Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 78 EQUESTRIAN DRIVE 4/30/2018
M i .• .i �� c e '94f, f ,,,, �, �f BMJ a �•• '.K I{^t'jI� •.r �' •'f OS r ,, 4 t, 4. ! f t.yi w 1} x _ .,.,p, .li4j rty,� d• r� let MAP # ,,,. LOT . # PARCEL #�.r//I,v STREET . �ONSTRUC.TIO.IV_APPROVAL, HAS PLAN REVIEW FEE .BEEN PAID? YES �> NO PLAN APPROVAL: DATE �C�� `//9 APP. BY " ry DESIGNER: /% PLAN DA"1'E. CONDITIONS WATER SUPPLY: WELL PERMIT WELL TESTS: COMMENTS: TOWN WELL DRILLER CHEMICAL DAZE APPROVED 9AC.-TERIA I DAIE (IPPRUVED BACTERIN DA T*E AT=,PRUVEL) _ FORM U APPROVAL: APPROVAL l'U ISSUE YES -NU i DATE ISSUED f�/ �� BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER 5� iU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: �D YES NO YES NU YES NO YES NU YES NO DATE - LACT_QLl :.. ..Farr v'i�f 'i. �. r _. ♦ 1.•..y y�,� "J'•. .!` i•. T ?. f:;�':i.'; \.t�: P•��, . �1 .: `iY.. Y' 'THE*INSTALLER LICENSED? :: `+ ` y,�7,; ':. ES NO --:!-'TYPE. OF CONSTRUCTION: t NEW REPAIR NEW CONSTRUCTION_ : ,.•. CERTIFIED PLOT PLAN REVIEW. ,LQYE NO CONDITIONS OF.. APPROVAL YES NO (FROM . FORM U) . ISSUANCE OF DWC PERMIT ! ' . YES NO DWC PERMIT NO. r 7V/ `"' INSTALLER: 7416/, lrtc 'L%Dolt✓ .. ' BEGIN) INSPECTION EXCAVATION. INSPECTION: NEEDED: '' •fir. _ .. •. L:.- �,--J.. PASSED HY .,•" CONSTRUCTION INSPECTION: NEEDED: BUILT PLAN SATISFACTORY: �E - APPROVALTO BACKFILL: DATE: HY "FINAL.GRADING APPROVAL: DATE J�S By ' FINAL CONSTRUCTION APPROVAL:" DATE: BY Date ... I.Z.I.13 /l ! ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .UStI h n ! } C o has permission for gas installation in the buildings of ......... 517i?t? , , .. Al. S, , . , , , . , . , , at 0r, ,v -e - ., North.Andover ass. FeeJ,04 Lic. NoJL?4. ll!44<... Oh1.a.... GAS INSPECTOR Check # yeeg 7961 NLASSAG SETMS UNU MM APPUCATON FOR PERNIrr TO DO GAS FITTING (Type or print) NORTH ANDOV ER, MASSACHUSETTS Date 12-03M Building Locations 79 E4t.r.e S 4-v: aN Permit # Amount $ Owner's Name Mac:a�r..d Sdr.K;�S New ® Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name MnaiA:�;co plMMb;,,spy�l �.dc�i ince ❑ Corp. Address _-1 F6c"+- Sf- VA -1d tv 6-A Partner. Business Telephone Firm/Co. :dame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3 No o If you have checked �, please indicate the type coverage by checking the appropriate box. Liability insurance policy© Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the :Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent hereby certify that all of the details and information I have submitted ('or entered) in above application are true and accurate to the - best of mN knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code ; of Chapter 142 of the General 1 iw B y: Title C i ty/Town WROVED (OFFICE USE ONLY) S nature of LicCl ensed Plumber Or Gas Fitter Number EDGas Fitter nSC i um er Master M Journeyman U zWz v� UO x F 0�y4+ H as o w e d x z Z oEOw �� C W W H H 6 x A 9 Z a 0 W - Cl EM ENT SUB -BA SEM--ENT--I-- U > BIDI ENT B;D. 1FLOOR r 2FLOOR 3 F L O O R 4FLOOR5FLOOR 6 T H. FL O OR 7TH. FLOOR 8TH. FLOOR (Print or type) Check one: Certificate Installing Company Name MnaiA:�;co plMMb;,,spy�l �.dc�i ince ❑ Corp. Address _-1 F6c"+- Sf- VA -1d tv 6-A Partner. Business Telephone Firm/Co. :dame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3 No o If you have checked �, please indicate the type coverage by checking the appropriate box. Liability insurance policy© Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the :Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent hereby certify that all of the details and information I have submitted ('or entered) in above application are true and accurate to the - best of mN knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code ; of Chapter 142 of the General 1 iw B y: Title C i ty/Town WROVED (OFFICE USE ONLY) S nature of LicCl ensed Plumber Or Gas Fitter Number EDGas Fitter nSC i um er Master M Journeyman The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ky www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 3 i o,rest st City/State/Zip: )4 j A, t„4.,,� Mak Phone #: R 715- 26s— 6 Esq Are you an employer? Check the appropriate box: 1. ® 1 am a employer with .3 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. -[No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction. 7. ❑ Remodeling. 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 I .!Plumbing repairs or additions 12.❑ Roof repairs 13.e Other_ *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HA.'a— ,& JAS"grewae Ca....aan v Policy # or Self -ins. Lic. #: U' "( 5 B R Lt Q C-3'70 Expiration Date: 3' 2,11 1). Job Site Address: -246 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town officiat City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: I Date . ///�e�1�� ......... TOWN OF NORTH ANDOVER s PERMIT FOR GAS INSTALLATION This certifies that .. /� L. ! �. �R",Wq ............. . has permission for gas installation ../`!!�. ,�?�?.:...Z; s . in the buildings of ... . at ....%. �� '.ST.j ............. North Andover, Mass. Fee. ,.2O,.�-U Lic. GAS INSPECTOR Check # Z3 57 7933 MA ' /010 —//1 INSURANCE COVERAGE - 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes I!fNo ❑ if you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy L 1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ By checking this box p;1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installatlons"�erformed under a ermit issued for this application will be In compliance with all Pertinent pr Isiorr of the Massachusetts State Plumbing..M-6- rind Chapter 14 of th General Laws. By Type of License: j [] Plumber Title 171 Gas Fitter Master Sig ature of Licensed lumber/Gas Fitter ❑ City/Town ❑Journeyman` APPROVED 1OFFICF [iSF ANI V% F] LP Installer License Number: `7 ESTIMATED COST OF JOB 0/oyv MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: N//1/D® i��/` MA. date: r/ Permit# ' Building Location: Owners Name, Ad Type of Occupancy: Commercial❑ Edu` tional ❑ Industrial 1`71 institutional F1 Residential [ New: Q/Aiteratlon: [3 Renovation:' Replacement: ❑ Plans Submitted: Yes ❑ No 12/ INSURANCE COVERAGE - 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes I!fNo ❑ if you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy L 1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ By checking this box p;1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installatlons"�erformed under a ermit issued for this application will be In compliance with all Pertinent pr Isiorr of the Massachusetts State Plumbing..M-6- rind Chapter 14 of th General Laws. By Type of License: j [] Plumber Title 171 Gas Fitter Master Sig ature of Licensed lumber/Gas Fitter ❑ City/Town ❑Journeyman` APPROVED 1OFFICF [iSF ANI V% F] LP Installer License Number: `7 ESTIMATED COST OF JOB 0/oyv z tl' W V mW 47 W 0 co H 0� � W CO m 0 Fa' W O jj0 111 W N to U W W O~ W N p Q Q= XSL Z W !W- W U)-4 Q W Q Om W O 0 O~ ►— — > I H v n O t=i. (Q7 __ 0 a rR F>>> z S p SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR WH FLOOR VH FLOOR 8 FLOOR r� 1 �(' , 11 installing Company Name: Nf �- /`' -�/J r�g✓� • /;N�t;L �l�.G:tff�`s. Check One Only Certificate # , 1— /f r. _, y� �✓j� Address./10 , / J iff u ' i City/Town: r 1, D Off- l<> L State: ❑ Corporation ! Business Tei: 7`K , 7 �7'-j - 4 �7 cri. i Fax: ❑ Partnership Name of Licensed Plumber/Gas Fitter: ` t- i%/�.�'f�iz ,�; �t Firm/Company INSURANCE COVERAGE - 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes I!fNo ❑ if you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy L 1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: i am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ By checking this box p;1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installatlons"�erformed under a ermit issued for this application will be In compliance with all Pertinent pr Isiorr of the Massachusetts State Plumbing..M-6- rind Chapter 14 of th General Laws. By Type of License: j [] Plumber Title 171 Gas Fitter Master Sig ature of Licensed lumber/Gas Fitter ❑ City/Town ❑Journeyman` APPROVED 1OFFICF [iSF ANI V% F] LP Installer License Number: `7 ESTIMATED COST OF JOB 0/oyv TR E 77 S RERVAN H P.'SMA 14 WAYNE RD PEABODY on alogn-Insiv SON15 1 ASTRUX2 ni 77X352 =mA T ia N, rft;mit W X. n let (Wnne CV TUZ WUME SPAM, The Commonwealth of Mnsachti-yetis Print Form Department of Industrial Accidents Of rice orini cstir,ations 1 Cort;ress Street Suite 100 Boston, 111A 02114-2017 wrvIv.mass. bov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractot-s/Electricians/Plumbers Applicant Information Please Print Legibly NameBusiness/Org.utirtttionilndividuai);4+1���' .