposal System ( ) constructed; (paired: by_ _ T 20 i4,c��.i located at 2 Z ppmk_ X01; was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated with an approved design flow of 4'16 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date.- Final ate: Final inspection date: Installer: Lic.#: Design Engineell.. Engineer Representative Engineer Representative Date: I / ID 0-5- Date: •S Date: RECEIVED APR 0 4 2006 TOWN OF NORTH ANDOVER HEALTH C)E=/;,RTi`✓?ENT 101 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.301: continued (h) Bankniptcy. Inspection of the system roust occur within two years prior to transfer by bankruptcy trustee to buyer or within six months after the transfer, provided that the debtor notifies the buyer in writing of the requirements contained at 310 CMR 15.300 through 15.305 for inspection and upgrade, if necessary. An inspection conducted up to three years before the time of transfer may be used if the inspection report is accompanied by system pumping records demonstrating that the system has been pumped at least once a year during that time. (i) Change inO_ wnershin or the Form of Ownership Where New Parties are Introduced (e.g., introduction of new beneficiarylies in a nominee trust; introduction of new joint tenant(s) or new tenant(s) in common; introduction of new parties where property, is transferring from joint ownership to nominee or business trust, or where a new general partner is introduced; creation of a legal life estate or an interest for life or for a term of years in trust for a party other than the creator or his or her spouse; a change in the controlling ownership interest of a corporation, etc.). inspection of the system must occur within two years prior to transfer or if weather conditions prevent inspection at the time of transfer, the inspection must occur as soon as weather permits, but in no event later than six months after the transfer, provided that the new party is notified in writing of the requirements contained at 310 CMR 15.300 through 15.305 for inspection and upgrade, if necessary. In a nominee trust situation, whoever has authority to add a new beneficiary is responsible for the inspection. An inspection conducted up to three years before the time of transfer may -be used if the inspection report is accompanied by system pumping records demonstrating that the system has been pumped at least once a year during that time. (4) Exclusions. Inspection of a system is not required at the time of transfer of title of the °n^ilityserved by the system in the following circumstances: (a) a certificate of compliance for anew system has been issued by the Approving Authority within three years prior to the time of transfer and system pumping records demonstrate that the system was pumped at least once during the third year, or (b) the owner of the facility or the person acquiring title has signed an enforceable agreement with the Approving Authority to upgrade the system or to connect the facility to a sanitary sewer or a shared system within the next two years following the transfer of title, provided that such agreement has been disclosed to and is binding on the subsequent owner(s); or (c) the facility is subject to a comprehensive local plan of on-site septic system inspection approved in writing by the Department and administered by a local orregional governmental entity, and the system has been inspected at the most recent time required by the plan. A comprehensive local plan may prioritize systems to be inspected on the basis of proximity to water resources, soil or geological conditions, age or size of systems, history of performance, frequency of pumping or other routine maintenance activity, or other relevant factors, and may establish different schedules and frequency of inspection on the basis of such criteria, provided that all systems are inspected at least once every seven years by a System Inspector approved by the Department; or (d) the transfer is of residential real property between the following relationships: 1. between current spouses; 2. between parents and their children; 3. between full siblings; and 4. where Elie grantor transfers the real property Lobe held in a revocable or irrevocable trust, where at least one of the designated beneficiaries is of the first degree of relationship to the grantor. (5) A system shall be inspected prior to any change in the type of establishment, or increase in design flow, or prior to any expansion of use of the facility served for which a building permit or occupancy permit from the local building inspector is required. If the system is a cesspool, or if the system is failing as set forth in 310 CMR 15.303 or 15.304(1) or is a significant threat to public health, safety, welfare and the environment as set forth in 310 CMR 15.304(2), then the system shall be upgraded prior to the change in the type of establishment, increase in design flow or expansion of use of the facility. Prior to an increase in the design flow to any cesspool, or to any system above the existing approved capacity, the cesspool or the system shall be upgraded in accordance with the standards applicable to new construction. Whenever an addition to an existing structure which changes the footprint of a building with no increase in 15. 9/22106 (Effective 4/21/06) - corrected E r 310 CMR - 550 „a, 9/ DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, February 06, 2008 2:32 PM To: 'punderwood@madrivergroup.com' Subject: 72 Paddock Lane El 2 Message from Message from KMBT 600 KMBT_600 Hello, Here is your Certificate of Compliance as well as some information from Title 5. Call if any further questions. SAW RagwVds, P41*044 AMAZOLOMW40 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 9978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com BY : T4 is Pi.,.�.t + 4c 9.n r ►cA-Rotil I'S -U cT A 014E '51AGe7UeAW-9 PToy.L 410,-reH , :VT i s A r_Lcot�a OF 11,4g La rr vQ A N4 ELEVArnoJ wF 'rs4re e,_vt1f jwA bY� GOHrOWLk Ty. APR 0 4 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT f 5a 6641AL. Q- � X72 •�� \ % r AS BUILT. PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN %2PA i7 �GU'i� L/a�1a AS PREPARED FOR DATE: SCALE: MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS 0 PLANNERS 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01610 or TEL (617) 475-3555, 373-5721 L TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: DATE OF PUMPING: CESSPOOL: NO L-- NATURE OF SERVICE: ROUTINE OBSERVATIONS: E1VED NOV - 9 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT (example: left front ofhouse) PUMPED C <, 'GALLONS SEPTIC TANK: NO YES C-- L'--fMERGENCY GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: 6 L, - . pORTy O��t�ec �6q�0 ~ 1A O�_ COCNIC MlwKM � 1` PUBLIC HEALTH DEPARTMENT Lommunity Development Division C�E127I F'ICA7E OAF CO�L�GIA�VCE As of: November 10, 2005 This is to cert that the individuaCsu6surface disposafsystem received a SX17SEAC`7'oRTINS(EMONof the: CompCete Septic System 12epair/12epCacement By. Todd Bateson At: 72 paddockStreet Wap 107.10; Parcef100 North Andover, W,4 01845 The issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function satisfactorily. f Sus n rY. Sawyer (Pu6fic Ifeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com N N TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The ndersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: located at 7 1✓A DDaG was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated , with an approved design flow of 4'1'O gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date.