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Miscellaneous - 770 BOXFORD STREET 4/30/2018 (2)
COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen NAME 770 BOXFORD STREET ------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well NUMBER BHP -2017-0332 FEE $135.00 This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires June -0-32-201-7 --_____ _ -_unless sooner suspended or revoked. March 06, 2017 -------------------------------------------------------------- BOARD OF R--------------------------------------------------------------- HEALTH ----------------------------------------- ----------------------- ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen ----------------------------------------------------------------------------------------------- NAME 770 BOXFORD STREET ----------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well NUMBER BHP -2017-0332 FEE $135.00 This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires June 032 2017-- ------------unless sooner suspended or revoked. March 06, 2017 --------------------------------------------------------------- BOARD OF HEALTH ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN NUMBER COMMONWEALTH OF MASSACHUSETTS BHP -2017-0332 North Andover FEE BOARD OF HEALTH Peter Breen ------------------------------------------------------------------------------------------------------------- NAME 770 BOXFORD STREET ADDRESS (.0 HEREBY GRANTED A PERMIT V Well Construction C �y f� r Well >' GJ G r, -ited in conformity with the Statutes and ordinances relating thereto, and U June 031 2017 _ -- - - unless sooner suspended or revoked. x,,= nn I March 06, 2017 --------------------------------------------------------------- BOARD OF ------------- � y HEALTH r-t�i--c --------- ---- ------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen ------------------------------------------------------------------------------------------ ---- NAME 770 BOXFORD STREET --------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well NUMBER FEE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires June 03, 2017 unless sooner suspended or revoked. March 06, 2017 --------------------------------------------------------- ---- BOARD OF --------------------------------------------------------------- HEALTH Or -------�--- BOARD OF HEALTH CHAIRMAN NUMBER COMMONWEALTH OF MASSACHUSETTS BHP -2017-0332 North Andover FEE $135.00 BOARD OF HEALTH Peter Breen --------------------------------------------------------------- NAME 770 BOXFORD STREET ----------------------------------------------------------------- -- ---- ----------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires June -0-31-201-7 __ _ unless sooner suspended or revoked. March 06, 2017 r.-- - -------------------------------------------------------------- BOARD OF ----------------------------------------------------------------- HEALTH ------------------------- ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen ------------- NAME 770 BOXFORD STREET ----------------- ADDRESS IS HEREBY GRANTED A PERMIT Well NUMBER BHP -2017-0332 FEE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ---------------- June 03, 2017_ - ___-_ _- _-unless sooner suspended or revoked. ------------------- $135.00 March 06, 2017 ---------------------------------------------------------------- BOARD OF ---- ---------------- HEALTH ----------------------------------------------------------------- ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen ----------------------------------------------------------------------------------------------------------- NAME 770 BOXFORD STREET ---------------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well NUMBER BHP -2017-0332 FEE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ----------------June-0-31-201-7 -_-_________ -unless sooner suspended or revoked. ------------ $135.00 March 06, 2017 ------------------- BOARD OF ------------------ :71 -qHEALTH . --------- ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN ----------------------------------------------------------------- f F- — — -- — -- — -- - -- — 1 COMMONWEALTH OF MASSACHUSETTS North Andover BOARD OF HEALTH Peter Breen -------------------------------------------------------------------------------------------------------- NAME 770 BOXFORD STREET --------------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well NUMBER - 1- -- FEE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ---------------- June 03, -2017 ________ - unless sooner suspended or revoked. ------------------- March 06, 2017 ----------------- BOARD OF -------------------------------------------------------------- HEALTH --------------------------- -------------- --------- -- BOARD OF HEALTH CHAIRMAN 978-375.6557 GEORGE W. ROu.iNs OFFICE: 978.887-2320 President FAX: 978.352-8236 l �o ?®L � C609 ���� �] ARL WELL DRILLING CONTRACTORS Domestic • Geothermal iIrrigation in cserial Full Pump System Installaton www.rollinswell.conm 126 DEPOT ROAD George®rollinswell.com $OXFORD, MA 01921 r TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 9__ --- 03`� Q — e)-00? — moo. e) �(0 Well and/or Pump Application J D (Please print) LOCATION to Drill Well or install a pump: Licensed Wel Contractor Name and Company Name: 587-23z� Cor. - Hoi ion Ad -t Cc T wl Ty Di Q A cP,�_ ill C/ Di S< D �1htJ Depth of water: Drawdown: Dati PU Na Si.. Pi S I A/e e/ (Pvt� ; r e: se of Casing: (p !pth of casing into bedrock: Ing GPM for: (how long) feet after pumping: hours at: `` GPM �cJ ~ 6t '� u. ( S Signature of Contractor K j" %. Ce,..�`S (NW pe: imp delivers: GPM alvanized Plastic o Type of well seal: ;pector S:\Health\Wells\a. Well -Pump Application May 201z).doc Signature of Pump Installer Health Department Representative i� f Town of North Andover RE: Applications for a permit to drill a well: Before a permit can be issued, you must have your contractor submit the following: s 1. Submit to the Health Department a site plan showing the house and or lot footprint 2. Indicate any wetlands within 200 feet of the proposed well location 3. Indicate any septic systems within 200 feet of the proposed well location 4. Indicate the proposed well location 5. Submit a check for $135.00 with the application Note: All submittals must be drawn to ''scale. `',Please note that you may also be required to file with the Conservation Commission i:,wetlands are near to the proposed well, and to the Planning Board if you are located in the Watershed District. - std'. J TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES .._ _ _• HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476—FAX ��/ healthdept@townofnortliandover.com �`7. n --� ��Ca 0000.6 www.townofnorthandover.com 103 0D t Well and/or Pump Application ; (Please print) DATE: LOCATION to Drill Well or install a pump: ��� �� t�LXt.G: Licensed Wel Contractor Name and Company Name: �-"�5., yC p 11 � 6 /l GGI46 `�' , 587-7-5 o C- 9. q r� — .. 1' �' � ! 2 6 1) a i ��. O 207 M A Contact Phone Numbers: I Homeowner: Ce? ) �. r & fp" Address: '726 '� j /j, A P Contact Phone Numbers: 7 WELLS (to be completed at time of pump test) /� Type of well: r) -r f' r5 u„ /� u,. iltd- " —" / Use: Diameter of well: C y Size of Casing: (p Depth of bedrock: Depth of casing into bed Seal been tested? Yes( ) No( ) Date of Depth of well: Depth of water:_ Delivers: Water -bearing rock: Drawdown: feet after pumping: Date of Completion: PUMPS (To be filled in before installation) Name & size of Pump: Size of Tank: Pipe used in well: Sleeve used to protect pipe? Date: Cast Iron_ Yes Date water analysis report submitted to Health Department: Plumbing GPM for: (how long) hours at: GPM ' Signature of WdContractor Type: Pump delivers: GPM Galvanized Plastic No Type of well seal: Wiring Inspector S:\Health\Wells\a. Well -Pump Application May 2015.doc Signature of Pump Installer Health Department Representative f rt A w Town Of North Andover RE: Applications for a permit to drill a well: Before a permit can be issued, you must have your contractor submit the following: 1. Submit to the Health Department a site plan showing the house and or lot footprint 2. Indicate any wetlands within 200 feet of the proposed well location 3. Indicate any septic systems within 200 feet of the proposed well location 4. Indicate the proposed well location 5. Submit a check for $135.00 with.the application Note: All submittals must be drawn to scale. Please note that you may also be required to file with the Conservation Commission ifilwetlands are near to the proposed well, and to the Planning Board if you are i'located in the Watershed District. 