�.)t'= ��'���J���'C�/•`rt::C o .I} , fz&, r, r Address: 1 /f Ci Phone #: ! C Are you no employer? Check the appropriate box: 1.0'l 1 111: a employer with / ��• 4. ❑ I am a general contractor and I employees (full and/or part-time), have hired the sub -contractors 2. ❑ 1 arts a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity, employees and have workers' [No workers' comp. insurance camp. insurance." required.] 5. (—} We are it corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp_ right of exemption per iM01, insurance required.] '` e. 152, § 1(4), and we have no employees. [No workers' coniv. insurance required.] Type of project (required) 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 101-1 Electrical repairs oi- additions 1 1.❑ Plumbing repairs or additions 12.❑ Roof repairs 1.3.❑Qthef��/1 � `( l�,tij.; I GY n../µ%4J F• ?C'l% ,Irrlf_L: 'Any applicrurt thm checks hos 1.1 must also till out the section belon'showing their workers' compensation polies' information, (` Homco)cners \thn submit tills affidavit indicating tile)• are doing ail work and then hire outside contractors nrost submit a new afndurit indicmine such. ,Ctill u'acaors that check this hox nwst attached an additional sheet showing the oanle of the suh•cnntraetors11ud state tchClhcr or not those entities have cn)pioyees. II'the sub-contraclors harc employees. IlteY most provide Illeir wmka)s Con),), poliCv 11!11141,;!-. 1 (!111 (111 C%11J1(lpei' !41(11 iS iJJ'oVi(/i/1�, tVo!'lie/'S'' L'oJltlJetiS'(flit)!1 I/LSIt!'(f/tCC �(J/' /tf,' G'pi1110)1CC'S'. Below is the poliq and job Site it{%ornurlion. Insurance Company Name: t r ' ..L luc Policy tt (n' Self -ins. l..,ie, #i: j r? Expiration Date: 0/ Job Site Address: — If e _s / �t l� %>(/ City/State/Zip:, Attach a copy of the �vot•kers' compensation policy, declarati n page (Showing the policy number and expiration (lat'e). Faittu-e to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of(i tine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine oftip to 5250.00 a clay aga tSAthe violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA, "for i lsurallce C(nlerape verification. 1410 that the i llbrltlatiolr proi'ided above is trijg (111(1 C 1.1'eCt, (I)"Iciat Ilse o» I),. Do r,tJt write in this urea, to be ColNpleted b.1, eilp or town o/Acitli. City ol- Town: PCI'll]it/L.ieettSe # Issuing Authority (circle one) - 1. Board of Health 2, Building Depal'tment 3. City/Town Cleric 4. Electrical hispectol• 5. Plumbing lnspectol• 0, Other Contact Pclsorr: Phone #: 310 C'.AR Form 5 �-_ _•�- Ccmmonweattn '— of Massacnusetts Lot 20A Equestrian Estates Order of Conditions A=ijcant Michael & La ur_ rip Pellegrino Massachusetts Wetlands Protection Ac: �. C.L. c. 131, §40 and under the Town of ;forth Andover's Wetlands Bylaw, Chapter 178 From NORTH ANDOVER CONSERVATION COMMISSION Tc Michael & Laure Pellegrino Sam (Na ;,e of Appiicanti 69 Perry Road Accrers Bedford, N.H. 01110 ACcre_s (Name of creoerty owner) This Crcer is:ssuec anc celiverec as fottows: oy r,2nc ce!ivery ;c acciic::.nt or reoresen;auve cn (ca'ei C oy Cor;f jea •;,a:i. return rece:at reauestea cn This crc:ec':s ioc=*ea G1 Lot 20A Equestrian EGtateG The crc=e.^•v is reccrcea at the Remstry cf Deeds, North FCQPY oc:: 2061 page 44 CEr:ttZie (if ror•e eron� (a --:E! f July 8, 1994 !care! The Net,ca Inten: fcr:n:s crc;ec: was fiiec cn he _••^'jc ne-aring was closed on August 3, 1994 !Cate: Fina;ncs The NACC nas reviewea the above-referencec Nc:::e cl Inter.: anc c:a; s anc nas neic a ---clic nearing ;ne _.c;ea:. =zseo on the intcr'mauon ava�iai:e tc the NACC at tftis ::rr:e.:ne NAC has ceterminea -ria: the area on wnrcn:ne crccoseo wont is to ce ccrie rs signnic ant to the teifowing interests in acccrcance witn :ne �rESutT�::cns of Significance set 1c n in ;fie reg:aanons'or eac.^. Area Suolec: ,a Prmec::an Uncer the Ac: ;c:_cx ze ac=1c=natel: Ch. 178 tC: Prevention of erosion and sedimentation Pu:.iic water suca:v Ficoe control L: Land cantwnine snelffisn f'OF l;t .:i,L. r'��(. DEP FA* m 242-703 AUG L� L s4 r ? � 9 Ch. (To to avow vy GEF) State Share,_ Torsi „inc GN•Town North Andover Lot 20A Equestrian Estates Order of Conditions A=ijcant Michael & La ur_ rip Pellegrino Massachusetts Wetlands Protection Ac: �. C.L. c. 131, §40 and under the Town of ;forth Andover's Wetlands Bylaw, Chapter 178 From NORTH ANDOVER CONSERVATION COMMISSION Tc Michael & Laure Pellegrino Sam (Na ;,e of Appiicanti 69 Perry Road Accrers Bedford, N.H. 01110 ACcre_s (Name of creoerty owner) This Crcer is:ssuec anc celiverec as fottows: oy r,2nc ce!ivery ;c acciic::.nt or reoresen;auve cn (ca'ei C oy Cor;f jea •;,a:i. return rece:at reauestea cn This crc:ec':s ioc=*ea G1 Lot 20A Equestrian EGtateG The crc=e.^•v is reccrcea at the Remstry cf Deeds, North FCQPY oc:: 2061 page 44 CEr:ttZie (if ror•e eron� (a --:E! f July 8, 1994 !care! The Net,ca Inten: fcr:n:s crc;ec: was fiiec cn he _••^'jc ne-aring was closed on August 3, 1994 !Cate: Fina;ncs The NACC nas reviewea the above-referencec Nc:::e cl Inter.: anc c:a; s anc nas neic a ---clic nearing ;ne _.c;ea:. =zseo on the intcr'mauon ava�iai:e tc the NACC at tftis ::rr:e.:ne NAC has ceterminea -ria: the area on wnrcn:ne crccoseo wont is to ce ccrie rs signnic ant to the teifowing interests in acccrcance witn :ne �rESutT�::cns of Significance set 1c n in ;fie reg:aanons'or eac.^. Area Suolec: ,a Prmec::an Uncer the Ac: ;c:_cx ze ac=1c=natel: Ch. 178 tC: Prevention of erosion and sedimentation Pu:.iic water suca:v Ficoe control L: Land cantwnine snelffisn Pnvate water sucZy ( Storm carnage areventton Cf Fisheries Grourt: water suc=ly 178Wildlife Prevention of bafiuuen Prc%ecrcn of wiidlife nani.o: Ch.17 Recreation Ch. State Share,_ Torsi „inc C''vr?own Share t117 5n ('f. tee in excel cl Total Retur.0 Cue : C:tvr?own Porion c State P --n cn 5 (1/2 :0/a11 ('/z :01211 #242-703 20A Equestrian Estates (Laconia Cir) 2 Therefore, the North Andover Conservation Commission (hereafter the "NACC") hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, the local ByLaw and Regulations, to protect those interests noted above. The NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent,xthe conditions shall control. GENERAL CONDITIONS 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order. 5. This order may be extended by the issuing authority for one or more periods of up to one year each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Where the Department of Environmental Protection is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 7. The proposed work includes construction of a dwelling and appurtenances. 8. The work shall conform to the following (except as noted in the remainder of this document where revisions may be required): (a) Notice of Intent filed by Michael and Laurie Pellegrini (b) Plans prepared by Neve Associates, revised July 28 1994. 9. The following wetland resource areas are affected by the proposed work: buffer zone and BVW. These resource areas are significant to the interests of the Act and Town Bylaw as noted above. These resource areas are also significant to the recreational and wildlife interests of the Bylaw. The applicant #242-703 20A Equestrian Estates (Laconia Cir) has not attempted to overcome the presumption of significance of these resource areas to the identified interests. 3 10. The NACC agrees with the applicant's delineation of the wetland resource areas on the site as shown on the plans dated 7/28/94. Prior to the issuance of a Certificate of Compliance, the applicant will submit a plan showing the site's wetland delineation at a scale identical to the Town wetland map for this location. 11. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject flooding or storm damage.. 12. The conditions of this decision shall apply to, and be binding upon, the applicant, owner, its employees and all successors and assigns in interest or control. to 13. The NACC finds that the intensive use of the upland areas and. It buffer zone proposed onthis site to construct a dwelling and due appurtenances will cause further alteration of the wetland W` resource areas. In order to prevent any alteration of wetland resource areas beyond those proposed in the Notice of Intent and approved herein, a twenty -foot (20) foot no -disturbance zo and throuah A-8. This wall shall be made of a twentX-five (25) foot no -construction zone shall be established �0 from7i e edge or the adjacent wetlands. No disturbance of construction and shall be constructed prio""" existing grade, soils or vegetation is permitted in the no-- o disturbance zone. (See Appendix 5 of the local Regulations). A �1 �.�p conditional waiver to the local bylaw requirement of a 25 foot nof no -disturbance zone and a 50 foot no -build zone to permit disturbance at 20 feet from flags A-3 tbgoucth A-8 and a 25 foot no -build fro -9 thrnu=- A-7 is granted with.�� following requirements. In order to prevent a potential must encroachment situation created by the no -disturbance and no -build ` �►� waiver, a landscape wall of at least Z_fe�.et constructed along the noted no -cut line due in hei t must be west from fla s A 3A throuah A-8. This wall shall be made of stone or timber ` construction and shall be constructed prio""" o i�iat' on of �1 �.�p the sanit nof o e ouri a i.on. T e •undation drain shown on the plan must be kept outside the 20 foot no -disturbance zone. PRIOR TO CONSTRUCTION 14. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department or Court have been completed. 15. This Order shall be recorded by the applicant at the Registry of Deeds immediately after the expiration of all appeal #242-703 20A Equestrian Estates (Laconia Cir) 4 periods. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the North Andover Conservation Commission on the form at the end of this Qr-der prior to commencement of the work. 16. A sign shall be displayed at the site not less than two s are feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection, File Number 242-703." 17. Any changes in the submitted plans caused by the applicant, another Board's decision or resulting from this Order of Conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds said changes to be significant, the NACC will call for another public hearing (at the expense of the applicant). Within 21 days of the close of said public hearing the NACC will issue an amended or new Order of Conditions. Any errors found in the plans or information submitted by the applicant shall be considered as changes. The proposed project may be still under review by other local or state boards or agencies. This may result in changes to the project plans or wetland impacts. If any such changes occur a revised plan and an explanation of the revisions shall be submitted to the NACC for review and approval prior to the start of construction. No work shall begin on a project until written Da proval has been granted by the NACC. 18. The applicant shall contact the Conservation Office prior to e preparation or construction and shall arrange an on-site conference with an NACC representative, the contractor and the applicant to ensure that all of the Conditions of this Order are understood. This Order also shall be made a part of the /100, contractor's written contract. The applicant or contractor shall notify the NACC in writing of the identity of the on-site construction supervisor hired to coordinate construction and to ensure compliance with this Order. DtheThe applicant shall submit a construction schedule/sequence NACC detailing the proposed sequence of work on site to atruction lete this project. Wetland flagging shall be checked prior to start of and shall be re-established where missing so that erosion control measures can be properly placed and wetland #242-703 20A Equestrian Estates (Laconia Cir) 5 impacts can be monitored. 02 A row of staked hay bales backed by a siltation e shall e placed betweena construction areas an wet ands. The ICY app erosion control barrier will be properly installed and placed as indicated on plan and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. All erosion prevention and sedimentation protection measures found necessary during construction shall be implemented at the direction of the NACC. Vsiturbance, The applicant shall have on hand at the start of any soil removal or stockpiling, a minimum of 20 hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence). Said bales shall be used only for the control of emergency erosion problems, and shall not be used for the normal control of erosion. 23. A proper bond or a deposit of money running to the Town of th Andover shall be provided in the amount of 4000 which shall be in all respects satisfactory to Town Counsel', --Town Q Treasurer, and the NACC, and shall be posted with the North Andover Town Treasurer before commencement of work. Said bond or deposit of money shall be conditioned on the completion of all conditions hereof, shall be signed by a party or parties satisfactory to the NACC, and Town Counsel, and shall be released after completion of the project, provided that provision, satisfactory to the NACC, has been made for performance of any conditions which are of continuing nature. The applicant may propose a bond release schedule keyed to completion of specific portions of the project for the NACC's review and approval. This condition is issued under the authority of the local Bylaw. DURING CONSTRUCTION 24. Upon beginning work, the applicant shall submit written progress reports every one month detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This will update the construction sequence. 25. Any fill used in connection with this project shall be clean fill, containing no trash, refuse rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any of the foregoing. 26. No exposed area shall remain unfinished for more than thirty (30) days, unless approved by the NACC. #242-703 20A Equestrian Estates (Laconia Cir) 6 27. No regrading in the buffer zone shall have a slope steeper than 2:1 (horizontal:vertical). Slopes of steeper grade shall be rip -rapped to provide permanent stabilization. 28 There shall be no stockpiling of soil or other materials hin twenty-five (25) feet of any resource area. 29. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system or wetland resource area. 4 30. All waste generated by, or associated with, the construction activity shall be contained within the construction area, and away from any wetland resource area. There shall be no burying of spent construction materials or disposal of waste on the site by any other means. The applicant shall maintain dumpsters (or other suitable means) at the site for the storage and removal of such spent construction materials off-site. 31. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 32. Members of the NACC or its agent shall have the right to enter upon and inspect the premises to evaluate and/or effect compliance with this Order of Conditions. The NACC reserves the right to require, following field inspection, additional information or resource protection measures. 33. During and after work on this project, there shall be no discharge or spillage of fuel, or other pollutants into any wetland resource area. If there is a spill or discharge of any pollutant during any phase of construction the NACC shall be notified by the applicant within one (1) business day. No construction vehicles are to be stored within 100 feet of wetland resource areas, and no vehicle refueling, equipment lubrication, or maintenance is to be done within 100 feet of a resource area. AFTER CONSTRUCTION 34. No underground storage of fuel oils shall be allowed on any lot within one -hundred (100) feet of any wetland resource area. This Condition shall survive this Order of Conditions, and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland Protection ByLaw. 