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Home My WebLink AboutMiscellaneous - 984 TURNPIKE STREET 4/30/2018 (3)Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 984 Turnpike Street, Septic system design Dear Susan: March 17, 2004 Enclosed are revised dosing calculations and design plans for the septic system design at the above referenced property. A small discrepancy between the design plans and the calculations was pointed out by Mill River Consulting. The discrepancy has been corrected on this set of calculations and plans. A copy of these calculations and the plan has already been provided to Mill River Consulting. If you have any questions please do not hesitate to contact this office. Sincerely, n 25 C l� Benjamin C. Os goo , r., EIT President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845,--(978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 fI -.y I�EW ENGLAND ENGINEERING SERVICES INC March 1, 2004 Susan Sawyer TOWN OF NORTH ANDt': :�31 BOARD OF HEALTH North Andover Board of Health 27 Charles Street a �A w 2004 North Andover, MA 01845 i Re: 984 Turnpike Street, North Andover, Septic system design Dear Susan: Enclosed are 5 sets of revised septic system design plans for the above referenced property. The changes made to the plan address the comments of a letter from Brian LaGrasse letter dated January 12, 2004 and include the following I. General note #6 states that there are no foundation drains. 2. The abutters have been added to the plans. 3. The system is still located 10 feet from the dwelling. Moving the system to another location or further back on the lot will require more variances and more expense than the site currently used. This office will request to be heard at the next board of health meeting regarding this local upgrade request. 4. The manhole covers are specified as being min 20" diameter on the profile view on sheet # 1. 5. The pump chamber is specified to be sealed in pump chamber note # 1. In addition the tank note indicating that the tank be supplied by the manufacturer as watertight has been labeled as a tank and pump chamber note. 6. Construction note #4 has been modified to indicate the removal of the first 6" of the "c" layer. 7. The soil notes have been revised on the plans. New form I 1 have been submitted with the proper depth of soil. 8. This comment is an affront of the honesty and integrity of this firm. It may well state that the reviewer feels the signature has been forged by someone other than Richard Tangard. All of the signatures belong to Richard Tangard. 9. The system is still designed with a three foot offset to the water table. This office would like to address this issue as a local upgrade request at a board of health meeting. 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 a< m 10. A leach field design has been used to conserve space. Trenches would require a much larger footprint than a leach field and would cause the need for large amounts of fill, local variances for the offset distance to a wetland, or the construction of large walls. The system as designed has been modified to a pressure dosed system and the calculations have been provided. This office would like to further address this comment as a local upgrade request in front of the board of health. In addition, the system has been designed per Title 5 requirements with respect to the dosing frequency of the system. If you have any comments or questions please do not hesitate to contact this office. Sincerely, -!�� c eJr, Benjamin C. Osgoo EIT President Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumoine Record System Owner - piv Wo Type: Emergency Routine Cesspool: iVo Yes Date of Pumping: r, ?— System System Pumoed Rv: Wind Qiw / / Location Septic tank: W =Yes PFJ Quantity Pumped: 1601U Gallons Date:;C (' U Z Pumper Signature: Condition of system/Other Continents Dep Approved From - 12/07/95 i3� �� ----- 1Q�'ccr--"�--------- �,_. _ _ f __ => _ . _. __ 4014 Gf MO oTN q4, � a Town of North Andover HEALTH DEPARTMENT ,SSACNUS�� CHECK #: oZ%3 c�DATE: LOCATION: / H/O NAME: CONTRACTOR NAME: 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) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 I ector $ itle 5 Report $ ❑ Other. (Indicate) $ l r Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 4014 of MORT1+,� w ,3a •� ,�.o :s.� oc Town of North Andover ,....: HEALTH DEPARTMENT 'SS�CHUst� CHECK #: oZ% c�D-�ATE: r/14 LOCATION: / H/O NAME: CONTRACTOR NAME: 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 Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ �itle5 pector $ port $ ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 1. 