9 Commonwealth of Massachusetts City/Town of System Pumping -Record ,a1,t, 8 Form 4 TOWN 0f= Nord HCAL77i ��ri��NoovF� DEP has provided this form for use -by local Boards of Health. Other forms may �be'use�, ts�#Tt)4T 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 housqa� rig rde of house; L;ft / Right side of building, Left / Right front of building, Left / Right rear of building, Under dec!`c"—' . Address 1. L( �f • e•rv� c�`�-- IV �r�-t,,,�. Citylrown State Zip Code 2, System Owner. Name' Address (if different from location) Cityfrown ' SIM- . '• `� `� 5""/ � , .B. Pumping Record 1. Date of Pumping date 2. Quantic Gallons 3. Type -of system: ❑ Cesspool(s) is TanK ❑Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yep 8-11�0 If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of Systern: 6: System Pumped By: Neil. Bateson ' F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location erre contents -were disposed: �,SJP Lowell Waste Water t6form4.doo• 06103 system Pumping Record • Page 1 of 1 ip : Commonwealth of Massachusetts City/Town of .� System Pumping.Record Form 4 Towry or- N� I1EA,LT14 E;jTt LJot/FR DEP has provided this form for use -by local Boards 6f Health. Other forms may ba bse�, iiij�rt 'r Information- must be substantially the same as that provided here. Before using -this form, check with your local Board of Health to determine the forrh 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 hous<& rig de of house,,ft / Right side of building, Left / Right front of building, Left / Right rear of building, Under dec c Address / L/ �1 C���C..=. �� l��r��• City/rown 1 ` l state Tip Code 2. System Owner: Name' Address (if different from location) City/Town - ✓� � tp C de ; �Yy Telephone Number B. Pumping Record 1. Date of Pumping date 1� 2. Quantity Pumped: Gallons r 3. Type -of system: ❑ Cesspool(s)tic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yeas ry'No If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of 6.. System Pumped By: Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locationmh re contents were disposed: A,L S- Lowell Waste Ws —i Date t5form4.doo• 06/03 system Pumping Record • Page 1 of 1 _ . of NORTH 'II V V ? • Town of North Andover HEALTH DEPARTMENT S�GNUS CHECK #: 605 DATE: LOCATION: 0.5922:26 6 H/O NAME: CONTRACTOR NAME11' Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ xWell Construction $135— S,s�: SEPTIC Systems. ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ teuvAgent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER NORTH ANDOVER, MASSACHUSETTS 01845 4 ��h Number Date ssued Emir on Date Jackie's Law — Permit Applic4tion Ge`o-0 �'�R op,cN PN ENZ OF N �PP�t�M Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et se .(as amended) nn PERMIT MUST BE FULLY COMPLETED PRIOR TO CO SIDERATION Name of Applicant 6Tk--, Phone Cell Street Address 2� C �(7 City/rownMA ,n v 1 ZIP d Name of Excavator (if different from applicant) Phone Cell Street Address City/Town MA ZIP Name of Owner(s) of Property6r--P(5' Re—yi �� Ph 5-D Cell nn Street Address (©a S. u l % �t� C-4 ! Lr City/rown A&40 MA Z P / v - 14 D L13 N Y Other Contact Permit Fee Receiv Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a d ription of what is (or is intended) to be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if addition 1 space is needed. 61 -D, I—L It YL T Insurance Certificate #: IJ � Name and Confaet Information of ren. 4-)ge.�z.- c r tolicy Expkation Date: WORK PROPOSED, IN Dig Safe #: q ,e,1r�, APPLICABLE 11UNLCLP Name of Competent PersoYn (ss mpe y 520 CMR 7.02): WORK DONE UNDER THE PERMIT ISSM FOR SUCH WORK WILL COMPLY THEREWITH MassachuSettS Hoisfieg License # _ I I d,'767 06/ AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. 01, License Grade: 1'"1 6 — �, — �X C � � '+-7 BY SIGNING THIS FO THE APPLICANT, .OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIIrY THAT ARE FAMILIAR WITH, OR, $EFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, IN TNG OSHA REGULATIONS, G.L. c. CA, 528 CMR 7.08 et seq., AND ANY APPLICABLE 11UNLCLP ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT WORK DONE UNDER THE PERMIT ISSM FOR SUCH WORK WILL COMPLY THEREWITH ALL RESPECTS AND WITH THE CONDITIONSSET FORTH BELOW. THE UNDERSIGNED O AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO IDERTAIKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURA N OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO IENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERUIG SUCH WORK THE UNDERSIGNED APP CANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE CIPALI. FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN NNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUD BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS F THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND ME S TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLIC OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DE AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED API ICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIF, , AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FRON ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR WSING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANT EXCAVATOR SIGNA OWNER'S 21Page DATE (1F DIFFERENT) DATE DIFFERENT) DATE: O`,MOPTH � 7781 Town of North Andover HEALTH DEPARTMENT SACNUSt CHECK #:6660 DATE:'/7 ao /� LOCATION: /•2.. S �r�_ H/O NAME: _141)lka CONTRACTOR NAME: /'04Z Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICS stems: i L ❑ Septic Soil Testing / $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ k Other: (Indicate) ✓ r $ 00` He?r *-AQent Initials White - Applicant Yellow - Health Pink - Treasurer DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, November 26, 2007 10:04 AM To: DelleChiaie, Pamela Subject: pis mail the MTBE letter to ... According to the GIS Addresses within 1/8 of a mile of 742 Boxford St. / 754 Boxford St - David Hart ,! 729 Boxford St - Jeffery Simmons ° 725 Boxford St - John Glasko 730 Boxford St - Brian Volke 770 Boxford St - Peter Breen 115 Ogunquit Rd. — Peter Breen This is the current recommended radius Susan Sawyer, REHS/RS Public Health Director 978 688-9540 4 PUBLIC HEALTH DEPARTMENT Community Development Division November 26, 2007 Dear Homeowner, RECEIVED DEC 0 5 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT This correspondence is an advisory from the North Andover Health Department. Please take note if you currently have a private well on your property that provides your home with drinking water. On October 05, 2007, residents at 742 Boxford Street reported odors in their drinking water and elected to have their well water tested by a private laboratory. On October 20, 2007, this office received a laboratory report from the testing, which identified methyl(t)butylether (MTBE) and benzene in the drinking water at concentrations of 240 micrograms per liter (µg/1) and 0.80 µg/1, respectively. MTBE and benzene are common chemicals associated with gasoline. The Massachusetts Department of Environmental Protection (MassDEP) has established a drinking water standard of 70 µg/1 for MTBE and 5.0 µg/1 for benzene. MTBE reported from the October 5, 2007 sampling event was above MassDEP's standard of 70 ug/l. In response to the discovery of this drinking water contamination, the Health Department contacted MassDEP and accepted an offer to have MassDEP collect and test additional drinking water samples. On November 9, 2007, MassDEP collected another drinking water sample from 742 Boxford Street. An initial screening of this sample found 320 ug/1 MTBE and 6.5 ugll benzene, thereby confirming the earlier sampling results. This sample was forwarded to the Null Experiment 'Station State Laboratory for analysis. When the State Laboratory results are available, they will be communicated to the homeowner as soon as possible. MassDEP will continue to investigate this matter and work towards identifying the source of the contamination. Per MassDEP's recommendation, the Health Department is now sending this information to you, due to your proximity to 742 Boxford 'Street. Please note that both MassDEP and the Health Department are recommending that you have your well water tested for MTBE, benzene, and other volatile organic compounds associated with gasoline by either a private laboratory or by MassDEP. If you elect to have your well water tested by MassDEP, MassDEP will request that you provide them with either verbal or written permission allowing them onto your property to conduct the water testing. They will also request that you provide to them, to the extent possible, any information you have regarding the depth of your well and any home treatment and/or. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com purification system that may be in use. The water test being offered by MassDEP is at no cost to the home owner. If you chose to have MassDEP conduct your water testing, please contact Larry Immerman, Environmental Analyst at MassDEP, at (978) 694-3347 at your earliest convenience to set a time. Finally, a fact sheet on MTBE has been included with this notice. you, Susan Sawyer, RBHS/RS / Public Health Director Cc: Mark Rees, Town Manager Board of Health Members Boxford Health Department MassDEP Encl. Fact Sheet 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com L COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION NORTHEAST REGIONAL OFFICE 205B.Lowell Street, Wilmington, MA 01887 • (978) 694-3200 DENTAL L. PATRICK IAN A. BOWLES Governor Secretary TIMOTHY P. MURRAY LAURIE BURT Lieutenant Governor • Commissioner February 27, 2008 Peter and Kerry Breen RE: North Andover 770 Boxford Street 770 Boxford Street North Andover, MA 01845 RTN: 3-27511 NOTICE OF RESPONSIBILITY NOTICE OF NEED TO CONDUCT IMMEDIATE RESPONSE ACTION PER M.G.L. c.21E & 310 CMR 40.0000, the MCP THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES. Dear Mr. and Mrs. Breen: The Massachusetts Department of Environmental Protection (MassDEP) has received information that indicate a release of hazardous materials occurred at 770 Boxford Street (the subject property). Testing of groundwater from downgradient sampling wells and drinking water wells detected the presence of benzene and methyl -tertiary butyl ether (MTBE) (see attachments). These findings indicate a likely release from a gasoline underground storage tank formerly used on the subject property. Based on this information, MassDEP hereby issues you a Notice of Responsibility. Please note that exposure to residents associated. with drinking water contamination at 730 and 742 BoxfordStreet has been addressed. The home owners have installed carbon filtration units on their drinking water well supply lines. NOTICE OF RESPONSIBILITY As described above, MassDEP believes that 770 Boxford Street or portion(s) thereof is a disposal site as defined in the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c. 21E, and the Massachusetts Contingency Plan, 310 CMR 40.0000 (the This information is available in alternate format. Call Donald M. Gomes, ADA Coordinator at 617-556-1057. TDD Service 1-978-694-3492. http://www.mass.goV/dep • Fax (978) 694-3499 ZAM� Printed on Recycled Paper North Andover, 770 Boxford Street, RTN 3-27511 Page 2 Notice of Responsibility MCP). The assessment and cleanup of disposal sites is governed by M.G.L. c. 21E and the MCP. This release requires one or more response actions. The purpose of this notice is to inform you of your legal responsibilities under state law for assessing and/or remediating the subject release. For purposes of this notice, the terms and phrases used herein shall have the meaning ascribed to them by the MCP unless the text clearly indicates otherwise. STATUTORY LIABILITIES MassDEP has reason to believe that you are a Potentially Responsible Party (a PRP) with liability under M.G.L. c. 21E, § 5, for response action costs. Section 5 makes the following parties liable to the Commonwealth of Massachusetts: current owners or operators of a site from or at which there is or has been a release/threat of release of oil or hazardous material; any person who owned or operated a site at the time hazardous material was stored or disposed of; any person who arranged for the transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is or has been a release/threat of release of such material; and any person who otherwise caused or is legally responsible for a release/threat of release of oil or hazardous material at a site. This liability is "strict", meaning it is not based on fault, but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. The MCP requires responsible parties to take necessary response actions at properties where there is or has been a release or threat of release of oil and/or hazardous material. If you do not take the necessary response actions, or fail to perform them in an appropriate and timely manner, MassDEP is authorized by M.G.L. c. 21E to have the work performed by its contractors. By taking such actions, you can avoid liability for response action costs incurred by MassDEP and its contractors in performing these actions, and sanctions which may be imposed for failure to perform response actions under the MCP. You may be liable for up to three (3) times all response action costs incurred by MassDEP. Response action costs include, without limitation, the cost of direct hours spent by MassDEP employees arranging for response actions or overseeing work performed by persons other than MassDEP or their contractors, expenses incurred by MassDEP in support of those direct hours, and payments to MassDEP's contractors. (For more detail on cost liability, see 310 CMR 40.1200.) MassDEP may also assess interest on costs incurred at the rate of twelve percent (12%), compounded annually. To secure payment of this debt, the Commonwealth may place liens on all of your property in the Commonwealth. To recover the debt, the Commonwealth may foreclose on these liens or the Attorney General may bring legal action against you. You may also be liable to the Commonwealth for damages to natural resources caused by the release. Civil and criminal liability may also be imposed under M.G.L. c. 21 E, § 11, and civil administrative penalties may be imposed under M.G.L. c. 21A, § 16 for each violation of M.G.L. c. 21 E, the MCP, or any order, permit or approval issued thereunder. L - North Andover, 770 Boxford Street, RTN 3-27511 Page 3 Notice of Responsibility NECESSARY RESPONSE ACTIONS You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at the subject site. You may obtain a list of the names and addresses of the licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals (Telephone: 617-556-1091). If one has not been submitted, a Release Notification Form (RNF) must be submitted to MassDEP pursuant to section 310 CMR 40.0333 within 60 calendar days of the initial date of oral notification to MassDEP of a release pursuant to 310 CMR 40.0300 or from the date the MassDEP issues a Notice of Responsibility (NOR), whichever occurs earlier. Initial site investigation activities in accordance with 310 CMR 40.0405 are necessary. Unless a Response Action Outcome Statement (RAO) or Downgradient Property Status Submittal (DPS) is submitted earlier, a completed Tier Classification Submittal pursuant to 310 CMR 40.05 10, and, if appropriate, a completed Tier I Permit Application pursuant to 310 CMR 40.0700, must be submitted to MassDEP within one year of the initial date notice of a release is provided to MassDEP pursuant to 310 CMR 40.0300 or from the date MassDEP issues a Notice of Responsibility (NOR), whichever occurs earlier. The MCP requires persons undertaking response actions at disposal sites to perform Immediate Response Actions (IRAs) in response to "sudden releases", Imminent Hazards and Substantial Release Migration. Such persons must continue to evaluate the need for IRAs and notify MassDEP immediately if such a need exists. If Imminent Hazard conditions are identified at the site, you must notify MassDEP within two hours and seek approval to perform an Immediate Response Action (IRA) to abate the Imminent Hazard. Furthermore, an Imminent Hazard Evaluation Form must be submitted to MassDEP if Imminent Hazard condition(s) exist. The MCP requires persons undertaking response actions at a disposal site or portion thereof to submit to MassDEP a Response Action Outcome Statement (RAO) prepared by an LSP in accordance with 310 CMR 40.1000 upon determining that a level of No Significant Risk already exists or has been achieved (Class A & B Permanent Solution RAOs) or that no Substantial Hazards exist (Class C Temporary Solution RAOs). The subject site shall not be deemed to have had all the necessary and required response actions taken unless and until a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 2 1 E and the MCP. Pursuant to MassDEP's "Timely Action Schedule and Fee Provisions", 310 CMR 4.00, a fee of $750 must be included with an RAO statement that is submitted more than 120 calendar days after the initial date of oral notification to MassDEP of a release pursuant to 310 CMR 40.0300 