35. Fertilizers utilized for landscaping and lawn care shall be organic and low -nitrogen content, and shall be used in moderation. Pesticides and herbicides shall not be used within 100 feet of a wetland resource area. This condition is issued under the authority of the Town's Wetland Protection ByLaw. Lff #242-703 20A Equestrian Estates (Laconia Cir) 7 36. Upon completion of construction and grading, all disturbed areas located outside resource areas shall be stabilized permanently against erosion. This shall be done either by loaming and seeding according to SCS standards. If the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. 37. Upon completion of the project, the applicant shall submit a letter to the NACC from a Registered Professional Civil Engineer certifying compliance with this Order of Conditions and the approved plans referenced herein (or approved revisions). A stamped "As -Built" topographic plan of all areas within the jurisdiction of the Wetlands Protection Act and Bylaw shall be submitted when a Certificate of Compliance is requested. This plan will include: a. "As -Built" elevations of all drainage structures constructed within 100 feet of any wetland. b. "As -Built" elevations and grades of all filled or altered wetland resource areas. C. Distances from structures to wetlands. d. A line showing the limit of work. "Work" includes any disturbance of soils or vegetation. 38. The following special conditions shall survive the issuance of a Certificate of Compliance for this project: 13. The landscape wall along the no -disturbance line. 33. Discharge or spillage of pollutants. 34. Prohibition of storage of fuels underground. 35. Limitations on the use of fertilizers, herbicides and pesticides'` **Due to the sensitive nature of this project with neighboring property owners along the no-cut/build waivers, the NACC recommends that the applicant retain as many trees along the side 7 property lines as is feasible., S 0, / n - 0 X 0 e 703 Registry of Deeds Northern District of Essex County Lawrence, MA 01840 09/28/95 MICHAEL PELLEGRINI DR # 90 Rec4time 1232 Type ORDER 14.00 Inst 22125 Copies 6.00 Postage 0.32 Total 00. 3---� # 91 Payment Cash 50.35 # 012 Change 30.03 THANK YOU' Thomas J. Burke Register of Deeds J Deta cn on ccttec line ana submit to the North Andover Conservation Comm. prior to commencement of work. .................................................................................................................................................................................................................. r To North Andover Conservation Commission 'ssL:'Ic Futncrity fU Please ce aav:sec tnat the Oraer of Conatuons for the orciect at Lot 26A Fq .ttPa�-v'; an Razatac .. c.ie Numcer 242-703 nas ceen reccrcea at the Aerrsry of Deeds North Essex Inc �t t nas peen notec in the cnain of title of the aftectec crcoerry in acccraance wom General Conatnon�8�o-n t 9 �,.. It reccrcea tans. the instrument numoer wntcn taennt:es m:s mansacnon is ` V t� If reo,sterea lana. the cccument numoer which taentdies tats transaction is cV • � �cc:�cc^' kir Jl N 03 i c i3 (w� 03) b2) _ 16W Issued By North Andover / Conservation Commission Signature(s) -� � v /11 17— This Oraer must be signed by a majority of the Conservation Commission. On this f -7 day of f✓�c A:( �� ? 19 C� , before me personally appeared �.-3 t J ' ; � .0 J -, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he: she executed the same as hisiher free act and deed. (1 / My Commission Expires June 20, 1997 Notary Public My commission expires The aacucant. the owner. any person aggrieved by this Order, any owner of land abuning tine land upon which the orcocseo work is to oe done. or any len residents of the city or town In whtCn SUCK land is located. are rtereoy notified of their right to request the Debanmenl of Environmental Protection to Issue a Suoerseding order, providing Ina request Is made by certified mall or hand delivery 10 the Deoanmeni. with the acoroartate filing fee ano Fee Transmittal Form as orovlaed in 310 C1.1R 10.03(7), within ten nays from the Cate of issuance of tints Determination. A copy at the request snail at the same time be sent by cenfiea mad or hano oeirvery to the Conservation Commission ano ins applicant. If you wish to appeal this decision under the Town Bylaw, a complaint must be filed in Superior Court. Detach on aottec line ana submit to the North Andover Conservation Comm, prior to commencement of work. .................................................................................................................................................................................................................. To North Andover Conservation Commission 'ssu:nc Aulnor ;v Please oe advised that the Order of Conatlions for the protect at Lot 20A FgiipgQ"yli nn R3C A t -pc =,ie Numoer 242-703 i,as been recoraec at the Re?,sry of Deeds North F.ccax Inc has oeen notes in the cnain of tine of the atteciea crooerry in acccrcance with General Conoiuon 8 on t 9 It reccroea lana. the Instrument numaer Wnlcn ICendties this czr=cuon t3 If registeree lana. the cccument numoer wnicn identifies thtStransaction is sicnature 5..:A Commonwealth of Massachusetts City/Town of System Pumping Record NORTH ANDOVER .y Form 4 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 Pum ifi4'R&ord,musAbe-submit ed to the local Board of Health or other approving authority within 14 days from thetpurnpii�gd�ate to accordance with 310 CMR 15.351, li i ' c B. Pumping Record at2. Quantity Pumped: Date of Pumping v - Gallons 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe):.. -- 4. Effluent Tee Filter present? es ❑ No 5. Condition of stem: - 6. System Pumped By: Name 01 CoTnpany 7. Location where contents were disposed: Signature of Hauler l�Q�/rence, MA. — Signature of Receiving Facility — If yes, was it cleaned? es ❑ No Vehicle License Number Date Date t5form4.doc• 03/06 System Pumping Record • Page t of 1 A. Facility Information TOWN OF NORTH ANDOVER I Important: HEALTH DEPARTMENT When filling out forms on the 1. System Location: S •CPN computer, use only the tab key to move yourh Address p P`� ---- -�S cursor - do not CitylTown _ ..-.._..__ . Sate Zip Code use the return key. 2 System Owner: — Name different from location) Address (if City/Town- State Zip Code _10V G/? _'.97c/-000.2 . Telephone Number B. Pumping Record at2. Quantity Pumped: Date of Pumping v - Gallons 3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe):.. -- 4. Effluent Tee Filter present? es ❑ No 5. Condition of stem: - 6. System Pumped By: Name 01 CoTnpany 7. Location where contents were disposed: Signature of Hauler l�Q�/rence, MA. — Signature of Receiving Facility — If yes, was it cleaned? es ❑ No Vehicle License Number Date Date t5form4.doc• 03/06 System Pumping Record • Page t of 1 o° rn�zd-�No ooNo�o�o� k v N— N— NNNNNN U - Lu J ti o II -4 ^�N � II II -- QJ ALJ �U �.�•�oo� NO h Qa (f)Q)C) Q ` v '�j 11 II II II vv Qm Q) C:) QQ) O CQ O I � • � o p i J o° rn�zd-�No ooNo�o�o� k v N— N— NNNNNN U - Lu J ti o II -4 ^�N � II II II II QJ ALJ �U �.�•�oo� NO h Qa (f)Q)C) o° k o U - Lu J -4 ^�N � II II II II QJ ALJ �U i NO h Q ` '�j 11 II II II vv Qm Q) C:) QQ) o° U � vC,i b ` \ k o Zo' - Lu J -4 �v o i NO h Q ` U � vC,i b ` \ y! i k o 00 F - Lu J I �v o i y! i � \ \ . / / / u / \ E n •§ / S \ o / m 00 \ 7 6 ® I )4 t o . q § }' \ / \ / _ .\ % \ \ / ƒ . Z «o \ » > 5 m m \ \ / 2 O w § f ) - k,u I v��-_tA t ±»\° 0 2 L ,� % \ / 000 e \ 0 =O ® / 0 > z 3 ® _\ �0 (2 2 ce / / / \ � a \ Z 2 . L_ e a >7f) -4 f \ % � 2 ¥LA \ ce � u \ 2c / § - . = w O w -Prd y u / ° / 2 k E » _ � O p g m V) 0 % a m/ U st o Un { 7 § } � / c � \ / 5 ! | % a � � / � ) 14 u J O , • w a114 r a y+ co 0 � O , • w a114 r co r -1 � y+ co A � � a Ec x a w 2 O z CD , • CD CL r co r -1 � y+ co -C . f� `. .i 4r Ec . • ` ,. . 