1� Lc I � �tl Owner Information is required for every page. Important: When filling out M- forms on the computer, use only the tab key to move your cursor - do not use the return key. monwealth`of Massachusetts le' 5 ns.pectio n � -k IrtaFe.,Sewage Disposal System Form - Not for Voluntary �&W Kl CEIVEC--7 W r 0 s 2009 HEALTH DEPARTMENT owner's Name Citylrown State Zip Code Date of Inspectioq Inspection results must be submitted on this form. Inspection forms may not be altere _ in any way. Please see completeness checklist at the end of the form. � S A. General Information Insaptor: NaMa of Inspector o/'icZot IfS!5 7/,-c 7 �I�t,'✓ �tiG Company Name Company Address Cityrrown 6O3_� �� state Zip Code ol3 Telephone Number License Number B. Certification 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.1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Xpasses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-z( -02 Inspe s Signature Date Th 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 DEPThe 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 ttow-the system will perform in the future under the same or different conditions of use. t5wo •Dema TIUe 6 Officlal Inspection Form: Subsurface Sewage Disposal System • page 1 of 17 ` ? . Commoinwealth of Massachusetts., Ti is -1 Iris e�tjon:.Fora" }Titl p Subsurtace Sewage Disposal System Form - Not for Voluntary Assessments Property Address _ V t' nr LC1 Owner informationOvmers Nameon Is �.-� D r � required for /V U Ve MA d t gym Cr_ZG ro every page. Cityfrown State Zip Code Date of Inspection' B. ,Certification (cont.) Inspection Summary: Check .A;B,C�D or-f-/-alrvays-Complete all of Section D Aj System Passes: V-4 have not found any information v h, ich indicates that an the In 310 CMR 15.303 or, in 310 CU915.304 exist. Any failure f criteria unot evaluated are re criteria ed indicated below. Comments: Wfi` ; /,v G�ca 6) System Conditionally Passes: Q 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 structuralty'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 Q ND (Explain below): •09M nua 6 omaal hapedion Form: sueswraoe see otsposd system . Page 2 a 17 Owner information is required for every page. Commonwealth of Massachusetts Title;5_0 cial Inspection Subsurface Sewage Disposal System Form - Not for orm �S Y Voluntary Assessments Property ^Address, Owner's Name '�� — Gty/Town �r v, S 9- B. Certification (cont.) State Zip Code Date of Inspection B) System Conditionally Passes (cpnt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due pass inspection if (with akroval of Board of Health): to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will ❑ broken Pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed Piss . Th system will pass inspection if (with approval of the Board of Health): p () e ❑ broken pipes) are replaced ❑ Y ❑ N El ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determ the system is failing to protect public health, safety or the environment. Ine if I. System will pass unless Board of Health -determines in accordance with 310 CMR 15,303(1)(b) that the system is not functioning in a manner which will protect public health safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ts;n8 • 06UElCesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 OKdal Inspection Form: Subsurface Sewage Disposal System • page 3 of 1! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage; Disposal System Form - Not for Voluntary Assessments Sf-- Property Address Vi a LC1w► Owner-- - -- -- - Owner's Name information is —/J,Q PV C l 0/ U VS- 210._ r9C� required for T / - _ I VS- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 supplylor 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 clogged 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 n n( .Liquid depth in cesspool is less than 6" below invert or available volume is less than %slay l-aw _-- t5ms - • 09M Title 5 Official Inspection Forth. Subsurface Sewage Disposal System • Page of 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 rU Property Address , U N 44, Owner's N me IV—�1VWVC-r Cityfrown B. Certification (cont.) State -ZIP Code Date of Inspection -- Yes No ❑ �� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ,� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 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- 10,000gpd. ❑ 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 "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the 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 It of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" 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. t&ns • 09+08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Dfj ia-I -Inspection -Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. qty