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HomeMy WebLinkAboutMiscellaneous - 649 FOREST STREET 11/2/2015 (3) • North ,Andover Health Department Community Development Division December 15, 2010 Greenscape Property&Building Attn: George Haseltine 66 Gilcrest Road Londonderry,NH 03053 Re: Subsurface Sewage Disposal System Plan for Forest Street, Map 105D,Lot 171, aka 649 Forest Street Dear Mr. Haseltine: The North Andover Board of Health has completed the review of the septic system design plans for the above referenced property. These plans dated October 26, 2010, final revision date of December 7, 2010,have been approved for a four(4)bedroom,maximum nine-room home. In accordance with 310 CMR 105. 020(2) " Construction of all systems for which a Disposal System Construction Permit application has been approved by the local Approving Authority and/or the Department shall be completed, and the Certificate of Compliance (COC) obtained within three years of issuance of the final approval."During this time a licensed septic system installer must obtain a permit and complete this work. Other items to be submitted prior to a COC is issued by the Town of North Andover are; an as-built of the system and an installation certification form endorsed by the installer, designer. This approval is subject to the following conditions: 1. Prior to receiving a building permit,the applicant must provide complete floor plans of the new home. Please include all living spaces. 2. Prior to receiving a Disposal Works Construction permit,the applicant must provide a foundation plan in 1"=20' scale to overlay on the septic plan. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Forest Street Map 105D Lot 171, aka, 649 Forest Street Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board,Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Susan Sawyer, REHS/RS/ Public Health Director cc: Vladimir Nemchenok,Merrimack Engineering, c/o: Bill Dufresne File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER Office of COMMMITY MVELOPMENTAND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING20; SUITE 2-36 NORTH ANDOWA, MASSAC1-1(JSE'1`TS 01845 40 - hone us an e low 78.68U476-- 'AX S V.Sawyr,RE11SIRS Public Health Director E-MAIL:fie WEBSITE:lit fthi dI p 1�01, 1-,ff f aniddoovv.ee..r r.-oo.....ir..In SEPTIC PLAN SUBMITTAL FORM n— Date of Submission:— Site Location: mer7-r KT 1-s-1 I—L� Engineer:- Ke;PMO Act- W6-1 0 MVt kA New Plans? Yes v" $225/Plan Check# O�P20(includes Is'submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes v � No Local Upgrade Form Included? a Yes No ) Telephone#: 61 A) 7'57_72!�5; Fax#: 7.45 E-mail: Homeowner Name: OFFICE USE ONLY When the submission is complete(including check): ➢ Date stamp plans and letter Complete and attach Receipt ➢ Copy File;Forward to Consultant ➢ C( Enter nter on Log Sheet and Database 0 D JZ E a =U) ° 3 m N O o a N a� m � } ❑ 11, i5 g (D a) N � o. (� Y U U ❑ El E, E a) Q L O � N - a Z O H d a Cl. � o0 o E E E N CD N a) '0 C6- ° N Z Q (6 > > N N ° a a > n N o o Q 0 0 ❑ U)d ❑ r } > ) m w � iri iri o 6 c > +C+ CL E 0 LL L N @ N Q a O O ° O 2 L C :3 Z Z Z Z a 0 N o a d c V� to N to W a) r_— m 2 co Q a ❑ ❑ m O �' Cl. Cl. � U c n Q N 7 . o �` Z a C 3 > o U) O Z > M . . °o °n N0 t O O v a° a° o O - _ `m `m aa) W r � �•• — o m o o id a`> C 0c y O a� c° ° LOO 3 0 °' ? `e c a u �° a) a) Q �°-' r ' E C O cu a� v a� E m °- W _ E O E •ow � 2 � = � � o � a°� � .a L LI. O in v V� U � v7 to c9 LL Q U O O . 