or after the date MassDEP issues an NOR, whichever occurs earlier, and before Tier Classification. A fee is not required for an RAO submitted to MassDEP within 120 days of the date of oral notification to MassDEP, or the date MassDEP issues an NOR, whichever date occurs earlier, or after Tier Classification. It is important to note that you must dispose of any Remediation Waste generated at the subject location in accordance with 310 CMR 40.0030 including, without limitation, contaminated soil and/or debris. Any Bill of Lading accompanying such waste must bear the seal and signature of an LSP or, if the response action is performed under the direct supervision of MassDEP, the signature of an authorized representative of MassDEP. North Andover, 770 Boxford Street, RTN 3-27511 Page 4 Notice of Responsibility MassDEP encourages parties with liabilities under M.G.L. c. 21E to take prompt action in response to releases and threats of release of oil and/or hazardous material. By taking prompt action, you may significantly lower your assessment and cleanup costs and avoid the imposition of, or reduce the amount of, certain permit and annual compliance fees for response actions payable under 310 CMR 4.00. If you have any. questions relative to this notice, you should contact Andrew Friedmann at the letterhead address or (978) 694-3217. All future communications regarding this release must reference the Release Tracking Number (RTN 3-27511) contained in the subject block of this letter. Sincerely, Andrew Friedmann, Ph.D. John F. Miano, Jr. Environmental Analyst, Site Management Branch Chief, Site Management BWSC, NERO BWSC, NERO cc: DEP Data Entry/File (NOR/ISSUED), (C&E/INTLET) cce: Susan Sawyer, Public Health Director, North Andover, ssawyer@townofnorthandover.com 0-' COMMONWEALTH OF MASSACHUSETTS J EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION NORTHEAST REGIONAL OFFICE 205B Lowell Street, Wilmington, MA 01887 • (978) 694-3200 DEVAL L. PATRICK IAN A. BOWLES Governor Secretary TIMOTHY P. MURRAY LAURIE BURT Lieutenant Governor Commissioner February 27, 2008 Peter and Kerry Breen 770 Boxford Street North Andover, MA 01845 RE: North Andover 770 Boxford Street RTN: 3-27511 NOTICE OF RESPONSIBILITY NOTICE OF NEED TO CONDUCT IMMEDIATE RESPONSE ACTION PER M.G.L. c.21E & 310 CMR 40.0000, the MCP THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES. Dear Mr. and Mrs. Breen: The Massachusetts Department of Environmental Protection (MassDEP) has received information that indicate a release of hazardous materials occurred at 770 Boxford Street (the subject property). Testing of groundwater from downgradient sampling wells and drinking water wells detected the presence of benzene and methyl -tertiary butyl ether (MTBE) (see attachments). These findings indicate a likely release from a gasoline underground storage tank formerly used on the subject property. Based on this information, MassDEP hereby issues you a Notice of Responsibility. Please note that exposure to residents associated with drinking water contamination at 730 and 742 Boxford Street has been addressed. The home owners have installed carbon filtration units on their drinking water well supply lines. NOTICE OF RESPONSIBILITY As described above, MassDEP believes that 770 Boxford Street or portion(s) thereof is a disposal site as defined in the Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c. 21E, and the Massachusetts Contingency Plan, 310 CMR 40.0000 (the This information is available in alternate format. Call Donald M. Gomes, ADA Coordinator at 617-556-1057. TDD Service 1-978-694-3492. http-.//www.mass.gov/dep • Fax (978) 694-3499 10 Printed on Recycled Paper North Andover, 770 Boxford Street, RTN 3-27511 Page 2 -�' Notice of Responsibility MCP). The assessment and cleanup of disposal sites is governed by M.G.L. c. 21E and the MCP. This release requires one or more response actions. The purpose of this notice is to inform you of your legal responsibilities under state law for assessing and/or remediating the subject release. For purposes of this notice, the terms and phrases used herein shall have the meaning ascribed to them by the MCP unless the text clearly indicates otherwise. STATUTORY LIABILITIES MassDEP has reason to believe that you are a Potentially Responsible Party (a PRP) with liability under M.G.L. c. 21 E, § 5, for response action costs. Section 5 makes the following parties liable to the Commonwealth of Massachusetts: current owners or operators of a site from or at which there is or has been a release/threat of release of oil or hazardous material; any person who owned or operated a site at the time hazardous material was stored or disposed of; any person who arranged for the transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is or has been a release/threat of release of such material; and any person who otherwise caused or is legally responsible for a release/threat of release of oil or hazardous material at a site. This liability is "strict", meaning it is not based on fault, but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. The MCP requires responsible parties to take necessary'response actions at properties where there is or has been a release or threat of release of oil and/or hazardous material. If you do not take the necessary response actions, or fail to perform them in an appropriate and timely manner, MassDEP is authorized by M.G.L. c. 21E to have the work performed by its contractors. By taking such actions, you can avoid liability for response action costs incurred by MassDEP and its contractors in performing these actions, and sanctions which may be imposed for failure to perform response actions under the MCP. You may be liable for up to three (3) times all response action costs incurred by MassDEP. Response action costs include, without limitation, the cost of direct hours spent by MassDEP employees arranging for response actions or overseeing work performed by persons other than MassDEP or their contractors, expenses incurred by MassDEP in support of those direct hours, and payments to MassDEP's contractors. (For more detail on cost liability, see 310 CMR 40.1200.) MassDEP may also assess interest on costs incurred at the rate of twelve percent (12%), compounded annually. To secure payment of this debt, the Commonwealth may place liens on all of your property in the Commonwealth. To recover the debt, the Commonwealth may foreclose on these liens or the Attorney General may bring legal action against you. You may also be liable to the Commonwealth for damages to natural resources caused by the release. Civil and criminal liability may also be imposed under M.G.L. c. 21E, § 11, and civil administrative penalties may be imposed under M.G.L. c. 21 A, § 16 for each violation of M.G.L. c. 21 E, the MCP, or any order, permit or approval issued thereunder. North Andover, 770 Boxford Street, RTN 3-27511 Page 3 Y Notice of Responsibility NECESSARY RESPONSE ACTIONS You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at the subject site. You may obtain a list of the names and addresses of the licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals (Telephone: 617-556-1091). If one has not been submitted, a Release Notification Form (RNF) must be submitted to MassDEP pursuant to section 310 CMR 40.0333 within 60 calendar days of the initial date of oral notification to MassDEP of a release pursuant to 310 CMR 40.0300 or from the date the MassDEP issues a Notice of Responsibility (NOR), whichever occurs earlier. Initial site investigation activities in accordance with 310 CMR 40.0405 are necessary. Unless a Response Action Outcome Statement (RAO) or Downgradient Property Status Submittal (DPS) is submitted earlier, a completed Tier Classification Submittal pursuant to 310 CMR 40.05 10, and, if appropriate, a completed Tier I Permit Application pursuant to 310 CMR 40.0700, must be submitted to MassDEP within one year of the initial date notice of a release is provided to MassDEP pursuant to 310 CMR 40.0300 or from the date MassDEP issues a Notice of Responsibility (NOR), whichever occurs earlier. The MCP requires persons undertaking response actions at disposal sites to perform Immediate Response Actions (IRAs) in response to "sudden releases", Imminent Hazards and Substantial Release Migration. Such persons must continue to evaluate the need for IRAs and notify MassDEP immediately if such a need exists. If Imminent Hazard conditions are identified at the site, you must notify MassDEP within two hours and seek approval to perform an Immediate Response Action (IRA) to