vr� fizz s` Property Address Owner Owner's Name information Is /L/ —� NDUV M 2 ��$y�' C -, -LG _0q required for -1� every page. City/Town 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 M. M. ❑ Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the 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? ❑ Were as built plans of the system obtained and examined? (If they were not 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: ❑ Existing information. For example, a plan at the Board of Health. ❑ f7{ 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): `/y° t5ins • tomos Title 5 Offidal tnspectlon Form: Subsurface Sewage Disposal System • Page 6 of 17 1111 oaf n� ij gJ'tt ai i - ,R°i Commonwealth,ofllassachusetts - Subsurtace Sewage D isposal System Form - Not for Voluntary Assessments f -r Property Address c,� Owner Owner's Name infortnauonia for �(/;-<��t.poyc�-0 required i -every page C1tylrown State Zip Code Date of Inspection MS, Ystqm Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system Inspected? Seasonaluse? Water meter readings, if available (last 2 years usage (gpd)): .Detail: ❑ Yes [ No ❑Yes No ❑ Yes D�- No ❑��Yes �?[ No -- 4 — Sump pump? ❑ Yes No Last, date of occupancy: Cvrrc��- Date Commercial/Industrial Flow Conditions: Type of Establishment: _ Design flow (based on 310 CMR 15.203): , -13allons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non sanitary waste discharged to the Title 5 system? ❑Yes El No I; Water meter readings, if available: ' Title 6�Kida1 mon Forts Supxrtaoo 3eWageDlpasel System • Page 7 a 17 i FAIN monwealth Q.- Massachusetts -on- 7" r}> 0', pltp£oss.3ystem Form ~-Not for VoluntaryAssessments a �x� � .s"i j' A r 3 n �. +".i �`,'r�.. / I " � rJ •� �I "l D� t� Property Address .,Owner `, Owners Name information is • , c ;required (or AV ANpov�-/ /�1A 0/g' every page . , : CKY/Tow State Zip Code Date of Inspection p.:Systeim 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? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: /t/0 ❑ Yes % No gallons �oymDTU A�,l ��,i�i�Z�/�r s ofL r. Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system (yes or no) (ifyes, 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 I/A system by system' operatorunder. contract ❑ Tight tank.. Attach a copy of the DEP, approval. ❑ Other (describe): l5iro • OBI08 r. TWe 6 Otfidal lnspacdon Fam: Subsurface Sewage Disposal System • Pow 8 or 17 Commonwealth of: Massachusetts Title 5`f#iciAl-ans-perAlon---Form r"$ubsurf ce Sewage Disposal System Form - Not for Voluntary Assessments Property Address. Owner: Owner's Name information Is r�AN�Ov� r /Gj d /g L/ -S Lro� gyp, required for ✓" rl every page. Clty/Town State Zip Code Date of Inspection D..System Information -(cont.) Approximate age of all zonents, date installed (if known) and source of information: 110,3 Were sewage odors detected when arritIng at the site? Building. Sewer (locate on site plan): Depthf below grade: Material of construction: cast iron ❑.40 PVC ❑ other (explain): Z/ feet zoi Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sof'vIS a tAd p c pl'vp- ar(- N G CC5uOti ?fJ&v ❑ Yes X, No Septic Tank (locate on site plan): 2 - Depth below grade: feet Material of construction: '6[J concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certficate of..Compliance? {attach a copy of certificate) ❑ -Yes ❑ No Dimensions: �O �/0 X 60 { — Sludge depth: ' Oa109 Title 6 Official hspedon Forth: Subsurface Sewage Disposal System • Page 9 of 17 Comlmonwealth of Massachusetts Title'�5:�#11ciaa Ins ec#i-on -Fora Subsurface Sewage Disposal System or - Not for VoluntaryAssessments sments Property Address / UtN CAGh Owner r—. ...1___ information is required for every page. '4/-4' :D0VC/ 1+ (7/tyS City/l"own q- 2lv'O� 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 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 4cgwrcj Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, li` Lidid�levels as related to outlet invert, evidence of leakage, etc.): �rJVGn��v<r�2�r5 r CA,e,-il /"�/�/fi�►yC< -- Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness ❑ fiberglass Distance from top of scum to top.of outlet tee or baffle Distance from bottom of scum to bottom of -outlet tee or baffle Date of last pumping: feet ❑ polyethylene ❑ other (explain): Date t6lns • oaoe T106 6 official hspection Forth: Subsurface sage Disposal system • page 10 of 17 Commonwealth of Massachusetts Title 5#fcia� ins-pection -Four Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -turN bie< Y/- Property Address - UI'ti Lg�, Owner owner's Name Informadon Is AA required for �, ,9NP�v � l"', o/$LAS every page. City/Town State ZiD COH Date nf