- Final ate: Final inspection date: Installer. :{ / 1•+'-1 Design Engin( Ci " Engineer Representative -� �,L==-= Engineer Representative Lic.#: Date: // J �D — -1-5 Date: /� / RECEIVED APR 0 4 2006 TOWN OF NC"R7, H ANDOVER HEALTH DE'/i,� iMENT EO TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION T�raindersigned hereby certify that the Sewage Disposal System ( ) constructed, ( paired: located at :2 7- Gk7er-4c L&OP, was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # dated , with an approved design `+" i flow of O gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: u - jy� Installer: Design Enginee' ?, M �3p. kv7vu U Engineer Representative Engineer Representative Lic. #: Date: Date: // / RECEIVED APR 0 4 2006 TOWN OF Nt,RTH ANDOVER HEALTH CJEr=i'.<<fl'AENT .% 0 AS -BUILT CHECKLIST I RCCc-:!!I APR 0 4 2006 LOTNUMBER, STREET NAME TOWN OF NORTH ANDOVER HEALTH DEPARTmENT 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 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 QTOWN OF NORTH ANDOVER C' Of NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES: �'`+``�"°OA HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845S C <� SACHU3t Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: Xi920' G� MAP: LOT: INSTALLER: Of DESIGNER: Lt PLAN DATE: 7 - Z r -p BOH APPROVAL DATE ON PLAN: �e DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION �C PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = 1-56c;, ✓�-tip,.. b . LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: -2-C yL SITE CONDITIONS Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Comments: Topography not appreciably altered Page l of 4 CTOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 s�c►wsc Susan Y. Sawyer, .REHS/RS 978.688.9540 —Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP AMBER ❑ Bottom of tank hole has 6" stone base e ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ P (s) installed on stable base ❑ Alarm t working ❑ Pump On/ loat working ❑ Drain hole in pre re line ❑ inch cover to withlih of final grade installed over one access port 13s be Water tightness of tank haen achieved Visual or Vacuum Test or Water held for 24 hrs Comments: E3Hydraulic cement around inlet & outlet Page 2 of 4 OTOWN OF NORTH ANDOVER O f NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 ,SSACHUEtt Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution Comments: ❑ Speed levelers provided (not required) SOIL ABSORPTION SYSTE Bottom of SAS excavated down to a Semi layer, as rovided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan ❑ 3/4-1 Y" double washed stone installed ❑ 1/8-1/2" (peastone) doubl h d J R Comments: PRESSURE DISTRIBUTION El El e was a stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan inch manifold laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals Comments: Elorifice size inch as per plan Page 3 of 4 OTOWN OF NORTH ANDOVER O ✓ t NORTh Office of COMMUNITY DEVELOPMENT AND SERVICES 3?0'`�`�� HEALTH DEPARTMENT16. 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 018454n°'''<� s�cNust Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Comments: Rated for exterior if placed outside SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: Page 4 of 4 ._ - ,._.,. .,j ,.;� Town ofNorth Andover Health Department Date: Location: (Indicate Address, if Residential, or Name of Business), Check #: _ Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ �O ❑ eptic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 511 Health Agent Initials �J White - Applicant Yellow - Health Pink - Treasurer J S Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ieMn Application.,or Septic Disposal Systet,-j Construction Permit —TOWN OF DAY'S TE TH ANDOVER, MA 01845 $ 250.00 — Full Repair $125.00 - Component Application is hereby made for a permit to: ❑Co struct a new on-site sewage disposal system* Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component A. Facility Information Address or Lot # City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ravity (choose one) ***If pump system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name Address (if different fr m above) p� - .� . City/Town State Telephone Number Zip Code 3. Installer Information J Name Name of Company I Address City/Town State 4. Designer Information Name Address City/Town o/�-/c Zip Code 17 r J; >/5-gL '>d�' Telephone Number (Cell Phone # if possible please) kt~tl('#tv%, C) -_ Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 l p Z 10 Z a6ed . liwaad uoilonilswo walsAS-Asi(] jo; uoileoilddy ,. - ON /s.1, : (Aluo uol;onaisuoo Mau) z suplg ,coolI -s (upld paloaddp sr alpas dzuvs) —off :(Aluoa uoiiongsuoo Mau) Z;Izng-sy uoz�ppuno r -t ON s9A pauaglpau;aalyO Woo qap;;y `Os fi pate- u.�ng •r ON `saA zpagap;;y uuol uortiv�zlgo iagpupyy;aa(oig •z ON /�saA zpagj=V aad 7 Ju0 ash aowo ao:j :suoseaJ 6UIMOIIOJ ayj Jo; panojddes1a uoijeoijddy ale(] aweN (8n!;e;uos9ad9y y;/eaH jo paeos) :AS panoiddy uoi}eoilddy ale(] aweN 'y;leaH JO pae0s shy; t4alenssi uaaq sey eouei;dwoo jo a;e"iptioo e;!;un uopejado ui wo;sAs ay; aoeld o; jou pue `aanopud yJJoN jo uMol ay; aoi suoi;elnBa& lesodsiQ aoe,HnsgnS le3o-1 ay; se item se `apoo;e;uawuoainu3 ay; jog el;!l {o suo►sInoad ay; y;im eouepr000e ut wa;sAs /esods�ip o6emes a;►s-uo peq!josep-aaoje eyl jo aoueua;uiew pue uopona;suoo ay; ensue o; saarBe pauB►siapun ayl IuauaaaaBV •8 JeiojewwoOE] ao 6uglam(] jeiluepisa : ulpp8 jo GCIAJL I ••••panu!luoo uo!jewj0jul j!I!3e=j •d Z=1OZ30Vd a ed M w j - 00 osi $ M10 VW 2I 9AO(INV HIM0 3111(] S,,l`d(]Ol 30 N&O I. — 4!wJGd uo!milsuo� WGIS S peso s!a og eS aol u61je5!! d N INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 0'7 JL A "L /� -LN ` relative to the application —"_ f !o—//—a-`� for plans by`''``'¢` I� wry=and of /dam 7�5�"� dated dated !"'