abate the Imminent Hazard. Furthermore, an Imminent Hazard Evaluation Form must be submitted to MassDEP if Imminent Hazard condition(s) exist. The MCP requires persons undertaking response actions at a disposal site or portion thereof to submit to MassDEP a Response Action Outcome Statement (RAO) prepared by an LSP in accordance with 310 CMR 40.1000 upon determining that a level of No Significant Risk already exists or has been achieved (Class A & B Permanent Solution RAOs) or that no Substantial Hazards exist (Class C Temporary Solution RAOs). The subject site shall not be deemed to have had all the necessary and required response actions taken unless and until a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21 E and the MCP. Pursuant to MassDEP's "Timely Action Schedule and Fee Provisions", 310 CMR 4.00, a fee of $750 must be included with an RAO statement that is submitted more than 120 calendar days after the initial date of oral notification to MassDEP of a release pursuant to 310 CMR 40.0300 or after the date MassDEP issues an NOR, whichever occurs earlier, and before Tier Classification. A fee is not required for an RAO submitted to MassDEP within 120 days of the date of oral notification to MassDEP, or the date MassDEP issues an NOR, whichever date occurs earlier, or after Tier Classification. It is important to note that you must dispose of any Remediation Waste generated at the subject location in accordance with 310 CMR 40.0030 including, without limitation, contaminated soil and/or debris. Any Bill of Lading accompanying such waste must bear the seal and signature of an LSP or, if the response action is performed under the direct supervision of MassDEP, the signature of an authorized representative of MassDEP. „North Andover, 770 Boxford Street, RTN 3-27511 Notice of Responsibility Page 4 MassDEP encourages parties with liabilities under M.G.L. c. 21E to take prompt action in response to releases and threats of release of oil and/or hazardous material. By taking prompt action, you may significantly lower your assessment and cleanup costs and avoid the imposition of, or reduce the amount of, certain permit and annual compliance fees for response actions payable under 310 CMR 4.00. If you have any questions relative to this notice, you should contact Andrew Friedmann at the letterhead address or (978) 694-3217. All future communications regarding this release must reference the Release Tracking Number (RTN 3-27511) contained in the subject block of this letter. Sincerely, Andrew Friedmann, Ph.D. John F. Miano, Jr. Environmental Analyst, Site Management Branch Chief, Site Management BWSC, NERO BWSC, NERO cc: DEP Data Entry/File (NOR/ISSUED), (C&E/INTLET) cce: Susan Sawyer, Public Health Director, North Andover, ssawyer@townofnorthandover.com Massachusetts Department of Environmental Protection / Bureau of Resource Protection Well Driller Please specify work performed: ]SEPu 9 2Q13 New Well j TO. -.',q 0.= i ,OR-; r P.i4DOVER // HEALTH DEPF,r,-4;i itj Please specify well type: Monitoring Number Of Wells: 11 ---� Well Location In public right-of-way: r Yes f'. No Subdivision/Property/Description: II Property Owner: Engineering Finn: ENDPOINT LLC Address at well location: Street Number: Street Name: 770 —� BOXFORD Building Lot#: Assessor's Map #: Assessor's Lot#: ZIP Code: 1I Citylrown: NORTH ANDOVER GPS (GPS for the deepest well) North: West: 42.40128 171.02350 Mailing Address: click here if same as well location add� Street Number: Street Name: 25 BUT-FRICK ROAD — City/Town: State: LONDONDERRY NEW HAMPSHIRE ZIP Code: 03053 Board of health permit obtained: Q Yes t: Not Required Permit Number: Date Issued:- -- I Massachusetts Department of Environmental Protection Bureau of Resource Protection —Well Driller Program Ll� Well Completion Reports(Monitoring) Well Driller - Monitoring Form DRILLING METHOD Overburden Auger Bedrock Choose Bedrock -- WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in Extra fast or slow Loss or addition of (ft) drill stem drill rate fluid 0� 15 Till 71 113rown L--� Ye r Fast Slow Loss r Addition PERMIT INFORMATION DEP 21 E RTN # DEP Groundwater Discharge # ADDITIONAL WELL INFORMATION Developed (__1 Yes r No Are these wells nested? 0 Yes r No Surface Seal Type Cement Area of group (sq. ft) Total Well Depth 115 Depth to Bedrock CASING !J' Is Casing above ground. From To Type Thickness Diameter Polyvinyl Chloride Schedule 40 SCREEN I ❑ No Screen From To Type Slot Size Diameter 15 Slotted PVC 0 0 WATER -BEARING ZONES Yield From To (gpm) 0 ANNULAR SEAL / FILTER PACK ter a From To Material 1 Weight Material 2 Weight (gWal) Batche Method Of Placement 0� 9� Native Material --- Choose Material --- = Gravity 4� Bentonite Chips/Pellets --- Choose Material --- Gravity F1 5-7 Sand --- Choose Material --- Gravity WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) 8/12/2013 10 COMMENTS Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program Well Completion Reports(Monitoring) WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete a knowledge. Driller IGARYCAOUETTE 7 Registration # 1606 Monitoring [M] 7 Supervising Dri Firm ITECHNICALDRILU G Rig Permit # 167 Date Job Com NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. r -n d-FOd§ ENGINEERS & ENVIRONMENTAL PROFESSIONALS June 19, 2016 Andrew W. Maylor, Town Manager 120 Main Street North Andover, MA 01845 ��,i► . W ?a 16 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Re: Notice of Phase IV Completion and Phase V Remedy Operation Status MassDEP RTN 3-27511 770 Boxford Street North Andover, Massachusetts Dear Mr. Maylor, EndPoint Project No. 2152-001 On behalf of Mr. Peter Breen, this letter has been prepared to notify you of the submittal of a Phase V Remedy Operation Status (ROS) completed to address a historical gasoline release at the above-mentioned property. This notice is being provided to you as required by 310 CMR 40.0000 of the Massachusetts Contingency Plan (MCP). The Phase V ROS was filed with the Massachusetts Department of Environmental Protection (MassDEP) Northeast Regional Office at 205B Lowell Street in Wilmington, Massachusetts. If you wish to review these documents, you may contact that office at (978) 694-3200, and reference MassDEP Release Tracking Number (RTN) 3-27511. Alternatively, you may view the document on the MassDEP website at: http://public.dep.state.ma.us/wse viewer by referencing RTN 3-27511 and selecting from the list of submittals for the Site. Please contact me at (603) 965-3810 if you have any questions. Sincerely, EndPoint, LLC Matthew Simmons Staff Hydrogeologist cc: Town of North Andover Health Department Director Brian LaGrasse Peter Breen 1\server\business\endpoint projects\2152-001 breen north andover\ros june 2016\cmo notification july 2016.docx 25 Buttrick Road, Unit D2 Londonderry, NH 03053 P: (603) 965-3810 F: (603) 965-3827 ,4 TOWN OF NORTH ANDOVER NORTH ANDOVER, MASSACHUSETTS 01845 �aatoe 1a gi,i 4-94 �L Teo SS�iGHUs�` AP ® MAW -is ftztd I . L-A;_ I Eration at Jackie's Law — Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant 6 Phone Cell Street Address 0 A c> -C r� 1 [ p "} / T City/own v -- MA 1, 1� I ZIP . f ( S Name of Excavator (if different from applicant) Phone Cell Street Address City/Town MA ZIP Name of Owner(s) of Property Phone Cell Street Address b C) City/Town MA ZIP r�U-'ivjr4V-� I Y5 Permit Fee Received No Yes Other Contact Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if additional space is needed. Insurance Certificate #: Lk-) p � �p 0 5- e ` t„� ! g �'-/ 2 // / 4/ G • ti- q CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application, the applicant understands and agrees to comply with the following: 21 iv. vi. No trench may be excavated unless the requirements of sections 40 through 40D of chapter 82, and any accompanying regulations, have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including, but not limited to, the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164 (DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section I of Chapter 82 of the General Laws, an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR 1926.650 et.seq., entitled Subpart P "Excavations". Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; By applying for, accepting and signing this pernrit, the applicant hereby attests to the following: (1) that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2) that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CMR 1926.650 et.seq., entitled Subpart P "Excavations" as well as any other excavation requirements established by this municipality; and (3) that he is aware of and has, with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application, complied with the requirements of sections 40- 40D of chapter 82A. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www.mass.gov/dns 3 1 P a g e Name and Contact Information of Insurer: -Policy Expiration Date: Dig Safe #: Name of Competent Person (as definiil by S20 CMR 7.02): 60 L_ -M 6 Massachusetts Hoisting License # /- fi� ( qw'� License Grade: l C 2` 4' L/ A Expiration Date: 7 2'vA BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c. 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW, THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORF_ THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILI'T'Y, CAUSES OR ACTION, COSTS, AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLICANTT S/I�GNATURE' DATE 61 45 IV EXCAVATOR SIGNATURE (IF DIFFERENT) / DATE < �' OWN R'S SIGNATURE (IF DIFFERENT) / DATE 21Page 10/03/2014 12:20 9786833147 rabt ni/ni A�aRt�° CERTIFICATE OF LIABILITY INSURANCEDATE(MMIODr" 10/3/2014 THIS CERTIFICATE 0 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIONTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATRt1;LY OR NEGATWLY AMEND, EXTEND OR ALTER TME CGv MGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 130WEEN THE ISSUING INSURER(S), AUTHORM R€PRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N lite cerpRCate Mkbw is an ADDITIONAL INSURED, the poicAles) Myst be en0orsed_ If SUBROGATION I$ WAIVED, aubjea to the temm Geld condltbrts Of flta policy, Canelo WHOM may mgrdee an endaM ment. A Stat nwi on thts c &#ftcate does not amfar Ngbb SD Sha certlflam hdldar In lieu of % ch andarsament(s PRODUCERCOWAGr M P ROBERTS INS AGCY INC11E1 PHONr . (978) 683-8073 1050 Osgood Street L ArG N�r.(978j 683-314 North Andover, MA 01645 aulao rabertssnsurance.coin 'gUREJae AyRORasm 0-1:11ABE NAMS INSURER A;MEii MITMS AT LLOYDS INWPED PETER PREEN EXCAVATING, INC. A/O INSURER a ; PILGRIM INSURAZTCM CO TRAVIS & TIM CONSTRUCTION INSURER G : ASSOCIATED EMPLOYERS INS CA 770 AOXFORD ST13ZET INSURER D, P=LzM&,SS INSURANCE NORTH ANDOVER, MA 01.845 INSURER E 978-687-7774 THIS IS TO CERT" Tw1T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A@OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TMI9 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED ]BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXGLU$IONS AND CONDITIONS OF SUCH POLICIES. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, AWL ? TYPE -OF INSURANCE POLICY NUMBER Y 4GMyym :�pIAFJiCtAL 6EgExaL LnullLrrr LIMIT$ F1,C14 4CCURR6NCE S 14000,000 Cl: J6tgMAD° I 2L I oxuR PRF,QtIsEslEaacaxre,ca� s 50,000 A GENL AGGREGATE UTAT APPLIES PER: Fi FOUCYPRC)- JECT LOC OTHER. AUTOM09ILE LtwLrrY ANYAUTD B A O OWNED v AUTOS LED X KWD A" ANUrOS UMNWUA LJAeOCCUR 8XCEW UAB n, •n,e ...,.� AND ENPLOYEW C o PROPIttraW e twnexwy In k" D I COMMERCIAL AUTO LGLI022141 02/19114 02/19/1, MrDG* PRODUM - COMMOP AGG 19 1.000.000 TS -�`I PGC00001007123 11/22/1311/22/14 BCDRYIN,IUW(Par pawn) S BODILY IWURY(ft eMdMQ S eraeelds S S �IN/A I IWCCSOOSO104372013A +11/13/13!11/13/14!EL 000 EL DI ME.IA EMPLDYdS 500,000 El. DISEASE-PDUCYUMrP I 1 500.0000 04461952-4 112/06/13112/06/141LI. $1,000,000 )ESCRIPTJDN OF OPERATJpNS I LOCATIONS / VEhOCLES (ACORD 105, Addlilonal Remarks sowula, may be saacmd Jr more aped is regw?W) 'AX: 978-689-87.40 'CM OF NORTH AICOVER IS LISTED AS AN ADDITIONAL INST,TRED IN RESMCTS TO GENERAL ,!ABILITY COVEXAM . TORN OP NORn ANDOVER 394 0S(MOD STREET NORTH MOM MR 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMRATION DATE TMEREC)F, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THh POLICY PROVISIONS. ALJ7MORrMD XRD25(2014M) The ACORD name and lop are registered marks d ACORD tights ltftrVed. EndFfbdg ENGINEERS & ENVIRONMENTAL PROFESSIONALS June 24, 2014 Andrew W. Maylor, Town Manager 120 Main Street North Andover, MA 01845—_ Re:otice of Phase II Remedy MassDEP RTN 3-27511 770 Boxford Street North Andover, Massachgg Dear Mr. Plan �Jc EndPoint Project No. 2152-001 RECEIVED JUN 3 0 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT On behalf of Mr. Peter Breen, this letter has been prepared to notify you of the submittal of a Phase IV Remedy Implementation Plan (RIP) completed to address a historical gasoline release at the above-mentioned property. This notice is being provided to you as required by 310 CMR 40.0000 of the Massachusetts Contingency Plan (MCP). The Phase IV was filed with the Massachusetts Department of Environmental Protection (MassDEP) Northeast Regional Office at 205B Lowell Street in Wilmington, Massachusetts. If you wish to review these documents, you may contact that office at (978) 694-3200, and reference MassDEP Release Tracking Number (RTN) 3- 27511. Alternatively, you may view the document on the MassDEP website at: http://public.dep.state.ma.us/wsc viewer by referencing RTN 3-27511 and selecting from the list of submittals for the Site. Please contact me at (603) 965-3810 if you have any questions. Sincerely, EndPoint, LLC Matthew Simmons Staff Hydrogeologist cc: Town of North Andover Health Department Director Susan Y. Sawyer Peter Breen zAendpoint projects\2152-001 breen residence\phase iv\cmo notification 6-19-14.doc 25 Buttrick Road, Unit D2 Londonderry, NH 03053 P: (603) 965-3810 F: (603) 965-3827 � H ,P V /Ni I V) tP•Ih'H �tp 00,1=(0 •z M d•.u.io ,� L� ffo�to ¢C',:1Mo0 Wo ifl tb O �n..� u �III�u o W J F. N m Ln d" c 00 Ln r , o� Lr) a Mpd -� Er .�� V) o 0 a Q) N V) C C) C3 V o ru4j +' m C3 m r E r.n d-F�!izd§ ENGINEERS & ENVIRONMENTAL PROFESSIONALS March 28, 2013 L 7 2014 TH ANDOVERPARTMENT EndPoint Project No. 21.52-001 Andrew W. Maylor, Town Manager 120 Main Street North Andover, MA 01.845 Re: ice 0TPhase Ll. Comp hensive Site Assessment Report, and Phase III Remedial Action Plan MassDEP RTN 3-27511. 770 Boxford Street North Andover—Massachusetts Dear Mr. Maylor, On behalf of Mr. Peter Breen, this letter has been prepared to notify you of the submittal of a Phase 11 Comprehensive Site Assessment (Phase 11) Report, and Phase III Remedial Action Plan (Phase III) completed to address a historical gasoline release at the above-mentioned property. This notice is being provided to you as required by 310 CMR 40.1403(3)(e) and 40.1403(6)(c) of the Massachusetts Contingency Plan (MCP). The Phase 11 report and Phase III plan were filed with the Massachusetts Department of Environmental Protection (MassDEP) Northeast Regional Office at 205B Lowell Street in Wilmington, Massachusetts. If you wish to review these documents, you may contact that office at (978) 694-3200, and reference MassDEP Release Tracking Number (RTN) 3-2751.1. Alternatively, you may view the document on the MassDEP website at: http://public.dep.state.ma.us/wsc®viewer by referencing RTN 3-27511 and selecting from the list of submittals for the Site. Please contact me at (603) 965-3810 if you have any questions. Sincerely, Endpoint, LLC Matthew Simmons Staff Hydrogeologist cc: Town of North Andover Health Department Director Susan Y. Sawyer zAendpoint projects\2152-001 breen residence\phase ii and iii\cmo notification 3-28-2014.doc 25 Buttrick Road, Unit D2 Londonderry, NH 03053 P: (603) 965-3810 F: (603) 965-3827 0 DATE PRINTED: 12/19/2011 ESTABLISHMENT NAME: Peter Breen File Number: BHF -2003-000011 LOCATED AT: Peter Breen 770 Boxford Street NORTH ANDOVER MA 01845 770 BOXFORD STREET ,MA Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions / Notes Septic Disposal Works BHP -2012-0395 Jan 1, 2012 Dec 31, 2012 $80.00 Affiliated with Peter Breen Installer Excavating, Inc. Total Fees: $80.00 PERMIT EXPIRES IDecember3l,2012 BOARD OF HEALTH r-1 r(-) py r� Y�.L-'..'