Incnwrtinn D. System Information (cont.) Comments (on pumping recommendations, inlet and .ouilet.tee or.baffle.condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other (explain): Dimensions: _ Capacity: _ gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date -- Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No thins - oaroe Tltla 5 Official Irtapectlon Form: Subsurface Sewage Disposal System • Page tt oft 7 ' - Pon1monwealth of Massachusetts Tktle 5 _.Official tns ectionfor. Subsurface Sewage Disposal System Form - Not for VoluntaryAssessments Property Address Owner Owner N me information 1,3/� 7�1 Vc required for , " �hl 0/iI5 yS' q z�-Q9 every page. City/Town State Zi Code ! _ P Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): i . Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of bob etc.): /90 L: lj�� 7!! � �_ 1P VA 0: 06 rs Pump Chamber (locate on site plan): Pumps in working order: Alarms in working order: ,0—?es ❑ No Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): �erg C u4,*l<r ®f�c f,v ` '�loo�l iu Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: tsku. 09M TWO 6 OfRdal ✓ QPWion Forth: Sub"04ce Sewage Disposal System • Page 12 of 17 �. t.`' '• : r "_.,xall' 4Jc Ow Q�,^�amor�nrealth of Massachusetts , r ,t t."s s i 4.?ih,.•'w"rw.i'� ,k t,' '� f 4 .i„ (,. °7�1�C1�/i 1 \/r $ubsu Ace, 5sswa a �Isp9sarSY► 0111 Form ••Not for Voluntary ss Assements a+7 i w rt ,� p�'t - ' •,;r^ 2,3iY >� 7{y ty' ari.. , ?,i t� ,f . { : i #�E1 �4 l,gS t r �,r9$ %vNQ;xL s� „s � c, ,ha 7''-'d�-�m_Y-,;• Piro 0 �d�'888 Y 3, , t' 'ry ` ,ti' rrA x'n k 'k h is xKYR, c. t�r.iute'�t..��-y,� 1�11�} Vrl„i F 3 .r' t own a r� e i ` 1Inf�m�aHor�is,na 'vcY3 ♦�' for h4` n+' vq t' 61—NU." - , r'+; •Alf a i n E - k i ,..`• fY/Town�x Code Rate of inspection ` .. XT'.i• t t,r' 4 r { ` y,,{,•,A�y?,,' ,�L:}+'fNy � fiJ '�y t dya�yry�e D,d-q V3 l "?{3""" a �IIX, k, f4nform;�tion (cont) ti 9 �•9'fi'��iA?H -d �•i'i�a . t• s > r�• �. ,.. f '� l i�* �n.�f �,:r e¢r i 1,j+ah, r � c • yl v � ( ... - .. kcr , f '= _=5 k ` r k ❑ leaching pits number. ! aro P ❑ leaching chambers., „• number: ❑ leaching galleries number: i ❑ leaching trenches numberjength ` leaching fields number, dimensions: ZS ' ' ❑ overflow cesspool number: ❑ innovativOltemative system ,• jt Type/name of technology: , �� Comments (note condition of soil signs o h drau le failure, level ... n o f I i e ofponding,-dam soli condition of 10 cC 'i rt �esspoglf (cesspool must be pumped as pact of inspection) (locate on site plan): T., ,' Number and cogfiquraUQn v • 7{ y. � ,j �f1 . i o r .., .. d Depth top of liguld.to inlet invert ' 't Depth)of solids layer s �At r r k, ..t.. .10 wti n•^ .t .( a ..t f ., Depth of scum layer` r 4 F i Dimensions of cesspool t 7 _ Materials of construction aA i IndicaLon of groundwater• inflow ❑Yes {] No ._� i t (; tum. Oa08 ? Title 6 Of8d81 hapection Form•: Subsurface Sewage Disposal System • Pape 13 of 17 i '( �rTT 'd�t Wr<*.FYh�Aph�1!L1'{?p�t°lub rhr�Fyt sApa�,Y4t �xt r rtr l.yt i .r' Fr x. N t a, VY. -.4YY s < . .. (4rl mot�wealth ofFly��ssachuse n p._ �ri I ell'#ibn •�.n3 F -. .. �'; .c •'. r itx, K :i;3ubsu�fce Sewage Dis,.posal System Form Not for Voluntary As � �� yr : -Own a oVHn@r's Name req —AA/V00CC «`information is ` ,�,{� p, Q .every State ZIP C d T Inspection k , Date of I Ion ,D. Sys co-nformat on (cont.) Comments (note condition of soil, signs -of hydr#Wic faUure, level-of.ponding, condition of vegetation, Privy (locate on site plan): Materials of construction: Dimensions s Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, { etc.): � .. I j • . Title 5 MW bspecOan Forth: & bvtdam sewage OiapoaW system • Page 14 of 17 commonwealth of Massachusetts Title 5.O ficial Inspection -Form Subsurface Sewage Disposal System Forth - Not for Voluntary Assessments Property Addre s 'Uf�N �G61 Owner Owners Name information is ,.,d Nprjv f—( B/4- 0 /gam/S Of Z•�o^� required for every page. City/Town State Zip Code Date of Inspection D. System 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: -hand-sketch in the area below, ❑ drawing attached separately .. .. -V VN 0 , f Vh � M4 • r/ f�-Aro0� NU L 3 It/1- w1 L&M - 08108 Title 6 official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Vo 7.,,�� Ips ` or T fi3ubsuyrt�ce Sewag Des Deal 3 stem Fo.: i xS �Y, p•��% Tk'"'F UM .4 Y ... + Not for Volunta ' ry Assess ,mems �Pfoe�yq ri 4rw-tw�`P,yr t�+ k # igfortatlon Ise^, Owner' ame t `f �yifor�QV ,1,Mlrypa�e j � r � '� k , t r i,,t rG �q N . $tate. • �^^ �nQrma� Q '��✓�t@� P Code Data of I t�On (CO(COnt rlspea(on e .. 