-"dS with revisions dated I understand the following obligations for management of this project: l . As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necgssary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 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 ard of verbal ion tiTom me. Instal er must be present or thisineer must be submitted to inspection. spection.Health,after ump system ch installer all electrical ls for work inspection 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. 4. As the installer I understand that only I.may perform the work (other than simple excavation) required 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 to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. 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 or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. 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. Undersign icensed Septic Installer ' Date: Disposal Works Construction Permit # TO: NORTH ANDOVER, MAS -S,. Dec. 9 , 82 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at Lot 5A Paddock Lane Site -Location North Andover, Mass. AtCMARp The grades and construction materials a a ci « in my plans and specifications dated Jan. 7 9i t� ec. 9 1982 MagilwWrl LA E Reg. P f.Engine Sanitarian Richard F. Kaminski .� ...�. - . v . r ✓ . DC S1G.1,4 At. eb-it-r 11.IV tC:-� =)'-11i1 i t—A en (>I 4 't "I'toiA w I -Irbe" M Oko� ow P k,p.N — G -EP i�c�t'rS -DoNe, t1i SPS� ape sy,� t s wry atsouFs � -A 5 E5uILT 5UE5-SumP-, I 5YST EM 1 ti! F o cz -- _ I OPAa` SGA LE 1"=4,.0, DATE;12�9�82 Mtnisy-I 1 a,S A SsC'<-t S EN(3itJEE Q,5 � AQ,LHiTEGTS 451 .L�.r..too�/EGZ ST Nc•ANoavE�.. ME PEN M, VA912=3 ROM 4 't "I'toiA w I -Irbe" M Oko� ow P k,p.N — G -EP i�c�t'rS -DoNe, t1i SPS� ape sy,� t s wry atsouFs � -A 5 E5uILT 5UE5-SumP-, I 5YST EM 1 ti! F o cz -- _ I OPAa` SGA LE 1"=4,.0, DATE;12�9�82 Mtnisy-I 1 a,S A SsC'<-t S EN(3itJEE Q,5 � AQ,LHiTEGTS 451 .L�.r..too�/EGZ ST Nc•ANoavE�.. '._o ll of �'✓4, til North "-dover,_�:a�s. kP Q,TED DATE 411 04 BE.` LIC SiSTIZ y 1 CSX Li ST '� LOT S �N�1�UclL G� Qi7II} DATE EXCAVATICN 0K FAIL ea3ansi 1. Distance Tot a. Wetlands b. Drains c. Well 2. Nater Line Location 3• No PVC Pipe }s. Septic Tank - a. _Tees --Length & To Clean Oat Covers.. b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. - Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench % a. Dimensions b. Stone Depth d c. Capped 'Ends d. Clew Double Washed Stone 7. Leach Pits a. Dimensions b. Stone/Depth c. Splash Pads d. Teas e. ment Pipe to Pit - Both bides f.,/Clean Double Washed Stone - 8. No Garbage Disposal 9. Final Grading Inspection d SY t —T v � r,lA. Barra ceding Covera sem' As Built Submitted _ a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test X d. Elevations / e; Water Table I ` _ Board OT Health Noi•tj?! Andover,Mass SLTBS[JRFACE DISPOSAL DESIGN CHECK LIST LOT �L PPROVID DATE DISAPPROVED DATE PPROWReasonst eds Ci tle V FAIL CK teg 2.5 The submitted plan must show as a minimums a) the lot to be served-areasdimensions lot #*abetters to location and lots observation rcol.at on testssdistanceeto tiesties -location and re Pe red leaching area dssign calculations & calculations showing requi ),location and dimensions of system -including reserve area ff existing and proposed contours g) location any wet areas thin 1001 of sewage disposal system or within disclaimer-check wetlands mapping h) surface and subsurface drains within 100' of sewage disposal /i system or disclaimer (i) location any drainage easements within 1DOI of sewage disposal system or disclaimer-Planning Board files (J) known sources of water supply within 200' of sewage disposal / system or discl.aimW % (k) location of any proposed well to serve 10t-1001 from �leaching gYfacility 1) location of water lines on property-109tion of benchmark (si) driveways (.o garbage disposals (p no pyC to be used in construction i e s tic tank (q profile of system-elevations of basements plumbs p p eP distribution box inlets and outlets, distribution field piping and either elevations maxdmum ground water elevation in area sewage disposal system s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (/a) 'c''ap`ac"i�t es-�50% of flows water tables tees depth of tees, access, pupi-ng b) cleanout (c) lot from cellar wall or inground swimming pool (d) 251 from subsurface drains .Reg 10.2 Distribution Boxes 0.08 1 a) s oPe grater than Reg 10.4 V b)sunmp :)=aface Design Check FAIL I - CK Reg 11.2 u.4 11.10 11.11 Reg 15.1 15.4 15.8 3.7 Reg 14.1 1144.4 14.6 14.7 14.10 Reg 9.1 9.6 Page 2' Leaching-Pit Leaching are preferred where the installation is possible a) calcn31zons of leaching area-mi.nirm m 500 eq ft b) epac c) OWce drainage 2%d) coo r material e'I V ' x4 N splash pad f e at elbow g) no bends in pipe from d -box to pipe Leaching Fields no greater than 20 minutes/inch b area -mini=m 900 aq ft construction of field surface drainage 2 % e) 202 from cellar all or inground ewimdng pool Leaching l ches a) cail—cuaticds oFTeaching area -min 500 sq ft b spacing-4/ft min 6 ft with reserve between ci dimensioAs d) construe tion e stone/ f� snrf4be drainage 2% a s pe y x -_Tto be shown y/x & 150 (to be shown; a) rsd�-b�y b) power FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** o A C, iv % Phone APPLICANT: � �, � LOCATION: Assessor's Map Number Parcel _ Subdivision Lot(s) Street �' ` ``"� t St. Number ************************Official Use Only************************ RECO14MEENDATIONS OF TOWN AGENTS: (/ Date Approved Conservation Administrator Date Rejected Comments 2 Date Approved Town Planner Date Rejected Comments F od Inspector -Health A_eef, Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved �ZL? Date Rejected Received by Building Inspector Date ICT TOWN OF NORTH ANDOVER ", of N° oT ,'a Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET-'-• ` ` NORTH ANDOVER, MASSACHUSETTS 01845 sSACIWb Susan Y. Sawyer, REHS/RS Public Health Director September 27, 2005 Peter & Maggie Delaney 72 Paddock Lane North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX RE: Septic System Design, 72 Paddock Lane, North Andover, Map 107D, Lot 100 Dear Mr. and Mrs. Delaney, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by Merrimack Engineering Services, Inc. dated, July 28, 2005, last revision date of September 12, 2005. The design has been approved for use in the construction of an upgrade onsite septic system. This approval is generally valid for three years from the date of the approval and 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. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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. The 4 -bedroom (9=room maximum) design has been approved for use in the construction of a replacement onsite septic system. At a regularly scheduled Board of Health meeting held on August 25, 2005 the following local variances were approved regarding the proposed septic system. 