3 m . t WE (X ts.l C 06 w C c a; � C3 CD = p .•-e c] O c w V V LQ ii s r, Q C O. L � . C ^: N Cc :mc QQ _ c, : > 3 LA - C ;v CD S i•�m r' cv i— O a o ": CO O w� LCA .,. Em •a C LAJ �. .. RCS r0. C 6t1 •..r;4; iii N m ' • :.0 � CC CD , • CD CL r co r -1 � y+ co -C . f� `. .i 4r Ec . • ` ,. . 3 m . t WE (X ts.l C 06 w C $ C3 m a C ^: N N _ c, : > 3 C ;v CD S i•�m N O t CO O O .,. Em •a �. .. RCS cm •g ,,: •..r;4; iii N m ' • :.0 � CC O p m C � C=, rn c Q m =:cmc c c N H IJJ O C,_ � _ •-• •N •Q= ev I-- c W E G)-0cGo o V m 0 N y a 4D g _ � ` N •a 0 =�a�m::o CD , • co r -1 � 4 -C . f� `. � r i? . t WE (X ts.l ` - 06 w C C3 9w� r� O z J a a U o cz v) w U w T` v O H w . U �w cn A w G 4 0 w 43 y O w • C: ,C �, O Df _CCD yr CR O CD p 0 CIE LL s CS c�� co Lj CJ •� Li -.: C O. O ��' ti. l t•.. $vj m c co c' `:nuc ^� m Ea Cl—CD .oca •y m � C •C p ... �- W H 'E .2 sC � 'o � H Z ta.4 CDa cm m� o= _O ~ E c C#* y 0 CD7 .� 06mi , co Y CL -- f C., m C C* § m �` y h ' .._._ ... H cm ccl 3 '50 C CA .0 .: H f H A CO O H w . U c�7 A w G 4 0 w P a� 0 CD O O v Z co a O h G C I CCM co CD O� CA 'E CO CO CD fr 3 O CL3 CD Q !D O o- c cc Ca C CDC Cc Cc JCA •� CD C Z V y ccC cc 'C c CL is Q V -140 E U) y O w • C: ,C �, O Df _CCD yr co CD w H Z 0 CIE LL -.: C O. O C •� ti. l t•.. m m c c' `:nuc ^� COD W LL •y m � C •C p ... �- W H 'E .2 sC � 'o � H Z ta.4 a cm m� o= _O ~ C#* y 0 .� 06mi a� 0 CD O O v Z co a O h G C I CCM co CD O� CA 'E CO CO CD fr 3 O CL3 CD Q !D O o- c cc Ca C CDC Cc Cc JCA •� CD C Z V y ccC cc 'C c CL is Q V -140 E U) I -OWN OF i-'\ N Lh_) U SYST1 ,.j PoMPINO ucc) OCT 0 7 2005 JY5r8M OtiYNKRADDJU�s --77':'TOWN OF NORTH ANDOVER SY$TE \;)EPARTVENT DAT'l OF PVMp]NQ: TITY pLlWpccl t ruKI5 Oe 3eRywa b N I t, K u t;,N (, , Ud�ttRY clooc) C*'r.40 V L I l'u zv 6�L5B 1\ . VZA3 3 KQQT�., 8AY_tr�83 IN 8XQU$jV8 SOLID& Le_A_-H�FleL 0 K UN "OL ID CA KA YQ ng- PLOODED ONER - EXPLAIN n 7') u WN 1 JRl ANL cR/ q BC 'OF WALT TOWN OF FORTH ANDOVER NOV -4 2002 SYSTEM PUMPING R-ECORD l Eh1 OWNER &-A DDRESS ! SYSTEM LOCATION - (e.xmPle: lef( front of housr). OF PUMPINC: QUANTITY PUMPED/S)6( ��1'001- NO V- YES A -i URE OF SERVICE: ROUTINE rRV \TIoNs: COOD CONDITION HFAVY CREASC ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SEPTIC' TANK: NO Y ES EMERCENCY FULL TO COVC'< BAFFLES IN PI" ACID LEACHFICLD 1ZLN�ACK FLOODED Oj�HFR (EXPLAIN,) i >> > I LNI PUMPED BY: .u�1���1CNTS: �GG� �Giit. t ✓o iz (� f wn U^\ I I;N I'5 TRANSFERRED To: S, , I 4- O cn a LL 1F - O N Z PJ IIi I 6 itG a >r E G f o m y c c n L Q U C � L L jq. R O .� EY C c r� +� a w � I + U ' fa a 2 w O O m O :s.+ I F- Q) � +O t Q w O O E m 3 V O O C im to Z n W 1•� D •v'=+ E o LL c v O 1 � • y J W O N = Z Z 0 a+ wN 'N° c E N a 0 m CL W to v O. O cd kA _ F— a V1 � C in Q J Q D 0 i- W > W s > = O o 'OLn v LL O a Q o. 3 m c Q p Q N 0 _ 0 Q z Z Ln v Z N O Ix w M -0 O O CD W m w C O v v Z O 3 N w c 0 m Q + N c o J fl O75 N bq oqta ra a> F p C O v O • � � o� y � N U f,, tiMo1 '�� Q N a .0 Li Town of North Andover, Massachusetts Form No. 3 HORTM BOARD OF HEALTH 19 95 Ot o e1h0 DISPOSAL WORKS CONSTRUCTION PERMIT Applicant 1(1/ll�01% 0'A-�� NAME ADDRESS TELEPHONE Site Location 1 o) -T- ir'n' n Permission is hereby granted to Construct (�or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Fee CHAIRMAN, BOARD OF HEALTH D.W.C. No. (k) !_ CV5 4 40 O z P— 0�0 O H C, n� c :moo O o � C O CO) C " c O v o V L3 � C�7 v • :�'`' a cc C w ch w° U w . c� w l�J w� cn c) O H W W co CD w L O Z co 0. O y � C co cm I O C CO) G-0 m m i � _ CLIn CD CD L M 0 CL �Q CO2 C Q f+ CIO V a oCD c Z m CD CL V y � C R H C, n� c :moo O o � C O CO) C " c O V L3 C. • Jn : a cc C K" CD4 O o a= v o a ca ��✓✓. d 4� V rte+ 4f c d: cCA cc fib; ,:• CO �7.• � L N is � � � .m ..:. W •p ,i ' E m CD .00 N `o'er c�•�2 1: C Q o Q CD3 m CD F- C F_ `j ; acn +• N m O�'OZ W C C 'a N = C W •E VO 'O V 03 pl v m C� c _02 ao a •O R C2 N F- = ON CL -P. m W W co CD w L O Z co 0. O y � C co cm I O C CO) G-0 m m i � _ CLIn CD CD L M 0 CL �Q CO2 C Q f+ CIO V a oCD c Z m CD CL V y � C R H 4 OCT -2 -1995 1':41 THOM.H'S E. hEl..'E / TE S-0 XTES, ING Tc:—S DATE.— MESSAGE; DF—AlZ SAIJ : HeRE -Aw--S C-0P1lF,;S- L-c>-r ZOATe-r-51' ?I-r'S SZ e3 We.Q.9 PERF–ORMEE> 6,J MARC -A J.T -71 werze P*zF;oRme--t> o, -J A)OV. j�CL -.T6'5-r.S WaRE PiSMICOOZMED -!"q------THC PJZe'5W--JCe OF /-Yllk-& - 07yJ-qf!.. Eo"' A. T�He-- .1497(.P�VL- - /P WO C-A,,,J,-J0-t- R6AP 7-NeSOE-- Mores c)rz j4Av4F 4 -JY FViF--rJ4GV– Pate I of R. 01 NOTE: If you have not received the cored amount or pages, please call. - ENGINEERS * , LAND SURVEYORS LAND USE PLANNERS - 447 Old Boston Road US, Route #1 Top*Tield. IMA 01963 508) 887 8586 rAX 0081 887.480 � � y� � � `/ � ~ i � •� cif . Town of North Andover 01 NORTN . OFFICE OF 3? e o e. ti L COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street KENNETH R- MAHONY North Andover, Massachusetts 01845SSNCHSACH �y 9US�t Director (508) 688-9533 FAX TRANSMITTAL �/ Deliver to M /y EI/vL Company DATE: From FAX Number 88 7- 13 FAX Number: 508-688-9542 Total Number of Pages Including Transmittal Form / CZ- P e J 7—ef-76 T '7717-5 � i 0,4' 77 v& -.e u 777zla,7" -,-17 -7/,-�A),e -5 729 BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell N May 16, 1994 I North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 20a Equestrian Drive Dear Board Members: Pursuant to our letter to you dated April 26, 1994, in anticipation of your conducting a public hearing on this matter on Thursday, May 26, 1994, find attached a notice to abutters sent by Certified Mailed - Return Receipt Requested in accordance with the State Environmental Code 310 CMR 15.00. We are looking forward to meeting with your Board to present this matter. If you should have any questions please do not hesitate to contact me. Very truly yours, THOMAS E. NEVE ASSOCIATES,.. INC. CZ -/ Thomas E. Neve, PE, PLS President TEN/km Attachment #965 PELLEGRIMPS • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 .1 THOMAS &NEVE ASSOCIATES, INC, Notice of Public Hearing The North Andover Board of Health shall be conducting a public hearing at the Town Hall, 120 Main Street, on Thursday, May 26, 1994, at a time to be determined by their agenda, for the application of Michael Pellegrini, Lot 20a Equestrian Drive requesting a Variance from the particular provisions of the State Environmental Code 310 CMR 15.00 in order to install an impervious barrier adjacent to a proposed leaching area and to sand fill around the leaching trenches. Certain local waivers are being required from the Board of Health Regulations as it relates to the design flow Section 2.14, the reserve area spacing Section 2.23, the proximity of the leaching facility to the wetlands Section 4.18 and the width of the trenches Section 17.04. The specific information shall be presented at the above -referenced meeting by the applicant's engineer, Thomas E. Neve, Associates, Inc., 447 Boston Street, Topsfield, (508) 887-8586. Plans may be reviewed at the Board of Health Office between the hours of 8:30 a.m. and 4:30 p.m. by appointment. • ENGINEERS - 447 Old Boston Road (508) 887-8586 • LAND SURVEYORS • U.S. Route #1 • LAND USE PLANNERS • Topsfield, MA 01983 FAX (508) 887-3480 i BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 -n Fn MEMORANDUM TO: Robert Nicetta, Building Inspector FROM: Sandra Starr, R.S., Health Administr RE: Lot #20A Equestrian Drive DATE: May 10, 1994 TEL. 682-6483 Ext23 For your information the engineer, Mr. Thomas Neve had requested a hearing before the Board of Health on April 28, 1994, to apply for a variance on this lot for distance to wetlands. He withdrew his request prior to the Board of Health meeting, therefore, no action has been officially taken on this lot. The owner does not have an approved septic design and can only get an approved plan with a variance from the Board of Health. After conducting a site inspection on Saturday, April 23, 1994, I could not recommend a variance