3iteg xam Check Slope ❑�Su,rfare water -2- Check cellar w ❑ Shallow wells Estimated depth to high ground water: � Cu�fer Please indicate all methods used to determine the high ground@water e Obtained fro y levat(on: 9 m s stem desl n p laps on record ' If the . eked, date of design plan reviewed: 03 Observed site (abuttin P Date rty g pro a /observatlon hole within 150 feet of SAS) 0 Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - ❑(attach documentation) Accessed USPS database - explain: You must vG� describe how you established the high ground water elevation: t Gvti 9. g and U ei on. rCommonwealth of Massachusetts Title 5 Offic"I -Inspection -Forte Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9� �� ,�• ,fit 5 � Property Ad ' dress / Owner IiII`/N. GG1� information Is Owners Name required for /V f)�vUOvt ( c every page. City/Town �%�' �/$ K.� State Zip Code We of Inspection 5-0 FNIOPWA vvmpieteness Checklist Inspection Summary: A, B, C, D, or E checked 13-Trispection Summary D (System Failure Criteria Applicable to All Systems) completed - Systern Information - Estimated depth to high groundwater X1 Sketch of Sewage Disposal Syster"p either drawn on page 15 or attached in separate file teals • OQU Title 5 official Inspection Forth. Subsurface Sewage Disposal System • Page 17 of 17 CONSERVATION DEPARTMENT Community Development Division NEGATIVE DETERMINATION OF APPLICABILITY SPECIAL CONDITIONS 984 Turnpike Street, North Andover At the August 11, 2010 public hearing, the North Andover Conservation Commission (NACC) voted to issue a Negative Determination of Applicability (after the fact) for grading and landscaping conducted in the Buffer Zone to Bordering Vegetated Wetland (BVW). The closest point of work to the BVW is approximately 5 -feet. Relocation of an existing fence to an area up -gradient of the 25 -foot No -Disturbance Zone was also proposed. Erosion control was installed upon discovery of the disturbance as directed by the Conservation Department staff. Applicant: David Dockham, II 984 Turnpike Street North Andover, MA 01845 Record Documents: Request for Determination of Applicability and Associated Plans Submitted July 16, 2010 Record Plans: 984 Turnpike Street, Assessors Map 107C Parcel 6, 1.27 AC Showing hand edited fence location Other Record Documents: Negative Determination of Applicability, 984 Turnpike Street, Conservation Conditions (including check marks and notes by previous conservation administrator) SPECIAL CONDITIONS: ❖ The applicant shall installresource area markers every 25 -feet along the relocated fence (1 square marker for every 3 round). These markers are available for purchase at the Conservation Department. ❖ Excess material and construction debris shall be properly disposed of off site and stockpiled material shall be stored within the erosion controls. Post Construction ❖ Immediately following completion of the work, any disturbed areas shall be permanently stabilized against erosion (loam and seed or other stabilization as approved by Conservation Department). ❖ Upon completion of all requirements, the Conservation Department shall be contacted to conduct a final site inspection. 1600 Osgood Street, Building 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web: http://,.vxvw.tokvnofnorthandover.com/Pages/NAndoveriNfA_Conservation/index ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rob A. General Information From: North Andover Conservation Commission To: Applicant David Dockham, II Name 984 Turnpike Street Mailing Address North Andover City/Town MA 01845 State Zip Code Property Owner (if different from applicant): Name Mailing Address City/Town State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: 984 Turnpike Street, Assessors Map 107C parcel 6 1.27 AC (hand edited) Title Date Title Title 2. Date Request Filed: Julv 16, 2010 B. Determination Date Date Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Post construction approval of grading and landscaping within the Buffer Zone to Bordering Vegetated Wetland (BVW) Fence relocation proposed up -gradient of the 25 -foot No -Disturbance Zone to BVW. Project Location: 984 Turnpike Street Street Address Map 107C Assessors Map/Plat Number wpaform2.doc • Determination of Applicability • rev.1016104 North Andover City/Town Parcel 6 Parcel/Lot Number Page 1 of 5 ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NAPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is. an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review (if work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaformIcloc • Determination of Applicability • rev. 1016104 Page 2 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 —Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 16 * 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located.' ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). See attached conditions ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. Page 3 of 5 wpaform2.doc • Determination of Applicability • rev. 10/6/04 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑5. The area described in the Request for on under the ct. Since rin her described and described therein meets the requirements rements the followinct to g exemption, asspecified the regulations, no Notice of Intent is required: Exempt Activity (site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. North Andover Wetlands Protection Bylaw Name C. Authorization Chapter 178 ordinance or Bylaw citation This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on ®'"by certified mail, return receipt requested on 9� I, 0 Date Date except erminations for This Determination is valid fors wh ch are valid foee years from r the t e du duration of the e de of issuance (Plan). This Determination Vegetation Management Plan Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see http7//WWW.mass.gov/de /about/region.findvour.htm) and the property owner (if different from the applicant). .91 � C2-3 lie) Date wpaform2.doc • Determination of Applicability • rev. 1016104 page 4 of 5 ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see http:/Iwww.mass.gov/dep/about/regio findvour.htm) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc - Determination of Applicability -rev. 10/6/04 Page 5 of 5 ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. teb A. Request Information 1. Person or party making request (if appropriate, name the citizen group's representative): Name Mailing Address Cityrrown Phone Number Project Location Mailing Address State Zip Code Fax Number (if applicable) CityFrown State up ..uuc 2. Applicant (as shown on Notice of Intent (Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address City1rown Phone Number 3. DEP File Number: B. Instructions State Zip Code Fax Number (if applicable) 1. When the Departmental action request is for (check one): ❑ Superseding Order of Conditions ($100 for individual single family homes with associated structures; $200 for all other projects) ❑ Superseding Determination of Applicability ($100) ❑ Superseding Order of Resource Area Delineation ($100) Send this form and check or money order for the appropriate amount, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform2.doc • Request for Departmental Action Fee Transmittal Form - rev. 10/6/04 Page 1 of 2 • LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see http://www.mass.gov/dep/about/region/findyour.htm). 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. wpaform2.doc • Request for Departmental Action Fee Transmittal Form • rev. 1016104 Page 2 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ A. General Information From: North Andover Conservation Commission To: Applicant Sandra Newell Name 984 Turnpike Street Mailing Address North Andover MA. 01845 City/Town State Zip Code Property Owner (if different from applicant): Same Name Mailing Address City/Town State Zip Code Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: RDA 1/12/04 Title Date Proposed Subsurface Sewage Disposal System Plan 12/15/03, last Title revised 3/15/04 Title 2. Date Request Filed: 1/12/04 B. Determination Date Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Installation of a new Subsurface Sewerage Disposal System outside of the buffer zone with associated grading in the Buffer Zone to bordering vegetated wetlands. Project Location: 984 Turnpike Street North Andover Street Address City/Town Map 107C Parcel 6 Assessors Map/Plat Number Parcel/Lot Number wpaform2.doc • rev. 12/15/00 Page 1 of 5 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2.doc • rev. 12/15/00 Page 2 of 5 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). See attached condition ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.doc • rev. 12/15/00 Page 3 of 5 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity (site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Name C. Authorization Ordinance or Bylaw Citation This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on dby certified mail, return receipt requested on Date Date This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commissio to the appropriate DEP Regional Office (see Appendix A) and the property o applicant). Signature: -, `:7 3 a Dat L� y-r-»tttt be sent (if different from the wpaform2.doc • rev. 12/15/00 Page 4 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc • rev. 12/15/00 Page 5 of 5 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix A — DEP Regional Addresses � Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax: 413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley • Middlefield Peru Tolland DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Worcester, MA 01605 Ashby Athol Douglas Hudson New Braintree Shrewsbury Webster Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancater Northbridge Southbridge West Boylston Fax: 508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchburg Leominster Oakham Sterling Westford TDD: 508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalslon Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax NewBedford Rochester Wellfleet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport TDD: 508-946-2795 Bourne Easton Harwich Norwell Scituate West Tisbury Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 205 Lowell Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohasset Hull Middleton Reading Waltham Wilmington, MA 01887 Ashland Concord Ipswich Millis Revere Watertown Phone: 978-661-7600 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 978-661-7615 Belmont Dedham Lexington Nahant Rowley Wellesley Beverly Dover Lincoln Natick Salem Wenham TDD: 978-661-7679 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield Wpaform2.doc • Appendix A • rev. 11/22/00 Page 1 o 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix E Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: 1 When filling out forms on the computer, use Name only the tab key to move your cursor - Mailing Address do not use the return key. City/Town State Zip Code r� Phone Number Fax Number -(if applicable) Project Location renin, Mailing Address City/Town State Zip Code 2. Applicant (as shown on Notice of Intent (Form 3), Abbreviated Notice of Resource Area Delineatidn (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address City/Town State Zip Code Phone Number Fax Number (if applicable) 3. DEP File Number: Person or party making request (if appropriate, name the citizen group's representative): B. Instructions 1. When the Departmental action request is for (check one): ❑ Superseding Order of Conditions ❑ Superseding Determination of Applicability ❑ Superseding Order of Resource Area Delineation Send this form and check or money order for $50.00, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform2.doc • Appendix E • rev. 2/00 Page 1 of 2 LllMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix E — Request for Departmental Action Fee Transmittal Form � Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see Appendix A). 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. wpaform2.doc • Appendix E • rev. 2100 Page 2 of 2 Negative Determination of Applicability 984 Turnpike Street Conservation Conditions Record Documentation: Request for Determination of Applicability dated 1/12/04; Plan entitled "Proposed Subsurface Sewage Disposal System, 984 Turnpike Street, North Andover, MA", consisting of sheets 1 & 2, prepared for Sandra Newall, dated December 15, 2003, last revised dated 3/15/04, prepared by New England Engineering Services. 1. Prior to the commencement of any work activities on site, the applicant shall ` comply with the following pre -construction conditions: • Erosion controls shall be installed in the locations depicted on the referenced site plan and shall be installed in accordance with the erosion control detail on sheet 2 of the record plan. The applicant shall have on hand 10 additional hay bales and an equivalent amount of silt fence for emergency erosion control purposes. • All landscaping debris (i.e. - leaves, brush/tree limb stockpiles) located along the entire 25 -foot no- disturbance zone and partially within the wetland resource area (between wetland flags Al and A3) shall be removed by hand and properly disposed of to a location outside of the 25' no -disturbance zone. • A buffer zone enhancement -planting plan prepared by a professional wetland scientist shall be submitted for approval to enhance the mentioned disturbed area and in lieu of allowing the swing set to remain in a portion of the 25' no -disturb area. Approved enhancement plantings shall be planted immediately following approval during the growing season. • Wetlands markers shall be installed along the existing rear fence line every 25' feet. These markers can be purchased at the Conservation Department. 2. Once the above pre -construction conditions have been completed, the applicant shall contact the Conservation Department, at least 72 hours in advance, to schedule an on-site pre -construction meeting to review proper completion and implementation of the above. 3. Upon completion of site activities, the area shall be immediately seeded for stabilization purposes and the applicant shall contact the Conservation Department for a post -construction inspection.