1. Local Upgrade Approval Setback from the SAS to a private well from 100 feet to 70 feet 2. Variance to N. A. Regulation5.02 Reduction in offset distance from wetlands to the SAS from 100 feet to 80 feet In addition, On September 26, 2005 the Board of Health approved a variance to the local regulation 13.02 to allow a portion of the leaching area to be located under a driveway. This approval is subject to the following conditions: 1. The attached DEP Form 9b must be submitted to the appropriate Regional Office of the Department of Environmental Protection at One Winter Street Boston MA by the property owner. September 27, 2005 Re: 72 Paddock Lane Page 1 of 2 2. If site conditions are fov-A in the field to be different from thosd, ,.dicated 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. 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 or imply compliance with any of the aforementioned requirement 4. The plan does not call for the installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use if you choose to install one. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. lublic CjIY. Sawyer, REHS S Health Director Encl: List of licensed septic system installers Local Upgrade Approval Form 9B Cc: Merrimack Engineering Services, Inc. File September 27, 2005 Re: 72 Paddock Lane Page 2 of 2 Town of North Andover Licensed Septic System Installers (Disposal Works Installer's) (Please note that the septic installer is licensed only -- not the company) 1 Five or more installations within the last Name year Amor, Robert # of 1 Company R.T. Amor Permit # BHP -2004-1349 Phone # 978-948-3341 2 Bateson, Todd 8 113ateson Enterprises, Inc. BHP -2005-0053 978-475-1474 3 Beaulieu, Serge R. -NEW 0 Roadway Excavators, Inc. BHP -2005-0071 603.893.9189 4 Breen, Peter 0 Peter Breen Excavating, Inc. BHP -2005-0038 978-687-7774 5 Busby, Philip A. Jr. 0 Busby Construction Co., Inc. BHP -2005-0011 603-362-4650 6 Carr, John 0 Ramey Construction BHP -2005-0034 978-683-6791 7 jColosi, Philip A. 0 Colosi Construction LLC BHP -2005-0012 978-777-5679 8 Coyle, Kevin 0 Kevin Coyle BHP -2005-0010 978-479.2818 9 10 Currier, James H. Daigle, Rob 0 1 _ James H. Currier Construction Co, IncBHP-2005-0009 Creative Builders BHP -2004-1355 978-774-6685 978-682-4948 11 DeLucia, Rocci Jr. 0 Frank DeLucia & Son, Inc. BHP -2004-1357 978-686-8200 12 DiVincenzo, John L. 0 Andover Septic/J&S Dev. Corp. BHP -2005-0006 978-521-5251 13 Giard, Daniel 0 Daniel A. Giard Septic Service BHP -2005-0001 978-686-7653 14 Hall, Bill, Inc. 2 Bill Hall, Inc. BHP -2004-1351 978-689-3711 15 Hartigan, James 0 James Hartigan BHP -2005-0028 978-766-0087 16 Hayes, John 0 _ J.B.H. Compact Equip. Co.' BHP -2005-0117 978-686-5229 17 Henderson, William S. -NEW 0 William S. Henderson PENDING 978-490-0085 18 Hoehn, Bruce 0 Bruce Hoehn BHP -2005-0092 978-372-8274 19 Hutton, Arthur 0 Hutton's General Construction, Inc. BHP -2004-1356 978-685-2627 20 lacozzi, Stephen -NEW 2 Stephen lacozzi BHP -2005-0095 978-479-4407 21 Innis, Robert L. 1 _ R.L.I. Corp. BHP -2005-0069 978-663-6006 22 Kellett, James 12 Kellett Excavating BHP -2005-0007 781.953.7146 23 Marsh, Steve 0 The Westchester Co. BHP -2004-1361 978-742-9778 24 Maynard, Dave 1 Imaynard Construction BHP -2004-1354 603-228-4436 25 McKee, Brian 0 D.P. McKee & Son Excavators BHP -2004-0023 781-942-7608 26 O'Connell, Kevin -NEW 0 Kevin O'Connell BHP -2005-0100 978-658-3933 27 Osgood, Ben 5 New England Engineering BHP -2005-0032 978-686-1768 28 Pearce, Warren 1 Pearce Construction BHP -2005-0010 978-664-5264 29 Petrosino, Angelo 0 Angelo Petrosino BHP -2004-1358 978-664-2030 30 Quinlan, Timothy 0 Quinlan & Rand Builders BHP -2004-1350 978-682-1570 31 Sawyer, William T. 0 Arco Excavators, Inc. BHP -2004-1353 603-642-8910 32 Shaw, John III 1 Wildwood Excavation, Inc. BHP -2004-1352 978-474-8088 33 ISlombo, Robert 0 Robert Slombo BHP -2005-0054 603-659-6962 34 Soucy, John J. E0 10 Soucy's Sewer Service BHP -2005-0013 978-470-1400 35 Surianello, Joseph 0 IRalph Surianello, Inc. BHP -2004-1360 617-799-3900 36 Todd, Charles R. 0 ICharles R. Todd Contractor, Inc. BHP -2005-0004 978-667-7853 37 Waelty, Craig(Skip) 4 Craig Waelty BHP -2004-0671 978-664-2126 38 Watson, Joseph 2 JW Watson, Jr. Inc. BHP -2004-1359 978-475-3262 39 Whyman, Jon 0 J. Whyman Construction BHP -2005-0005 781-334-2323 40 Zaher, Charles 0 Charles Zaher BHP -2005-0037 978-441-9429 Note: The Septic Installer Exam is held in January. March, May. July and September of each year. You must call the Health Department to sign up for the exam at 978.688.9540. The testing fee is $25. Last Updated: 8/9/2005 1 � Commonwealth (Massachusetts City/Town of a Local Upgrade Approval Form 913 c, LSM DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. 'A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer, use Peter and Maggie Delaney only the tab key Name to move your 72 Paddock Lane cursor - do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code tab 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code 3. Type of Facility (check all that apply): X Residential ❑ Institutional 4. Design flow per 310 CMR 15.203: 5. System Designer: 60 Park Street Address Telephone Number ❑ Commercial ❑ School 440 gpd Anthony Donato Name Andover City/Town B. Approval 1. Local Upgrade Approval is granted for: X Reduction in setback(s) — specify: Reduction in setback distance between SAS to ❑ Reduction in SAS area of up to 25%: X PE ❑ RS MA 01810 State, ZIP well from 100' to 70 ' (current setback is 75 SAS size, sq. ft. % reduction 72 Padock Lane form 9b • rev. 5/02 Local Upgrade Approval* Page 1 of 2 Commonwealth�kjr Massachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): List local variances granted not requiring DEP approval per 310 CMR 15.412(4): Variance to N. A. Regulation5.02 Reduction in offset distance from wetlands to the SAS from 100 feet to 80 feet Variance to the local regulation 13.02 to allow a portion of the leaching area to be located under a driveway. List variances granted requiring DEP approval: Susan Sawyer Approving Authority Public Health Director Print or Type Name and Title September 27, 2005 Date 72 Padock Lane form 9b • rev. 5/02 Local Upgrade Approval* Page 2 of 2 LETTER OF TRANSMITTAL North Andover Health Department 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax healthdent(a)townofnorthandover com - E-mail www.townofnorthandover.com - Website TO: WILLIAM (BILL) DUFRESNE, PROJECT MANAGER COMPANY: MERRIMACK ENGINEERING SERVICES Phone: 978.475.3555 Fax: 978.475.1448 Page / of DATE: r1f lD'-5 - - pO R Try O Sl -20 i "M6 *6 OOH► FROM: Pamela DelleChiaie, Health Dept. Assistant