%fto6 IN Page 1 Cf NOM TN 1 ."Alp 0 • ' • Op Town of North Andover ❑ Body Art Establishment $ emuSEt HEALTH DEPARTMENT CHECK #: DATE: LOCATION: ❑ Food Service - Type: H/O NAME: 5969 CONTRACTOR NAME: / J Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ 9- Septic Disposal Works Installers (DWI) $m-_� ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ r Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Susan Sawyer, REHS/RS Public Health Director TOWN OF NORTH ANDOVER °' "CRT" Office of COMMUNITY DEVELOPMENT AND SERVICES p HEALTH DEPARTMENT } *i,'^+ na ✓tom 1600 OSGOOD STREET; Building 20; Suite 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 - Phone 978.688.8476 - Fax APPLICATION FOR DISPOSAL WORKS INSTALLER'S LICENSE *** Please note that the individual septic INSTALLER is licensed, not the company *** DATE: je-C /�_ TO THE LICENSING AUTHORITIES: The undersigned hereby applies for a license in accordance with the provisions of the statutes relating thereto: NAME: Pe -TC- 6 AFFILIATED WITH FIRM OR CORPORATION: 9 i_`e� C kC c%-U� 1 ( '1zG L v --i C ADDRESS OF COMPANY: ? ? ��}�,v `Sl �� TELEPHONE OF COMPANY: / � y G F- 2 i ? `( E -Mail: ��1,/� ) %v FEDERAL ID#ISS#: TO: CONSTRUCT AND REPAIR SUBSURFACE DISPOSAL SYSTEMS In the Town of North Andover, Massachusetts in accordance with the rules and regal ions made under authority -of said statutes. Contact Phone #: Signature of Applicant Home Address: 2 �U FEE: $80.00 RENEWALS - LATE FEE: Additional $80.00 - after January lst Please make check payable to the Town ofNorth Andover, and mail to above address. Include with application: ➢ Three (3) letters ofreference ➢ Copies oflicenses from other towns ➢ Copy of Heavy Equipment Operators License ➢ Proof of $100,000 General Liability insurance %a wA) oic7 IJ647FI Leo Rg l> OP 40ILTfi .5 A e -._ ...... CA a �CrJ=i0----------- IU F NORTH ANDO` ;R/ BOAR) OF HEALTH FFR . 2 .�.. z -d HCH -4 wdrIv _ R nnRF__R7-q r r. N Town Of North Andover Community Development & Services • : 27'Charles Street ' (978)tor As68.8--9531—- North Andover, Massachusetts 01845 (g78) Aw s78.688-9542 Conservation (978) 688.9S30 Dear Peter: tteotn At the Board of Health's regularly scheduled meeting on March 23, 2000 the Avartmenr North Andover Board of Health granted a two-year extension on the soil test (978) 588-9540 results obtained on Lot 24 (or 770 rear) Boxford Street. The results shall be valid until Murat 23, 2002, providing the topography on the site has not changed. Public Health Nurse If you have any questions please feel free to call the office at 978-688-9540. (978) 688-9S43 Planning Sincerely, awrbwAr Sandra Starr, RS., C.H.O. Health Director cc: file July 13, 2000 Board of APPealS (978) 688-9547 Nk. Peter Breen Sodding 770 Boxford Street Deparr"M No.. Andover, MA. 01845 (978) 688-9545 Conservation (978) 688.9S30 Dear Peter: tteotn At the Board of Health's regularly scheduled meeting on March 23, 2000 the Avartmenr North Andover Board of Health granted a two-year extension on the soil test (978) 588-9540 results obtained on Lot 24 (or 770 rear) Boxford Street. The results shall be valid until Murat 23, 2002, providing the topography on the site has not changed. Public Health Nurse If you have any questions please feel free to call the office at 978-688-9540. (978) 688-9S43 Planning Sincerely, awrbwAr Sandra Starr, RS., C.H.O. Health Director cc: file TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr Public Health Director February 27, 2003 Mr. Peter Breen 770 Boxford Street North Andover, MA 01845 RE: Lot 24 (770 Rear), Boxford Street Dear Mr. Breen: riaasH F A x - • SACttUSi Telephone (978) 688-9540 FAX (978) 688-9542 At the North Andover Board of Health meeting on January 23, 2003, the Board reviewed your request for a one-year extension of the soil test results obtained on August 17, 1998 at Lot 24 Boxford Street. The Board determined that too much time has elapsed since the soil tests were performed, and that updated tests should be carried out. The Board therefore denied your request for another extension. In the year you are ready to build on this lot, please apply for soil testing. In addition, a site visit by the Board of Health staff must be done prior to sign off on the Building permit. If you have any questions, please feel free to call the office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Xc: File Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director March 1, 2002 Mr. Peter Breen 770 Boxford Street No. Andover, MA 01845 Dear Peter: f NCRIq� Q then e�7`O ti p M's SACHUS�S Telephone (978) 688-9540 Fax(978)688-9542 At the Board of Health's regularly scheduled meeting February 28, 2002 the North Andover Board of Health granted a one-year extension on the soil test results obtained on Lot 24 (or 770 rear) Boxford Street. The results shall be valid until February 28, 2003, providing the topography on the site has not changed. A site visit by the Board of Health staffmust be done prior to sign off on the Building permit. If you have any questions please feel free to call the office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: file BOARD OF APPEALS 688-9541 BLIILDNG 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 -7-6tvN oil: /MV71 AtvboUe,, BoAgI�> dP7 4oqL.774 _-- _-5,�Af_DO� AT __ .... i 7 -A Down Of North Andover Community Development & Service WIAW" j. scorn a 27 Charles Sb%W Direttar ` — - North Andover, Massachusetts 01845 (978) W-9531 PDX 978-688-9542 &Wrd of July 13, 2000 Appeals (978) 6W-9541 W. Peter Breen 8+a?Q(ng 770 Boxford Street Depart~ No. Andover, MA 01845 (978) 688-9545 CoaStrVaL10R �r rr bear Peter. (978) 688A530 lkmd, At the Board of Health's regularly scheduled meeting on March 23, 2000 the pr#WnMW North Andover Board of Health granted a two-year extension on the soil test (978) 6W -9S40 results obtained on Lot 24 (or 770 rear) Boxford Street. The results shalt be valid until Alarob 23, 2002, providing the topography on the site has not changed. Public Health Abase ('978) 688-9543 lel WFWAg O" arb»ent (978)588-9535 S 'd If you have any questions please feel free to call the office at 978-688-9540. Sincerely, -,ja"J44a., Sandra Stan, R.S., C.H.O. Health Director cc: file InIM4J IA -4 1 r - G nl-AM'7 G7 n NORTa Town Of North Andover OF tt�ao r°�$O Community Deveiopment & Services 27 Charles Street o .^ M --..... . North Andover, Massachusetts 01845 9SSACHU`��� Fax 978-688-9542 Board of July 13, 2000 Appeals (978) 688-9541 Mr. Peter Breen Building 770 Boxford Street Department No. Andover, MA 01845 (978) 688-9545 Conservation Department Dear Peter: (978) 688-9530 William J. Scott Director (978) 688-9531 At the Board of Health's regularly scheduled meeting on March 23, 2000 the Health Department North Andover Board of Health granted a two-year extension on the soil test (978) 688-9540 results obtained on Lot 24 (or 770 rear) Boxford Street. The results shall be valid until March 23, 2002, providing the topography on the site has not changed. Public Health Nurse If you have any questions please feel free to call the office at 978-688-9540. (978) 688-9543 Planning Sincerely, Department (978) 688-9535 l Sandra Starr, R.S., C.H.O. Health Director cc: file NpRTIr BOARD OF HEALTH 30 SCHOOL STREET NORTH ANDOVER, MASS, 01845 APPLICATION FOR SOIL TESTS DATE: -7/ 171'7- LOCATION OF SOIL TESTS.- Assessor's ESTS:Assessor's map & parcel number: Lo-- �2y 131x'4-JQ r1C f 5i TEL. 688-9540 0WNER: �� f� — TEL. NO.: -Z -- ?'7 ? ADDRESS: —7-7Z' � z �e .- �S '7'• ./�/ °L�� v ENGINEER: TEL. NO.: 7 SSI CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commercial 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 V75.00 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. July 6, 1998 Ms. Sandy Starr Board of Health 120 Main Street North Andover, MA 01845 Re: Soil Testing'- Lot 24 Boxford Road Peter Breen, Owner Dear Sandy: On behalf of our client, Peter Breen, we are hereby requesting a scheduled soil testing date to test at the above -referenced lot. The lot has an existing barn on it and we would like to conduct soil testing for a proposed septic system for new construction. We have attached 2 plans which show the lot; Peter will be providing the check for $275. We understand that you will be forwarding this request to Port Engineering, the Town's consultant, and they will schedule the date. If you have any questions regarding this please do not hesitate to contact our office. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. 