HomeMy WebLinkAboutMiscellaneous - 415 BOXFORD STREET 11/19/2015 (4) I
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Grant, Michele �
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From: Kfoury, Eric r
Sent: Monday, November 09,
To: Grant, Michele
Subject: RE: Seive Analysis
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Great. Thanks.
Regards, Q '
Eric J. Kfoury
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Director,Community and Economic Development1 ,) .( ... rI✓
Town of North Andover
1600 Osgood Street—Suite 2035
North Andover,MA 01845
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Phone 978.688,9533 (�
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Fax 978.688.9542 .-
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Email elcfaur � townofnorthandraver.com �
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Web www,TownofNorthAndover.com
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From: Grant, Michele
Sent: Monday, November 09, 2015 9:36 AM
To: Kfoury, Eric
Subject: FW: Seive Analysis
There's a company out of Stoneham that will pull the sand themselves, for the installer and the Engineer. I spoke with
the engineer and he will handle it. With that being said, I'll follow the chain of custody through them.
Thx
Michele E. Grant
Public Health Agent
Town of North Andover
1600 Osgood St I Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email ingr over.com
Web www,TownofNorthAndover.com
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ISS T (E TIFYT„ th diVCival e age Dis sal ysf'em (Repu)'`�.,
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ha be tat din a or n e wit the pro ision of E 5 f th Sat Envt ore, eta Codd as described err the
apation fo rsposal Wor Co structron Pe it No. BHP-2015-08 fed ber 15
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Printed On: Oct-29-2015 --- -- -------- ---
---- -------- BOARD OF HEALTH
tn� . Commonwealth of Massachusetts Map-Block-Lot
105.00010
BOARD OF HEALTH
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Permit No
North Andover BHP-2015-0893
PEE
$250.00
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DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted peter Breen
to(Repair)an Individual Sewage Disposal System.
at No 415 BOXFORD STREET
as shown on the application for Disposal Works Construction Permit No. BHP-2015-089 D ated October 29,2015
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Issued On:Oct-29-2015 -
- — BOARD OF HEALTH
stem
TODAY'S A E
Construction Permit — TOWN OF
$ 250.00—Full Repair
NORTH ANDOVER, MA 01845 $125.00 -Component
Important: Application is hereby made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal system*
forms on the
computer,use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key F71 Repair or replace an existing system component—What?
to move your
cursor-do not
use the return A. Facility Information
key. tit
VQ Address or Lot#
City/Town
2.-*TYPF- OF SEPTIC SYSTEM*:
➢ 0 Pump r_1 Gravity(choose one)
***If pump system, attach copy of electrical permit to application***
➢ ❑ Conventional System (pipe and stone system)
➢ E3rInfiltrator or Blodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.)
➢ F-1 Pressure Distribution S.A.S.(No D-Box)
➢ ❑ Pressure Dosed(D-Box Present)S.A.S.
➢ ❑ Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES =(no further info. needed)
NO=(installer must specify brand of filter before DWC issuance)
Mia t is the Make? lfhat is the Model?
2. Owner Information
A6 ch
Name
Address(if different from above)
.2, a
6 o t
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
0c'��- 8 F e- Cloy 4T t vj
�
Name Name of Company
Address
M A_ v 5-
A-z'
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
4. Desioner Information
6
Name Name of Company
Address
City/Town State zircode'
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
Application for Septic Disposal System,
TODAY' E
Construction Permit - TOWN OF
11"-
(�$250.00 ull Repair
NORTH ANDOVER, MA 01845 -2M Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of BuilqLng EI'Residential Dwelling or❑Cornrnercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. /understand that until a final Certificate of Compliance has been issued by
this Board of Health, the installed system is not approved.
/141— 10
— bz�
Name Date
Ap ti Approved of Henalth Representative)
Name Date
Application Disapproved for the following reasons:
For Office Use Only:
L Fee Attached? Yes No
2. Project Manager Obligation Form Attached? Ves No
3. Pump Svs P If so,Attach copy ofElectrical Permit Yes No
Applican t received copy of
"Electrical Inspection Notes Jbi-Septic Systems" Yes No
Handout?