RE: �� la We are sending you: ,®Plan Review Letter OAPPROVED OSystem Construction Follow -Up T APPROVED OOther These are transmitted as checked below: a-)Fo' our File AAs Re Y quared OAs Requested or Your Use REMARKS: COPY TO: Fax Homeowner or Mailed COPY TO: Fax # File or Mailed COPY TO: Fax # or Mailed 0 TRANSMISSION VERIFICATION REPORT TIME 09/09/2005 15:54 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATEJIME 09109 15:49 FAX NO./NAME 89784751448 DURATION 00:01:18 PAGE(S) 03 RESULT OK MODE STANDARD ECM 0 1% 0 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS LVI 11 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL: merreng@aol.com September 13, 2005 Ms. Susan Sawyer Public Health Director 400 Osgood Street North Andover, MA 01845 Re: 72 Paddock Lane Dear Ms. Sawyer: SEP 5 2005 TOJA'N' 'Jr-;vn,� NL��EPA TMEN7' We have received your review letter dated September 7, 2005 regarding the above referenced project. We have revised the plan with regard to item #2 and provided a clean out for the sewer pipe. With regard to item #1, test pit #5 was excavated from the existing paved driveway edge in a southerly direction approximately 12-15 feet in length. The symbol chosen to represent the test pit does not accurately depict the actual length and shape of the test pit however the location and elevation shown does accurately represent the precise location where the test pit was logged. With regards to item #3, we did discuss the fact that the proposed S.A.S extends under the existing paved driveway with the Board Members at our presentation last month and presumed the issue was approved however if a formal request needs to be made please accept this as a variance request from N.A. 13.02 and we ask that this matter be approved as soon as possible. Enclosed herewith are (3) copies of the revised plan. We feel your concerns have been adequately addressed and respectfully request the design be approved as re -submitted. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager ti enc cc: Peggy Delaney 72 Paddock Lane North Andover, MA 01845 r i061 TOWN OF NORTH ANDOVER cE NOR*N 7 ��/J� �f Z Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845CH SS�cMuse Susan Y. Sawyer, REHS/RS Public Health Director September 7, 2005 Anthony Donato, P.E. Merrimack Engineering Services 66 Park Street Andover, MA 01810 978.688.9540 — Phone 978.688.9542 — FAX Re: Subsurface Sewage Disposal System Plan for 72 Paddock Lane, Map 107D, Lot 100 Dear Mr. Donato: The proposed septic system design plan for the above site dated July 28, 2005 and received on August 9, 2005 has been reviewed. Unfortunately, it 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 town consultant indicates that the locations of the test pits do not appear to be accurately depicted on the plan. Specifically, Test Pit 5 was excavated at the edge of the driveway, and therefore should be at elevation 96.0, not 95.7. 2. The sewer pipe should be laid on a continuous grade in a straight line (222(7)). The site conditions do not seem to allow this so cleanouts should be placed preceding any changes in alignment. —222(8). 3. The leaching field is located partially under the driveway, and a variance is required. — NA 13.02 The September 22 d BOH meeting has been cancelled, however, the Board of Health is having a special 30 -minute meeting on September 2e at the N. Andover High School. As you are aware the other variance requests were granted on this property, and the local regulation regarding driveway was missed. This can easily be taken care of and will not require a second appearance by you to represent your client. Therefore, once the other items listed above are addressed than the plan will be approved contingent upon the local issue being approved on September 2e and if there is a time constraint work will be allowed to proceed. f 1 �J C�I Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system, which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere XuY. Sawyer, REHS/RS Public Health Director cc: Owner File GOWN OF NORTH ANDOVER of NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 •°°'° �Ss�cMus�� Susan Y. Sawyer, REHS/RS Public Health Director September 7, 2005 Anthony Donato, P.E. Merrimack Engineering Services 66 Park Street Andover, MA 01810 978.688.9540 — Phone 978.688.9542 — FAX Re: Subsurface Sewage Disposal System Plan for 72 Paddock Lane, Map 107D, Lot 100 Dear Mr. Donato: The proposed septic system design plan for the above site dated July 28, 2005 and received on August 9, 2005 has been reviewed. Unfortunately, it 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 town consultant indicates that the locations of the test pits do not appear to be accurately depicted on the plan. Specifically, Test Pit 5 was excavated at the edge of the driveway, and therefore should be at elevation 96.0, not 95.7. 2. The sewer pipe should be laid on a continuous grade in a straight line (222(7)). The site conditions do not seem to allow this so cleanouts should be placed preceding any changes in alignment. —222(8). 3. The leaching field is located partially under the driveway, and a variance is required. — NA 13.02 The September 22°d BOH meeting has been cancelled, however, the Board of Health is having a special 30 -minute meeting on September 26`� at the N. Andover High School. As you are aware the other variance requests were granted on this property, and the local regulation regarding driveway was missed. This can easily be taken care of and will not require a second appearance by you to represent your client. Therefore, once the other items listed above are addressed than the plan will be approved contingent upon the local issue being approved on September 260' and if there is a time constraint work will be allowed to proceed. o K Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system, which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincer Y. Sawyer, REHS/RS Public Health Director cc: Owner File a Town of North Andover Health Department Dattee: Location: (Indicate Address, if Residential, or Name`of Business) Check #: v ��`✓ Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) you Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978)475-3555,373-5721 • FAX (978) 475-1448 • E-MAIL: merreng@aol.com August 8, 2005 Ms. Susan Sawyer, R.E.H/R.S. Public Health Director 400 Osgood Street North Andover, MA 01845 Re: 72 Paddock Lane Dear Ms. Sawyer: RECEWl D AUG 0 9 2005 TOWN OH p�TH AN'D0VER DEPgRTUENT We have completed a septic system upgrade design for the above referenced site. The site and surrounding sites are serviced by on site private wells. The subject site contains a significant amount of wetlands located on the southerly side (rear) of the site. Due to the aforementioned constraints a design in full compliance with Title 5 and the North Andover Board of Health requirements is not possible. We have designed the subsurface disposal system to maximize the environmental protection given the existing conditions however a waiver is required from the North Andover B.O.H. regulations which require the S.A.S. to be 100 ft. from a B.V.W. where 80 feet is proposed. Additionally, a local upgrade approval is required for the horizontal setback from the S.A.S. to a private well from 100 ft. to 70 ft. (see enclosed state L.U.A Form). Someone from our office will be available to discuss this proposal in more detail at your next available meeting. We appreciate your consideration of this matter. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager ti Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01845 97&63&9540 healthdepfaVorvnofaorthandover. com RE CEP ► 71) AUG U 9 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SEPTIC PLAN SUBMITTAL FORM l DATE OF SUBMISSION: k S—d SITE LOCATION: 72. &Voocr1Glc ENGINEER: 51,12y1e,6r5 NEW PLANS: YES $225.00/Plan Check #: 3 (Includes 1'`�"Ew and one Ro-Reviero Only) REVISED PLANS: YES $ 75.00/Plan Check ft SITE EVALUATION FORMS INCLUDED: NO LOCAL UPGRADE FORM INCLUDED: ES NO Telephone #:�`7) ei-7 5--3,5q 5- Fu #: 4'75 " 144 E-mail:�- I Qg&::gftJ6 0 "L . e-: C,4-1 HOMEOWNER NAME: E i; a - c f?/ j (,+ Y OFFICE USE O?1rLY When the submission is complete including check): Lstamp plans and letter Z. Complete and attach Receipt 3. 7" -,Copy File; Forward to Consultant 4. Enter on Log Sheet and Database r%-Ai►�'.,�trJt'Owner's NataT► : � . l o? 0 7`L Iry Address:24, �p�y Tel #:972 - i 3?0I Nex tsssoX__gepRlr f Date: - o W S Zoae II=Soil Symboi�fk_SoIl Blame G"it. Son Qln 3 Deep Observation Hole Logs Elevidan Depth Son HOrizoa Soll Tesmre Soil Color Soil MOttllag . % Gravel, Stones, etc: Fg�� J �� Lk if..l -' 1��l� �K.-KM• LeG- � T �z Parent Matt:tivA . TI v!. Dept', to Bedtsc1�_ Stmttta= �Yiur in else Hely SlPeepin= from lft Faee i f? %v`� 4 �_ESHGNs f� Obse Deptl Stat Time Time Time Time -Rate 4` 2 BO V. Fit J Vp, L P llepthg8eltseft�,_ _St�ailrs=�ifaterinttuHela I ��_Neepta=lratalitFaee tD,�ESFiCLY:�_ i Percolation Tests Performed Bp: -j , SLI D N� Witnessed Br. A • "c. IP.+k��2 Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 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 5.404(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 15.417. 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 a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer, use only the tab key Name to move your -7L,f 2A-19 cursor- do not "—T Street Address use the return { .u�� , 1 ,� rye „�H �� key. Porn L ► t+ l_ ' 1 Zip Code City State ar 2. Owner Name and Address: 19 f-111 A461 I Name Street Address city State Zi �� Telephone Number 3. ;'Residential oacility (check all that apply): F1Institutional ❑ Commercial ❑ School 4. Describe Facility: �JGYaY��;E din Mal 0— 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Lam+ Ff 4 A�z t5form9a • rev. 5/02 Application for Local Upgrade Approval, Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wastewater Management Program jForm 9A - Application for. Local Upgrade Approval ' Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility B. Proposed Upgrade of System gpd spdi`l•„ �,Pb gpd w Proposed upgrade is (check one): EKVoluntary ❑ 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: 1�J I5-4, 6A G TAN i -i 3. Local Upgrade Approval is requested for: a/Reduction in setback(s) — describe reductions: 02 IC"'! 7 5�-i ❑ Percolation rate for 30 to 60 min./inch: min.Anch ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): t5form9a • rev. 5/02 W min./inch ft. Application for Local Upgrade Approval, Page 2 of 4 OAF Massachusetts Department of Environmental Protectio Bureau of Resource Protection — Wastewater Management Program L71 l -I Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) ❑ 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)(i)(1). The soli evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: nature Date of evaluation Evaluator's Name (type or print) Si 9 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: u16 --D,41212 A n sE✓i L C' ��V l'a/�7yll�� IZc' y 7i - r.� 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: rVA 3. A shared system is not feasible: !U 4 4. Connection to a public sewer is not feasible: t5form9a • rev. 5/02 Application for Local Upgrade Approval* Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wastewater Management Program Form 9A — Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 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 Q�-&mplete plans and specifications ite 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 consequence,consequence,91 or submittingfa Information, including, but not limited to, penalties or fine and/or imorisonme t for eli el tevi at' ns,," x Print �'f1-� �!�LF�iU�%Ll ���►.1��iC LA:Fi�i?�Ts'N��'.z Name of Preparer (ik Q UAL !>tCMCET Preparer's address %—IA 3;5 - vI F io state/zip Date Date AJ -j , ert- City/Town Telephone NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before. commencement of construction. t5form9a • rev. 5/02 Application for Local Upgrade Approval* Page 4 of 4 -L PROFILE & PERCOLATION TEST J" TA North Andover, Mass. Street No 'Fb.ppC>e-' - Lot No 5 Loc/Subdiv. Pland Owner 5 •ItENsr�.,'�E�c Investigator Observer MT Q - SOIL PROFILE DATES l Alev 2. Elev 3. El ev 4. Elev 0. © 7 - CA --OV CSV ef..• 1 -a - c �pl1E v � 5 v%1bqlep.. 5 t'20kow 6 r -6d " c F dED Benchmark Elevation 4 J- 5 7 DATES 1 E "rop w+ - L. -11 4, l b, 2 le 3 4 Tins P" Test e 5 5 1.4 a»t 6 6 7 7 � t s s ToW Tv �(GW O.tE e�rT 9 9 si �EDoOF, 10 to Location Datum N� W 4i�rs►2. PERCOLATION TESTS Pit Number 1 2 3 4 Start Saturation Soak -Minutes start Drop of 3" -Time Drop of 6" -Time M6ms-Ist 3" drop Mins.2nd " Drop Percolation e e - E e Stevens Water Analysis 38 Montvale Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, N.H. (603) 893-3106 LABORATORY NUMBER: 14543 SAMPLE DATE: 3/10/85 SUBMITTED BY: YOUNG BROS. 36 Pelham Road Salem, NH 03079 SAMPLE SOURCE: New Well - Sam Dagata, No. Andover, MA Lot #"!:,� ANALYSIS: According to Standard Methods of Water and .Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . 0 per 100 ml Chlorides. . . . . . . . . . . . 5 mg/L pH. . . . . . . . . . . . Hardness . . . . . . . . . . . . Manganese . . . . . . . . . . . . Sodium . . . . . . . . . . . . . Iron . . . . . . . . . . . . . . Nitrate . . . . . . . . . . . . . Nitrite . . . . . . . . . . . . . Arsenic . . . . . . . . . . . . . 