approval for this lot. If you have any questions, please give me a call. Thank you. SS/cjp t_ I TH April 26, 1994 Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 20a Equestrian Drive Dear Board Members: On March 21, 1994, I wrote you a letter updating you as to the status of the above -referenced project. Since that date I met with the Zoning Board of Appeals and have requested a front line setback of 20 feet in order to eliminate filling of the vegetated wetlands behind the house. I also redesigned the location of leach field in order to minimize grading within the buffer zone. The septic plan has been revised dated March 21, 1994, and was previously submitted to you with correspondence of the same date. The Zoning Board of Appeals has continued their hearing until May 10, 1994. During your meeting of January 27, 1994, you had indicated that you would be receptive to the variances being requested, however, wanted to reserve judgment until such time as you could view the site and see how the lot was to be developed. At this time I ask that you schedule a site visit for that purpose. Please note that I would like to accomplish the following agenda: 1. Have a site visit with your Board prior to May 10, 1994, and establish through a "straw vote" how you feel about the variances being requested. 2. Return to the Zoning Board of Appeals on May 10, 1994, asking them to make a final determination on the variance setback. 3. Appear before the Conservation Commission on May 11, 1994, and ask them to render their decision with respect to this final design. 4. Then I would request that you place us on the agenda for your meeting scheduled for May 26, 1994, so that we can have an official public hearing on the variances being sought. Please note that the variances must be decided upon at a public hearing duly advertised with abutters notified of the 11 days in advance of the hearing. This hearing must be held in strict accordance with Title V (3 10 CMR 15.20). • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 Board of Health April 26, 1994 Page 2 I hope you are able to accommodate this schedule. I thank you in advance for your cooperation in this matter and I look forward to meeting with you soon. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. Thomas E. Neve, PE, PLS President TEN/km Enclosure cc: Michael Pellegrini #965 PELLEGRIMPS MI, April 26, 1994 Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 20a Equestrian Drive Dear Board Members: ING. On March 21, 1994, I wrote you a letter updating you as to the status of the above -referenced project. Since that date I met with the Zoning Board of Appeals and have requested a front line setback of 20 feet in order to eliminate filling of the vegetated wetlands behind the house. I also redesigned the location of leach field in order to minimize grading within the buffer zone. The septic plan has been revised dated March 21, 1994, and was previously submitted to you with correspondence of the same date. The Zoning Board of Appeals has continued their hearing until May 10, 1994. During your meeting of January 27, 1994, you had indicated that you would be receptive to the variances being requested, however, wanted to reserve judgment until such time as you could view the site and see how the lot was to be developed. At this time I ask that you schedule a site visit for that purpose. Please note that I would like to accomplish the following agenda: 1. Have a site visit with your Board prior to May 10, 1994, and establish through a "straw vote" how you feel about the variances being requested. 2. Return to the Zoning Board of Appeals on May 10, 1994, asking them to make a final determination on the variance setback. 3. Appear before the Conservation Commission on May 11, 1994, and ask them to render their decision with respect to this final design. 4. Then I would request that you place us on the agenda for your meeting scheduled for May 26, 1994, so that we can have an official public hearing on the variances being sought. Please note that the variances must be decided upon at a public hearing duly advertised with abutters notified of the 11 days in advance of the hearing. This hearing must be held in strict accordance with Title V (3 10 CMR 15.20). • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 Board of Health April 26, 1994 Page 2 I hope you are able to accommodate this schedule. I thank you in advance for your cooperation in this matter and I look forward to meeting with you soon. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. Thomas E. Neve, PE, PLS President TEN/km Enclosure cc: Michael Pellegrini #965 PELLEGRLWPS PPP G.. .?_-4 h _11 !-!E', F `i . _1 --!TF.`. r April 26, 1994 - Board of Health 120 Main Srtre?et North Andover, MP, 01 S 4 .7 Ke: Lot 20a Eque:strxa.z Drive Dear Board Members. L7%" _ IC 0 P On March 21, 1994, 1 wrote you a letter updating you as to the status of the above -referenced project. Since that date I met with the Zc:ning Board of Appeals and have requested a front line sefoack of 20 feet in order to eliminate filling of the vegetated wetlands behind the House. I also redesi,ned the location. of leach field in order to minimize grading within the buitler. Zone. The septic, plan has been revised dated March 21, 1991, and was previously submitted to you with correspondence of the same date. The Zomng Board of Appeals has continued their hearinz until May 10, 1994. During yo4T rneetbng of :sanuary 2 7, 1991, vont had indicated that you would be ruc`ptive to the variances being requested, however. wanted to reserve judgment until such time as you could view the site and see how the lot was to be developed. At this time I ask that yo. �cheduic a3 site Visit for that purpose Please nota that I would like to accomplish the following agenda: 1. Have a site visit with your Board prior to May 10, 1994, and establish a "sera w vote" how you feel abou7 the varriarces being requested. F to the Zorririg Board of Appeals on May 10, 1994, asking thein to make a final nation on the variance setback. I Appear before the Cons --:rvatlon Commission on 111vlay 11, 1594, and ask therm to r:,,aer their decision with respelct to this Lina! design. 4, Then I would rtiauest that you place us on the ageno.2 Ter your meeting scheduled for May 26, 1994, so that we can have an official rublic hearing on the variances being sought. Please. note that the variances angst be dc� :ru upon at a public hearing duly ad, ertised with abutters rc ,.tied of the 1 ! d2 rdva ic;v o, 1f tho hearing. This nearing must be held In sisiCt aCCLi:.cL ."�' Wilh TiiRC 1. IR. 15.20). • ENGINEERS • • "AND ,:,URVEYORS • • LAND USE PLfiNWAS 447 Ofd Mostor. Roar, Jle art ToPs;iei , f}*yb . (508) 887,8586 FAX (500, G87 -348f, HFR 'ya 09:31 HE`:'E Board of Health April 26, 1994 Page 2 F. I hope you are able to accommodate this schedule. I thank you in advance for your cooperation in this matter and I look forward to meeting with you soon. Very truly yours, TITS ONL,kS E. NEVE ASSGCIATES3, INC. Thomas E. Neve, PF., PLS President T EN,rkm Enclosure cc: Michael Pellegniru #965 PELL;'GRS.WPS PPR �5 s t?E: _a_l HEV'E �,-='_;!::IPTE' TH FAX COVER ` H EL i TO: FAX �# OAT E : _� s�.r _`'.1._ • .. �.� MESSAGE: ��ff""""��•.�� �^'p�, !} �. _ !Sly^.ar_�,3,la.�s.��.__� _� ti's u.`a.er 0.1 Page 1 of NOTE; It you have riot re;�Yived the correct amount of pages, piea.