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Site Information When forms on the � computer,use f F' only the tab key Owner Name to move your yr cursor-do not use the return Street A dress or Lol# key. D__WTO Apnniffo City/Town State Zip Code (fyJ ) *L 0 ontact Person(if different from-owner) Telephone Number B. Test Results Date Time Date Time Observation Hole# Depth of Perc Start Pre-Soak Pool End Pre-Soak I I I I Time at 12" 1 "T II ! � Time at 9" II Time at 6" Time(9"-6") Rate(Min./Inch) Test Passed: Test Passed: Test Failed: ❑ Test Failed: ❑ Test Performed By: IAA Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 N J � ' aco ti. J W can m ° NHSRO cc an . a S -5; TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 5 CHUS NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y.Sawyer,REHS/RS 978.688.9540—Phone RECEIVED R -C E'VE "D Public Health Director 978.688.8476—FAX h L � •ealthdept@, towpofh rtliand Fer.conif­-� �j r"C ­ IJ 11 www.townofiloilliandover.co I 'tOWN OF WORI'H At�00VER P MM T Well and/or Pump Application E, 0��DE' Z �l ALj'H'0E`PAR1'MFEm'T (Please print) DATE: It 0 LOCATION to Drill Well or install a pump: 1a (;(eA sh, AloyV— A-y, cjc-,—v1,xA ws-2�r Licensed Well Contractor Name and Company Name: SU[wk"'m so("s \Vc Contact Phone Numbers: L Homeowner: GeD01, 1-UeA6,j_ V Address: Contact Phone Numbers: WELLS(to be completed at time of pump test) Type of well: Use: Diameter of well: Size of Casing: Depth of bedrock: Depth of casing into bedrock: Seal been tested? Yes No Date of test: Depth of well: Water-bearing rock: Depth of water:_ Delivers:— GPM for: (how long) Drawdown: feet after pumping: hours at: GPM Date of Completion: Signature of Well Contractor PUMPS(To be filled in before installation) Name&size of Pump: Type: Size of Tank: Pump delivers: —GPM Pipe used in well: Cast Iron— Galvanized Plastic Sleeve used to protect pipe? Yes No Type of well seal: Date: Signature of Pump Installer Date water analysis report submitted to Health Department: Plumbing Wiring Inspector Health Department Representative C:\DOCUME—I\bcurTan\LOCALS—I\Temp\WelI Application.doc 13 ® n 090 w - llWll oo N 'd0�ld X08-0 Q OZ—H I `r 1 'd08d lot AN ld0 005 'dO8d i Q 86 J r 0 j 0 nvz z + d = r H080d '7 L r G 0 00 L T FOOL='d'0 U' rq VQ (( ONVll3M f my l W2ia8 t ' � ;d02id � V ,t p tf, >1030 1 r- E t - t r 113M 'd08d a os F 1 _L Ir ► t64° - 'iris 1 13 wn <201 NO L - �� - I'Z1 h F r L �- -- else74)' , - i l VZ,7 �g- t IVY Z3-126-C ESN e-2g . r CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application,the applicant understands and agrees to comply with the following: i. No trench maybe excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been compiled with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164(DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry, iii. Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR 1926.650 et.seq.,entitled Subpart P"Excavations". iv. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et.seq,,entitled Subpart P"Excavations"as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. vi. This permit shall be posted in plain view on the site of the trench, For additional information please visit the Department of Public Safety's website at www,mass,gov/dns 3 1 P a g e TORN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 41845 �oRrH Date Issued Fli� 3y.$s;¢ v,•p OIL x � � Expiration Date AC �Siy /Ci �SHV°� _ Jackie's Law — Permit .Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant ' ! Phone Cell Street ddress City/Town MA ZIP Name of Excavator(if different from applicant) one Cell Street Address City/Town MA I ZIP Name of Owner(s)of Property , 6 PrA-s i!,L1°1 OE Phone Ce ( y� Street Address Y City/Town MA ZIP o Other Contact Permit Fee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc-)Please use reverse side if additional space is needed. Insurance Certificate#: Name and Contact Information of Insurer: PC Policy Expiration Date: ',2 C Dig Safe Name of Competent Person(as defined by 520 CMR 7.02): 7`` Massachusetts Hoisting License# �� � License Grade: IN Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.c. 82A,520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. AP CANT SIGNAT E DATE - b o EXC AT SIGNATURE(IF DIFFERENT) DATE r / ? O NER'S SIGNATURE(IF DIFFERENT) DATE: f N TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT � E 1600 On GOOD STREET; BUILDING 20; SUITE 2-36 NORTH f._ TTS 01845 El Susan Y. Sawyer,REHS, RS llealthdej)t 78.688.9540-Phone Pviwic health Director A N ° 1 2010 78.688.8476- FAX ow nofnorthanclover.eom TOWN OF NORTH ANDOVER r wwAownofiiorthandover.com HEALTH DEPARTMENT APPLICrATION FOR SOIL DATE: �Z�—l� MAP&PARCEL: O� / 1 -71 LOCATION OF SOIL TESTS: r-0MVr7-r *OfW-r OWNER: PAU L,- �7 Contact#: (56P>) APPLICANT: �i oe6 6 L" I e Contact#: (62o� ) 77e6�' 0703 ADDRESS: lwy ENGINEER: 1 I _ ' � N� ontact CERTIFIED SOIL'EVALUATOR: / 1 L�O 44 We ii� Intended Use of Land: Residential Subdivision Sid n e Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testinz(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Linen` Q 4l U 6- A,N.A. Conservation Commission Approval Date: �� c�- Signature of Conservation Agent: ' /rx C©�, Date back to Health Department: (stamp in): PLAN OF LAND LOCAMOIN NORTH ANDOVER,MASS OWNED BY KENMETHM a DOR07W.4 R4ss sr.4LE 1'40' MMCH23,1.989 SCOrrL.62ESRLS. 4-1 A-2- L r µ May 19, 2010 To Whom it May Concern: Regarding property located at 0 Forest St, North Andover, MA, Parcel ID: 210/105.D-0171-0000.0,OL- A1: I, Paul Rabs,the owner of the referenced lot above, give permission to George Haseltine and contracted resources hired by him,to perform tests, execute permits, and other means of action for the purpose of acquiring a building permit of a single family residence on the property referenced above. If you have any questions please feel free to call me. Regards, 6 �4 � � Cc II Paul Rabs Owner of 0 Forest St, North Andover MA, Parcel ID: 210/105.D-0171-0000.0,OL-A1. � o +� IN CIO a L ® m° L. 0 LL lu ,u o p. u ,a "uJ L Z LIM LV CL It Rt Bill n I r I m l�. 