6.6 54 mg/L 0.01 mg/L 5.8 mg/L 0.01 mg/L 0.23 mg/L less than 0.10 mg/L less than 1.0 ppb COMMENT: The results of these analyses meet the federal and state standards for drinking water. Chemist Microbiologist f j l Page 1 of 1 P-01 bl DelleChiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Tuesday, June 14, 2005 12:54 PM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 72 Paddock Lane soils Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 6/14/2005 ,�w vi 0 J v NORTH TOWN OF NORTH ANDOVER °?°;MI's D ;•:;"o°� Community Development & Services Division HEALTH DEPARTMENT 400 OSGOOD STREET �r1 11CMUa t4' NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax DanielOttenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: r Septic Plan Review L/ ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Address: d Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File BOARD OF HEAL (J, NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: � --? - O 5 MAP & PARCEL: LOCATION OF SOIL TESTS: if- (An/t�- OWNER:. Y EC,( Y—l��l G t7t;1&Vh.��caTEL. NO.: e77 i; - ADDRESS: 7& ENGINEER: 1:1 TEL. NO.: cl -7 CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision g e Family a Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No 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 $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 $360.00 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. N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: b1 T t .. _ �",;4 ,,p�� _:;..,. 'S`,!;�. `�.. r. r R � ;., �.',.� ���;' -_ .. _ �",;4 ,,p�� _:;..,. 'S`,!;�. `�.. 04 LO 1p C.0 <J Dellechiaie, Pamela 0 From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Wednesday, May 11, 2005 12:00 PM To: 'Pamela Dellechiaie' --- Cc: dano@millrivercoing.com'Andy McBrearty' Subject: 1500 Forest Stree and ` 2 Paddock Lane- Soil Test sults Importance: . High Forest Street # 1500.tif Here are soils for 1500 Forest Street and 72 Paddock Lane. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com Wastewater Management -----Original Message ----- From: health department [mailto:healthdept@townofnorthandover.com] Sent: Wednesday, May 11, 2005 8:53 AM To: 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; 'McBrearty Andrew (E-mail)' Cc: Osgood Ben (E-mail) Subject: 1500 Forest Street - Soil Test Results Importance: High Hi Guys, Ben Osgood was asking about the Soil Test results for this address, particularly the water table. He has a staff person coming in this morning for something else, and I would like her to be able to pick this up also. Any chance? Thanks! 0 Best Regards, Pamela DelleChiaie Health Department Assistant Town of North Andover 400 Osgood Street North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 Page 1 of 1 Dellechiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Wednesday, April 27, 2005 10:44 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; dano@millriverconsulting.com Subject: soil tests Hi there, The following soil tests have been scheduled: 72 Paddoc�Lane May 5, a.m. 1500 Forest St — May 5, p.m. (if a.m. test at Paddock Lane'goes longer than expected, Forest Street will be RS to May 10) 240 Farnum Street- May 12, 9:00 Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinv-.com 4/27/2005 Page 1 of 1 Dellechiaie, Pamela From: Lisa LeVasseur [lisal@millriverconsulting.com] Sent: Wednesday, April 27, 2005 10:44 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie'; dano@millriverconsulting.com Subject: soil tests Hi there, The following soil tests have been scheduled: 72 Paddock Lane — May 5, a.m. 1500 Forest St — May 5, p.m. (if a.m. test at Paddock Lane goes longer than expected, Forest Street will be RS to May 10) 240 Farnum Street- May 12, 9:00 Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 5/5/2005 TOWN OF NORTH ANDOVER ° <<.•° •." Community Development & Services Division p HEALTH DEPARTMENT 400 OSGOOD STREET -Too Sscwust NORTH ANDOVER, MASSACHUSETTS 01845 .4 Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: 978.282.0014 /, � /�& Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle 0 Comments: Septic Plan Review Soil Test - OTHER Address: /0 �> Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File r1\ DATE: q_2-0 5 BOARD OF HEALI"D NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS MAP & PARCEL: LOCATION OF SOIL TESTS: OWNER: LJ b) =V 1' n ((cjTEL. NO.: F57 / ADDRESS:—]? ENGINEER: tqZ4 is-,1A1 /2 TEL. NO.: Gi 7 (;;_' 3, CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Is This: Repair testing f�— Undeveloped lot testing In the Lake Cochichewick Watershed? Yes gle Family a Commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Upgrade for addition No Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. 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 $360.00 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. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: i Town of North Aiidove r Health Department Date: Location: / y �' `'r `n (�✓ LL?'L�� (Indicate Address, if Residential, or Name of Business) Check #• 4gx�.5 Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: "❑ S�tic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 763 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 0 7 i � � f NORTH q TOWN OF NORTH ANDOVER 3r;.�•,�`.° ,�•,"oar Community Development & Services Division HEALTH DEPARTMENT 400 OSGOOD STREET SAC14US� NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 - Fax Daniel Ottenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: t Septic Plan Review L/ ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Address: �� a /4' Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File A TRANSMISSION VERIFICATION REPORT TIME 04/1312005 14:32 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 04/13 14:26 FAX N0./NAME 819782820012 DURATION 00:01:37 PAGE{S} 03 RESULT OK MODE STANDARD. ECM f ) � BOARD OF HEALTI9 NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: �+-- 7 — O 5 MAP & PARCEL: LOCATION OF SOIL TESTS: 77/ e-�I�o L64,h OWNER: Y EYMAXk jTEL. NO.: 875-- 1'5,-7 ADDRESS: 77i ENGINEER: e!jZjZ _1 vl 0< (/� TEL. NO.: Gi % CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Is This: Repair testing 1� Undeveloped lot testing In the Lake Cochichewick Watershed? Yes gle Family a Commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Upgrade for addition No 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. 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 $360.00 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. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: .par�si ear. - q.�; .. L►w a�'� � � '4+ i i... .l -- I" PAM,,OVT 40V didI L FW,0j 4ILv6tAei S S -0-K yC�Ro1�1s'H � � �O�^ �'A'►KK" .: ; ' '`'' ". £L..fN AS f� ASSOGt�TE 5 014 P10*4 -. D6GP o1E'rs e`.^�z SbEi ► G g;. C nt Cz. AtBC.i-11'3 E GTS 1�oN8 I� �tRa"�S t 4roi .A,.wt.