�, caU. • ENGINEERS • 4 LAND SURVEYORS • • L-. D USE PLANNERS + 447 fid Bosion Road U -S Rnute #1 Ttopsfield, MA 0198..3 (508) 887.8686 FAX (508; 887.3430 ��C��ASS"iNI-ALATE ING March 21, 1994 Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 20a Equestrian Drive Dear Board Members: On Thursday, January 27, 1994, I met with your Board to discuss waivers from your Local Regulations and Variances from Title V which apply to the above -referenced lot. Again, for your records this lot was created in 1985 and a Construction Works Disposal Permit was issued for this lot at that time since it did conform to Title V and under Local Board of Health Regulations. The Pellegrini's, then owner and current owner of this lot, planned on building in 1985, however, during that period their son was born with severe medical problems and has undergone major medial operations and reconstructive surgery over the past 9 years. His condition is now stable, the Pellegrini's visited my office recently and I informed them that the permits on this lot had expired and that they must conform to new regulations which have since been passed by the Conservation Commission and Board of Health. It seemed at your meeting of January 27 that you were not opposed to the granting of these waivers and variances under these particular site specific circumstances. Since the development of this lot also required waivers from the Conservation Commission you asked that I file with them and return to you with the final plan which would be submitted to the waivers and variances. On Wednesday, March 16, 1994, I appeared before the Conservation Commission pursuant to a filing of a Notice of Intent, many issues were discussed. The Conservation Commission seemed receptive to issuing an Order of Conditions for this lot, however, asked that I make every attempt to minimize environmental impact. In order to do this I have redesigned the septic system plan showing a dwelling 20 feet from the front lot line. This condition would require a variance from the Zoning Board of Appeals which is being applied for. • ENGINEERS • 447 Old Boston Road (508) 887-8586 • LAND SURVEYORS • U.S. Route #1 • LAND USE PLANNERS • Topsfield, MA 01983 FAX (508) 887-3480 North Andover Board of Health March 21, 1994 Page 2 The septic system has also been redesigned and a clay barrier has been proposed along the front line and left side line of the lot. This barrier is required in order to satisfy the breakout criteria established in the Code. By the installation of this barrier the septic system can now be moved a distance of 71 feet from the edge of bordering vegetated wetland. This distance seems to be in conformance with distances historically acceptable to your Board. The redesign of the septic system was recommended as well by the Conservation Commission. In addition to this variance, the following waivers from the local regulations are also being sought: 1. Section 2.14 - Required design flow = 165 gallons per bedroom, system design on 150 gallons per bedroom. 2. Section 2.23 - Reserve area not 4 feet from active leaching area 3. Section 4.18 - Leaching facility not 100 feet from wetlands (71'). 4. Section 6.04a - No benchmark shown on plan, to be set prior to construction. 5. Section 17.04 - Maximum width of trenches shall be 4 feet, 6 foot wide trenches used for design. Could you please contact me when this matter can be heard. Please understand that I must notify the abutters to this lot 11 days prior to your Public Hearing. If you have any specific questions about this project please do not hesitate to contact me. Very truly yours, THOMAS E. N ASSOCIATES, INC. Thomas E. Neve, PE, PLS President TEN/km #965 PELLEGRLY PSw lk USE T-7 OCT, 0 6 2009 pep. hl i pig ld# M tQt(n t?, IQ A. YK y Sn (I A I InAl I" r -q 91 0010 PIPYM Ten, Tot' P 1(#( NQ Qn 90 l0pqw: I ffopp( VI ( —7 .'vl is.-, a no 0 ? C --'T- 1131DD 1^ 4i THOMPS E. t;L'JE i All y_!/;,,V `- `r _ N � ,i f •� -�f�lX= 3? �_�.f/i'rr.�:"1te �;4.�� �J�ed...';.� — � - I�l�+`I V �'f/�l✓_! Gi� \'.�i �' � �-/�'�'.� +�y V/ � � � ; �� � ;r�'� r �� �� � �! �1 _C- r � — ' - 1 I ' r.r(sI "' �" � � .�13� C • � .'!'�- � r��. ' —. %� j; - � � ._ �. �� _ _ _ .�.�. Y.T. - -,- - ----- - ; - 4--� -- � - • r i. � r ((%%��//�_ I ,,��+ l ....�.-� �,..."'-ate.. "y-�- •%��J `/ � `�S+ "t 27 `i4! .^f �W/9-�C�ST g aha u45,-5• �� �le- 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***************** PLICANT: �F-� a�_ -r Phone Cao 3 s 9P- JOZga LOCATION: Assessor's Map Numbers Parcel °"subdivision /csz. Lot(s) Zm /9 `S`treet .A M St. Number -7 Use Only************************ RECOMW ATIONS OF TOWN AGENTS: { bl_Cdnservation Administrator V,, Comments `� TT wn Planner Comments Food Inspector -Health ic Inspector -Health d q � hAzLa, 4±,,1 A_1� ) ± Mys �o Comments Date Approved'�� Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected blic Works - sewer/water connections ��(LJ - driveway permit�� ire De artmet� e (_nom L i re PT C Received by Building /ti/k_U /0/%3/ 9y Inspector (Tc Date Pr 1v O �D r— O 1.0 r— O N 1, :� Z h O Cb o . Cb II Tw I J a O� 2 zzz J c''9 L _ c.n I h Q II Tw zzz O o Q CD Q J' o � Cb b � � v (�o cD Q Q i 0�4 .Ah r, 4 Q V o 5 MORTI/ . O 0 �a �� 0 Town of North Andover s HEALTH DEPARTMENT $ACMUS! CHECK #: %�� DATE: 5—, LOCATION:�� H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check bof) ❑ 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) $ ❑ Septic Disposal Works Installers (DWI) $ ;,,Mittle `Inspector $ Report $� ❑ Other: (Indicate) $ r Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. IL ISI [Im" X Commonwealth of Massachusetts Title 5 Official Inspection ForK-7 Subsurface Sewage Disposal System Form -Not for Voluntary Asses ments 78 Equestrian Dr. SEP '16 2010 ` Property Address Karen Mayer TOWN OF NORTH ANOOV�R Owners / N. Andover MA 01845 8/21/10 V City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information Inspector: James Wright Name of Inspector --- Aspen Environmental Services LLC Company Name 270 Lawrence St Loompany Aaaress Methuen Cityrrown 978-681-5023 Telephone Number B. Certification MA State 2035 License Number 01844 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ peeds Further Evaluation by the Local Approving Authority 8/21/10 In ss, Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 I Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner's Name N. Andover Cityfrown t3. certification (cont.) MA 01845 8/21/10 State Zip Code Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N [I _ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ND (Explain below): ❑ The system required pum Ing more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspec 'on if (with approval of the Board of Health): ❑ broken pipe ) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstructi6n is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Boar ealth: ❑ Conditions exist which require further a nation by the Board of Health in order to determine if the system is failing to protect pub ' ealth, safety or the environment. 1. System will pass unles oard of Health determines in accordance with 310 CMR 15.303(1)(b) that the sy em is not functioning in a manner which will protect public health, safety and the envir ment: ❑ Cessp I or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 � t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner information is Owner's Name required for every N. Andover MA 01845 8/21/10 ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N [I _ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ND (Explain below): ❑ The system required pum Ing more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspec 'on if (with approval of the Board of Health): ❑ broken pipe ) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstructi6n is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Boar ealth: ❑ Conditions exist which require further a nation by the Board of Health in order to determine if the system is failing to protect pub ' ealth, safety or the environment. 