0 y� y 32'-0' 17'-0' - Ts s� I , Ir--- — ------------- III--— ————————————- i I I L J I II I g I I I 6'-3' 14'-0' I I o IN , ulxl s R I I L , I RAILING 1 - I I 4'CURB ----- I I 131114R III I I W I UP a I I I ( I I III b I I I � nio`f'- ow I ew rn I I ga m I I -w �- I ul I m I I m m A I I F 19 I I a a � .o _a-m ° I s m� I I �2zI0 FLR JSTS I w ( ° 1 2x10 FLR JSTS I g� - z I I I I L_mJ 12'-0' wN I IAN a_ I c�I I III � am I 18'x1 r� s I 8 I 1 I 18° uIN I I pq% 8�y� AN2� -Imp w p�m D w -W 9'-0' 4'-0' 9'-0' p m 9'0 z TO O.N.DR. q'0 z 7'0 O.N.DR. 6-01 261-0' o N DROP T.O.FR05T WALL A5 REQ.FOR DR.OPGS. .1" N z 5 Z FOUNDATION PLAN Forest St. Realty Trust N Q z�n THE SUMMERSET 2 88 CILCREASP ROAD D< ' LONDONDERRY, N.H.03063 O O A`i ^' WITH GARAGE UNDER Td:(603)425-2300 RAX:(603)425-7881 NZ DZ opzZ xZ D'mmOrta pZO �JT57 0 m 1 rmZA(p3 K) i W O Omr, g- y O o-1NA4_i L �TNjm bA O w AT Z W Q�LI S O A A Z1 pA O1 m Z 3 rN x x p D : r' O N N T z 3 _ m - p mL fZitNNN N N m D O_ �L p hNNOA A 32'-0' 703101 p 0 Z-12 14'-0' o„ m ?Z3ms Sj sZpm 9'-2° 15'-8° 7' Gqfi A o 7c w III HFARTH 2828 D.H. III I I�g I s N I HIM I I III r 3 -+ Am 2828 D.N. III _.g 113—j III a En" � z� W 4'-0° 2'_0' 11 3'-q' g'-3' 3'-p' 11'_0° A i 6 II RAILING °u a o. 13T414R 13Tt114uR ? UP jai RAILING 3'-0i s sobs .c. (�"••- I N ti N O° 3036 SLIDER I I = I w G==a REF. I [0;;c J r__ O o 36'N'C. 36'OFCi. w r �m A q'g' 2'-6° 4'-10° 'it I Ilim 2-2828 D.H. - NIII � VIII 2-2828 D.N. (�� I IIIt \� Illm 12'-0° I I 14'-0* u± i I c+ I I v � m S 6'-0 26'_0° 3j 32i_0r 0 9 > c N - 1T �Z PIR5T FLOOR PLAN Forest St. Realty Trust �'-` I I N5 pZ� n THE SUMMERSET 2 88 C[LCREAST ROAD O y - LONDONDERRY,N.H.03053 N o o mN— WITH GARAGE UNDER M:(603)425-2300 FAX:(603)425-7661 m0 >z i0()zpfz 1i7.. o�iA4� �n R DTNjm 1 tS N r�0u:2 A 07A-ppn�� A mZONA RRp tmry� zz iFP 32'-0° 3 8 3 (—' z °ia _> (p N 2'-4' 12'-6' o_z = D mmmN�j 3'-10' 5'-4' A NOF O O ?TQ= 'a m z3 P8 u m O = O w III I I L III I I III I I y ' 2828 D.H. III I I o III O m I ( �$$ o$ III I I 6 'w_ I'-2' ti 2-2828 D.N. Ci III 6' L �ti N 2828 D.N. III III 5, 7, 5'-3' 5'-q 1/2' w w III w G49 '% o = ° III y4i RAILING = �' I, 1668 r 4i z 4'-0 III 13TWR _ DN _ - III_ stP � m -q° 1, 7'-8' 2416 D.H. 2828 D.N. mIII c R'Q 3 S�III N� 3 2416 D.H. I m• �III � 4,_q0 2,_50 7'_5, III 3,_qa b 'o 4K d- G 2-2828 D.H. N glll rrF III� I I III —StP L------ o a 12,_00 12'-0' 14'-0' 26'-0' Ir w N ZT s z SECOND FLOOR PLAN Forest St. Realty Trust 0 g ' u N 1 =�,� 86 GILCREART ROAD 7 - 1 g�^- n<- THE SUMMERSET 2 LONDONDERRY,N.H.03063 6 c o mN- ;° KITH GARAGE UNDER TeL(803)426-2300 PAX:(603)426-7881 = A� Ir I�°" C Commonwealth of Massachusetts4M3 City/Town of M System Pumping Record iai ril�iiIsE� ['MEN� ; 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 Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left ZjEjffhi nt Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address tt gg City/Town State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? [ 'Yes ❑ No 5. Condition of System: c mm , 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc' Company 7. Locatio contents were disposed: G_., S. Lowell Waste Water Sign t e Hauls Date t5form4.doc•06103 System Pumping Record.Page 1 of 1