�o EiZ ST. No. o oovF- . wit pro �p�fpSiB r t l 1; .par�si ear. - q.�; .. L►w a�'� � � '4+ i i... .l -- I" PAM,,OVT 40V didI L FW,0j 4ILv6tAei S S -0-K yC�Ro1�1s'H � � �O�^ �'A'►KK" .: ; ' '`'' ". £L..fN AS f� ASSOGt�TE 5 014 P10*4 -. D6GP o1E'rs e`.^�z SbEi ► G g;. C nt Cz. AtBC.i-11'3 E GTS 1�oN8 I� �tRa"�S t 4roi .A,.wt.�o EiZ ST. No. o oovF- . wit pro �p�fpSiB r 1 ' x, yam' n T T- .par�si ear. - q.�; .. L►w a�'� � � '4+ i i... .l -- I" PAM,,OVT 40V didI L FW,0j 4ILv6tAei S S -0-K yC�Ro1�1s'H � � �O�^ �'A'►KK" .: ; ' '`'' ". £L..fN AS f� ASSOGt�TE 5 014 P10*4 -. D6GP o1E'rs e`.^�z SbEi ► G g;. C nt Cz. AtBC.i-11'3 E GTS 1�oN8 I� �tRa"�S t 4roi .A,.wt.�o EiZ ST. No. o oovF- . wit pro �p�fpSiB r % 1 e e - E 06 e --= - Stevens Water Analysi's 38 Montvale Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, N.H. (603) 893-3106 LABORATORY NUMB -ER: 14543 SAMPLE DATE: 3/10/85 SUBMITTED BY: YOUNG BROS. 36 Pelham Road Salem, NH 03079 SAMPLE SOURCE: New Well - Sam Dagata, No. Andover,'MA Lot #1k—�- ANALYSIS: According to Standard Methods of Water and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . . 0 per 100 ml Chlorides. . . . . . . . . . . . 5 mg/L pH. . ... . . . . . . . . . . . Hardness . . . . . . . . . . . . Manganese. . . . . . . . . . Sodium . . . . . . . . . . . . . Iron . . . . . . . . . . . . . . Nitrate. .. . . . . . . . . . . . Nitrite . . . . . . . . . . . . . Arsenic. . . . . . . . . . . . MM. 54 mg/L 0.01 mg/L 5.8 mg/L 0.01 mg/L 0.23 mg/L less than 0.10 mg/L ,less than 1.0 ppb COMMENT: The results of these analyses meet the federal and state standards for drinking water. Chemist/Microbiologist . 11 e E e Stevens Water Analysis • 38 Montvale Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, N.H. (603) 893-3106 LABORATORY NUMBER: 14543 SAMPLE DATE: 3/10/85 SUBMITTED BY: YOUNG BROS. 36 Pelham Road Salem, NH 03079 SAMPLE SOURCE: New Well - Sam Dagata, No. ,Andover, MA Lot ANALYSIS: According to Standard Methods of Water and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . . 0 per 100 ml Chlorides. . . . . . . . . . 5 mg/L pH . . . . . . . . . . . . . 6.6 Hardness . . . . . . . . . . . 54 mg/L Manganese. . . . . . . . . . . . 0.01 mg/L Sodium . . . . . . . . . . . . . 5.8 mg/L Iron . . . . . . . . . . . . . . 0.01 mg/L Nitrate . . . . . . . . . . . . . 0.23 mg/L Nitrite. . . . . less than~0.10 mg/L Arsenic . . . . . . . . . . . . . less than 1.0 ppb COMMENT: The results of these analyses meet the federal and state standards for drinking water. Chemist/Microbiologist Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Oth��A R e information must be substantially the same as that provided here.gfo ore �� 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. RECEIVED NOV 13 2008 A. Facility Information Important: When filling out 1. System Location: Left front, left reaCrerside of ho . Right front, right rear, right side of house. forms on the computer, use only the tab key Address L \ to move your < cursor - do not City/Town State Zip Code use the return key. 2. System Owner: 4 - h � d -0-� Name Address (if different from location) City%Town Stat c Zip erode Telephone Number T B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) — eptic Tank 8 Tight Tank C1 Other (describe): 4. Effluent Tee Filter present? 0 Yes -P3''ITo— If yes, was it cleaned? 0 Yes [ No 5. Conditiort,Of S,ystte'� (auj 0 u,,– —4,--, ' 6. System Pumped By Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.D Lowell Waste Water of F 5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record ERECOVED Form 4 2 3 2009 DEP has provided this form for use by local Boards of Health. Otay be used, but he information must be substantially the same as that provided hereg,t is�ID�V15 k with your local Board of Health to determine the form they use. The System - ubmitted to the local Board of Health or other approving authority. A. Facility Information 1. System Locatio .�eftdeof hous�ight side of house, Left front of house, Right front of house, Left rear of ho-rLrr� Left rear of building. Right rear of building. Address 11 � �G Cityrrown 2. System Owner: Name Address (if different from location) Cityrrown �f� State Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Condition of System: \ n n7 f �M� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company Zip Code ��� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 7. Locaf ere contents were disposed: G.L.S.D Lowell Waste Water Signature of Hauler F5821 Vehicle License Number Date t5form4.doc• 06103 System Pumping Record • Page 1 of 1 s TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: _ ; - S _ SYSTEM OWNER & ADDRESS SYSTEM LOCATION lA� (example: left front of house) DATE OF PUMPING:_ i3 -1S co QUANTITY PUMPED _ GALLONS t.. CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE ,EMERGENCY 1 OBS:,ERVATIONS: GOOD CONDI TION HEAVY GREASE :ROOTS _ EXCESSIVE SOLIDS _ SOLIDS CARR YOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) _ SYS?'EM PUMPED BY:. COMMENTS: CONTENTS TRANSFERIZED TO. 6� a ,C\ Commonwealth of Massachusetts 4 City/Town of 14E+B1 a System Pumping Record Form 4 APR726 '1011 4 M Svy'y TOWN OF NORtu e�ir.� DEP has provided this form for use by local Boards of Health. Other for q,jlp }q" "�K information must be substantially the same as that provided here. Before using this form, c � 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 front of house, right front of rear of house, right rear of house, left side of build le,� ft side of Nous ght side of house, Left ht rear of building, under deck. City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record , 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Cond�tll 'on .of System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. LocatiQQ here contents were disposed: L r" Signature State r—,— Zip Code Telephone Number — 2. Quantity Pumped: Septic Tank f 4 �Z-- Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 JJA 6 i [ui4" M V DEP has provided this form'for use by local Boards of Health. Other f "y"'�� ,�"' N199VIt information must be substantially the same as that provided here. Bef, > ith 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 eft righ side of house Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under eck Address .11 City/Town 2. System Owner. Name Address (if different from location) City/Town State �A� ��49� Zip Code state ✓�� LzTi Cede Telephone Number 3v� B. Pumping Record 9 —,r� k 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ET Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Conditign of System: 6. System Pumped By: . Neil Bateson Name Bateson Enterprises Inc Company 7. Locatiogmhhere contents were disposed: G.L S. _ Lowell Waste Water If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1