6,tL9 Kathy Molina Personal Assistant Attachments #684 BrccnTcsts.wps • ENGINEERS LAND SURVEYORS LAND USE PLANNERS 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (978) 887-8586 FAX (978) 887-3480 Applica Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH 19� APPLICATION FOR SITE TESTING/INSPECTION Aee-4 77tl Asa Site Location I -Q % 22 6 36 Engineer M Test/I nspection Date and Time F7-77 CHAIRMAN, BOARD OF HEALTH Fee �. Test No. �6l S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts BOARD OF HEALTH i APPLICATION FOR SITE \ TESTING/ INSPECTION on e.icne .aP``.5 Form No. 1 19 ' Applicant NAME ADDRESS TELEPHONE Site Location - Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee `' Test No. , S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11— SOIL EVALUATOR FORM Page 1 of 3 No. 684 Date: 8/24/98 Commonwealth of Massachusetts North Andover, Massachusetts Soil Suitability Assessment_ for On-site Sewage Disposal Performed By: Thomas E. Neve Date: 8/17/98 Witnessed By: Robert Desmaris Date: 8/17/98 Location Address or 770 Boxford Street Owner's Name Peter Breen Lot # 9 North Andover, MA Address and 770 Boxford Road, N. Andover, MA 01845 Telephone # (978) 687-7774 New Construction Repair Office Review Published Soil Survey Available: No = Yes 0 Year Published 1981 Publication Scale 1" = 1320' Soil Map Unit CbC Drainage Class `B" Soil Limitations Surficial Geologic Report Available: No 0 Yes Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No Yes X Within 500 year flood boundary No X Yes Within 100 year flood boundary No X Yes Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range: Above Normal Normal 0 Below Normal Other References Reviewed: T DEP APPROVED FORM —12/7/95 DocumenQ JUL 2 1 FORM 11— SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 9, 770 Boxford Street On -Site Review Deep Hole Number OP98-1 Date 8/17/98 Time 9:00 am Weather Rainy 70° F Location (identify on site plan) See Plan Land Use Residential Slope (%) 0-3% Surface Stones Few Stones Vegetation Wooded Landform Outwash Plain Position on landscape (sketch on the back) Distances from: Open Water Body — feet Drainage Way — feet Possible Wet Area 1150 feet Property Line 30 feet Drinking Water Well — feet Other — DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Bounders, Consistency, % Gravel) 0-81, A FSL 2.5Y4/3 No 8 — 20" Bw FSL 2.5Y6/6 No 20 —108" C FSL 2.5Y5/4 Nested Rock 108 — 132" Cr *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) Ice Contact Outwash Depth to Bedrock: 132" Depth to Groundwater: Standing Water in the Hole: 120" Weeping from Pit Face: -------- Estimated Seasonal High Ground Water: 69" DEP APPROVED FORM —12/7/95 DocumenC FORM 11— SOIL EVALUATOR FORM Page 2a of 3 Location Address or Lot No. Lot 9, 770 Boxford Road On -Site Review Deep Hole Number OP98-2 Date 8/17/98 Time 9:00 am Weather Rainy 70° F Location (identify on site plan) See Plan Land Use Residential Slope (%) 0-3% Surface Stones Few Stones Vegetation Wooded Landform Outwash Plain Position on landscape (sketch on the back) See Plan Distances from: Open Water Body — feet Possible Wet Area I Z.0 feet Drinking Water Well _ feet Drainage Way — feet Property Line %0 feet Other — DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Bounders, Consistency, % Gravel) 0-81, A FSL 2.5Y4/5 No 8 — 30" Bw FSL 2.5Y6/6 No 30 — 120" C FSL 2.5Y5/4 C, @ 120" *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) Ice Contact Outwash Depth to Bedrock: 120" Depth to Groundwater: Standing Water in the Hole: ---------------- Weeping from Pit Face: Estimated Seasonal High Ground Water: 72" DEP APPROVED FORM —12/7/95 DocumenQ FORM 11— SOIL EVALUATOR FORM Location Address or Lot No. Lot 9, 770 Boxford Road Determination_for Seasonal High Water Table OP98-1 Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles 69" inches Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment factor Adjusted ground water level Page 3 of 3 Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/95 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature DEP APPROVED FORM —12/7/95 DocumenQ FORM 11— SOIL EVALUATOR FORM Location Address or Lot No. Lot 9, 770 Boxford Road Determination _for Seasonal High Water Table OP98-2 Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles 72" inches Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment factor Adjusted ground water level Page 3 of 3 Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/95 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature a'c Date $1 34)9% DEP APPROVED FORM —12/7/95 DocumenC FORM 12 — PERCOLATION TEST Location Address or Lot No. Lot 9, 770 Boxford Road COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test* Date: 8/17/98 Time: 10:00 am Observation Hole # Perc 98-1 Perc 98-2 Depth of Perc 36" 72" Start Pre-soak 10:29 11:57 End Pre-soak 10:51 12:12 Time at 12" 10:51 12:12 Time at 9" 11:19 12:30 Time at 6" 12:08 1:15 Time (9"-6") 49 Min 45 Min Rate Min./Inch 17 MPI 15 MPI *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed Performed by: Thomas E. Neve (Engineer) Witnessed by: Robert Desmaris, Port Engineer (Board of Health) Comments: DEP APPROVED FORM —12/07/95 DocumenO 1 ,1 � � � �r � o � �� � 1 �\ 1 � 1 � 1 � � � -_ � � � THO July 14, 2000 Board of Health 27 Charles Street North Andover, MA 01845 Attn: Sandra Starr Re: Lot 9, 770 Boxford Road — Peter Breen Dear Sandy: In accordance with 310 CMR 15.018 — Function of Soil Evaluators, find enclosed copies of the certification forms for the soil testing which was conducted at the above -referenced property on 8/17/98. If you should have any questions regarding any of this information please do not hesitate to contact our office. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. VA. M'v ' John M. Morin, PE Executive Vice President JMM/jmp Enclosures 684nabh.DOC • ENGINEERS LAND SURVEYORS LAND USE PLANNERS 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (978) 887-8586 FAX (978) 887-3480 c c 0 c c Z a v 1 O c a C c CD LAfll 1 Z a� a v I n 9 3 (D D _a- 0 7 n 0 3 3 L 0 1 m 0 Zi -- Z foo v 0 n 0 a o' J rY' i c� aov n w lD (D rr O c�D � m � � o C 'a O N m 0 c 0 n c 3 al rr D 0 a 1 l Q C) O V) (D CL x n� V g r FORD U - LOT RELEASE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having have been obtained. This does not relieve thea lant is landowner from compliance with any applicable local state law, regulations or requirements. ****************Applicant fills out this section***************** VAPPLICANT: �e Tc.T G �1 Phone t/ LOCATION: Assessor's Map Number 0 !-t Parcel Subdivision • ,, / Lot(s) Street St. Number—22 ************************Official Use•Only************************ DATIONS OF, WN �S: /7 Conservati Administrator Comments���' ° :; / �?L, Ix - 1 Town Planner Comments Date Approved /c, Date Rejected Date Approved Date Rejected Food Insp or -Health Date Approved Date Rejected e is Inspector -Health Date Approved 7 Date Refected Comments i Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date W t SOIL PROFILE & PERCOLATION TEST DATA North Andover,Mass. No.&Stif4eet Lot No. Loc./Subdiv. Plan Owner LAInvestigator b)tir,,.Jl� Observer SOIL PROFILES -DATE Y -1 -f -7g 1' Elev. �' Elev. 3' Elev.` 4'Elev. 0 0 0 0 1 1 1 1 Ties to Test Pits' 2 2 2 2 3 3 3 3 4 n 4 QA 4 4 - S 5 -- 5 5 i i 6 6 6 6 x-76 6 7 7 7 .7� 8 8 8 8 9 9 9 9 A- LO 10 10 10 Benchmark Location Elevation Datum r Percolation Tests -Date Pit Number 1 2 3 4 S Start Saturation 11 i Soak -Mins. S Start Test -Time c� Drop of 3" -Time - 1 Trop of 6 "-Time :31 Mins.lst 3"Dro b Mins.2nd 3"DroIq Notes & Sketches on Back Commonwealth of Massachusetts Massachusetts System Pumping Record vvvrj OF iwfr r. -; " ROh�V .l.. f .'1 )OVER/ System Owner System Location Ro �-cl Date of Pumping: ' Cesspool: No Yes Ij Quantity Pumped: lab gallons Septic Tank; No Yes System Pumped by: Fctadda 5,I&7 q4w License # D Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: WELL DATABASE ADDRESS: AGE OF W- WELL DRILLER: W -ELL WELL LOCA=F� -'W= PF-RvILT DA -7-E:- DEP711 OF WELL: TYPE OF WELL: a- DRD= b. DUG C. WKI-NIC)IRNI. MF-OFWA=EakRISG RCCK- WA= AYAT-YaS DA=- EICH!keCGANYESE:. Y HIGEIRGN. y N OTHER CCNTANM'TANTS. y N AGE OF W1 "W"'HL PERI WELL PERI TYPE OF 7�7=: a.. DRILLED << b. DUG TYPE OF WATER BEARD, TG ROCK: WATER ANIALYSIS DATE: IEC -F, MANGANESE. Y I -IGH IRON: Y N OTHER C ONTA-'Lv�, 4-N,7S: y �a THO ; AS E NEVE MAR 10 ASS"C RTES, INC. s March 8, 2000 Ms. Sandy Starr Board of Health 27 Charles Street North Andover, MA 01845 Re: 770 Boxford Street Owner: Peter Breen Dear Sandy: On August 17, 1998 we conducted soil testing at the above -referenced project. Our client does not expect to do any work on this site this year, however, Board of Health Regulation 7.05 states that the test pit data expires in 2 years unless the Board of Health or their Agent determines the test pit data to be sufficient and that the site has not changed. Please be aware that the testing done is'sufficient for the design of a septic system and the site has not changed since the testing. At this time we are requesting a 1 year extension of the deep observation hole results extending the expiration of the test pit data to August 17, 2001. If you would like us to make this request in person please schedule us for the next available Board meeting and notify us of that date. If you have any questions please do not hesitate to call. Sincerely, THOMAS E. NEVE ASSOCIATES, INC. John M. Morin, PE Executive Vice President JMM/kmm ... cc: Peter Breen #1651BH.doc _ .. . • ENGINEERS LAND SURVEYORS LAND USE PLANNERS 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (978) 887-8586 FAX (978) 887-3480