1. System will pass unles oard of Health determines in accordance with 310 CMR 15.303(1)(b) that the sy em is not functioning in a manner which will protect public health, safety and the envir ment: ❑ Cessp I or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 No- Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner's Name N. Andover MA 01845 Cityrrown State Zip Code t3. certification (cont.) 8/21/10 Date of Insoection 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or �ged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters ----due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded _,,-Or—clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is every N. Andover required for eve MA 01845 8/21/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or /obstructed pipe(s). Number of times pumped: ❑ E2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 2e-*" Any portion of cesspool or privy is within 100 feet of a surface water supply or nbutary to a surface water supply. ❑ 1.1'1" ny portion of a cesspool or privy is within a Zone 1 of ap ublic well. ❑_Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privyis less than 100 f t b t t 44, ee u Urea er an 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- ,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either' y�o"o each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the sys em is within 400 feet of a surface drinking water supply ❑ ❑ he system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well If you/hewered "yes" to any question in Section E the system is considered a significant threat, or anes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 5 of 17 D. System Information Residential Flow Conditions: Number of bedrooms (design): —— Number of bedrooms (actual): -— DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °< 78 Equestrian Dr. Property Address Karen Mayer Owner information is Owner's Name required for every N. Andover MA 01845 8/21/10 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No �❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? E ❑ the as system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? El as built plans of the system obtained and examined? (If they were not �❑ available available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: �f LJ Existinginformation. For example, Ian p p at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): —— Number of bedrooms (actual): -— DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r< 78 Equestrian Dr. Property Address Karen Mayer Owner Owners Name information is required for every N. Andover MA 01845 8/21/10 page. Cltyfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes E;-ITo- Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ®-'Iqo Laundry system inspected? ❑ Yes Q-'Iqo Seasonal use? ❑ YesNo Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes Last date of occupancy: Dat Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallo r day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding to present? ❑ Yes ❑ No Non -sanitary was ischarged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name informafion is required for every N. Andover MA 01845 8/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes E�lo If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons Type, of System: Ili'/Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the UA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 09/08 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner's Name N. Andover MA 01845 8/21/10 City/Town State Zip Code Date of inspection D. System Information (cont.) Approximate age of all components date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes E;-lq-o-- Building Sewer (locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 0 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: oncrete ❑ metal ❑ fiberglass ❑ polyethylene El other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins • 09/08 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments lug 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is required for every N. Andover MA 01845 8/21/10 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle �S Distance from bottom of scum to bottom of outlet tee or baffle g �� How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ Dimensions: Scum thickness Distance from to f scum to top of outlet tee or baffle Distance from ottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins - 09108 feet ❑ polyethylene ❑ other (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rl 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is required for every N. Andover MA 01845 8/21/10 page. Cdyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tan�ank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: Comments ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No / Date of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owners Name information is N. Andover required for every MA 01845 8/21/10 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 5' Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of Pup; chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is forevery N. Andover MA 01845 8/21/10 page. 6f own State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits leaching chambers ❑ leaching galleries ❑ leaching trenches ❑ leaching fields ❑ overflow cesspool ❑ innovative/alternative system number: number: number: number, length: number, dimensions: number: Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of sspool Materials construction IndicatiTn of groundwater inflow ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is every N Andover required for eve MA 01845 8/21/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failu level of ponding, condition of vegetation, etc.): Privy (locate on site Materials of Dimensions Depth ofgolids Comr)4�nts (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)•/ t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is required for every N. Andover page. Cityrrown MA 01845 8/21/10 State Zip Code Date of Inspection D. 5ystem Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ nd-sketch in the area below drawing attached separately t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner's Name N. Andover MA 01845 8/21/10 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site E m: Check Slope El Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: �P G / Date �Y Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: _fes 'e" . s`/" i— Before filing this Inspection Report, please see Report Completeness Checklist on next page t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 78 Equestrian Dr. Property Address Karen Mayer Owner Owner's Name information is required for every N. Andover MA 01845 8/21/10 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 09/08 rife 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Town of North Andover Page 1 Tax Map # 210-105. D-0142-0000.0 Parcel Id 17102 78 EQUESTRIAN DRIVE HAZELTON, CHARLES 78 EQUESTRIAN DRIVE NORTH ANDOVER, MA 01845 Class 101 Single Family Size Total 1.32 Acres Property Type 1 Residential EY 2010 UB Mailing Index Name/Address Type Loan Number From Active/Inact. HAZELTON, CHARLES Payor Until 78 EQUESTRIAN DRIVE NORTH ANDOVER, MA 01845 UB Account Maint Account No Cycle Occupant Name Bldg Id. 17532.0 - 78 EQUESTRIAN DRIVEActive/Inactive 3170202 03 Cycle 03 Last Billing Date 7/7/2010 Active UB Services Maint. Account No. 3170202 Service Code Rate MISCFEE ADMIN FEE 0.635/8 Charge Multiplier/Users WTR WATER 01 ALL METER SIZE 7.82 68.40 1/ /1 UB Meter Maintenance Account No. 3170202 Serial No Status 36393510 a Active Location ERT HH Brand Type Size YTD Cons Date Reading Code b Badger w Water 0.63 0.63 0 6/7/2010 11 a Actual Consumption Posted Date Variance 4/16/2010 0 n New Meter 11 7!1512010 e -100% 4/16/2010 1288 r Replacement 0 7 7/15/2010 -100% 3110/2010 1281 a Actual 7/15/2010 % 12/10/2009 1264 a Actual 17 4114/2010 _00% 9110/2009 1246 a Actual 18 1/12/2010 -40 0 618/2009 1215 a Actual 31 10/1512009 -26% 3/12/2009 1176 a Actual 39 20 7/20/2009 4/29/2009 108% 12/8/2008 1156 9/9/2008 1138 a Actual a Actual 1/20/2009 6%18 -53% 6/5/2008 1097 a Actual 41 19 10/10/2008 7/16/2008 93% 3/11/2008 1078 12/10/2007 a Actual 15 4/11/2008 36% 1063 9/5/2007 1046 a Actual a Actual 17 /22/20 108 /22/20007 -8% -66° 6/15/2007 1003 a Actual 43 1 119% 3/15/2007 981 12/12/2006 m Manual estimate 22 14 7/2012007 4/16/2007 59% 967 Trouble Code:03 a Actual 14 1/19/2007 _2% 50% 9/12/2006 953 Trouble Code:03 a Actual 28 10/20/2006 52% 6/13/2006 925 Trouble Code:03 a Actual 20 7/10/2006 26% 3/6/2006 905 Trouble Code:03 a Actual 12 4/17/2006 2% 12/21/2005 893 Trouble Code:03 a Actual 15 1/17/2006 48%