4. Reviewed appfovallettefaZ(paperwo-rkreceived? Yes No
Missing:
9. Foundation As-Built?(new construction only): Yes No
(same scale as approved plan)
6. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSTALLER PROTECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic xyatooz for the property u1:
For plans by 6"
(,\cwress of septic systern) (Engineer)
Relative to the application of
(Installer's 11"Itne), And dated
Dated 0 1;)"-i With revisions dated
Last revised date)
Imnderstand the following obligations for management of this project:
1. As the installer, I am obligated to obtain all permits and Board of Health approved plans pilior to
performing any work oousite. I must have the al?proved..121ans and the permit on site when any work is
being
1. Ao the installer,I must call for any and all inspections, If homeowner,contractor,project manager,orany
other person not associated with ozy company schedules uniuopccdooumdtbooyatcouisuot ready,then
item three shall 6eapplicable.
3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspec ion,without completion.of the items in accordanc
with Title 5 and the Board of Health Regulations ma result in a$50.00 fine being levied aga
�inst me and/
� coMaU.
u. Bottom of Bed—Generally, this is the first (1'� inspection unless there is a retaining wall,which
should be done first. 1hcinstaller must request the inspection but does not have tobupresent.
b. Final Construction Inspectio —Engineer cuust8zxtdodzeiiiuxperdoofbzolcvx600a, tieo` etc.
As-built of verbal{}IC (or e-mail to from the engineer mnxt
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause pump to work and alarm tofunction.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to6cou-siLc
4. As the installer, I understand that only I may perform the work (other than simple excawfion)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done b)�others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the s)�stern and/or revocation or suspension of my license to operate in the Town of
North Andover, sip�nificant fines to all persons involved are also.-]2ossible.
5. As the installer,1 oodorutuud that must be on-auc during the performance of the fvuv`"i^g construction"
steps:
a. Determination that the Juropxrelevation of the xxcunwbom has been reached.
b. Inspection of the sand and stone to be mzxmC
c. Final inspection Board of Health staff or consultant.
«[ Iwxbv�a/W*w »F task, D-Bv` p6ox4 stone, vent,pump chamber, retaining wall and other
xo*wpowx*yt,
6. As the installer,I understand that I am solel):resi2onsible for the installation of the system as 12er the
approved 121ans. No instructions by the homeowner, general contractor,or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Toda),'s Datc)
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North Andover Health Department
Community and Economic Development Division
October 28, 2015
Rico Isidore& Karri Orem
415 Boxford Street
North Andover, MA 01845
Re: Subsurface Sewage Disposal System Plan for 415 Boxford Street(Map 105C,Lot 10)
Dear Mr. Isidore and Ms. Orem:
The proposed wastewater system design plan for the above site dated September 24, 2015 with a
final revision date of October 19,2015 and received on October 28,2015 has been approved.
The design plan has been approved for use in the construction of a new on-site septic system for
a 4-bedroom(max 9-roam)home utilizing a Quick 4 Standard Infiltrator Chamber system.This
design plan approval is valid until October 28,2017.
During this time,a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover. In the event an imminent health problem, such as sewage backup into the dwelling is
occurring,the North Andover Board of Health may reduce the time period for which this plan is
valid.
At a regularly scheduled meeting of the Board of Health,this plan received the following
approvals by the members.
Local Upgrade Approval:
® To reduce the requirement of soil test pits in the area of the proposed leaching facility
from 2 test pits to 1 test pit
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
415 Boxford Street October 28,2015
This approval is also subject to the following conditions:
I 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 Permit is
void, installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit(3 10 CMR 15.020(1))
2. 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.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Si I c. rely,
"I
Michele Grant
Health Inspector
Encl. Installers list
cc: Ben Osgood,Jr.,P.E.
File
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Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978,688.9540 Fax: 978.688.8476
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CERTIFICATION
I Rico Isidoro and Karri Isidoro as property owners of 415 Boxford Street, North
Andover hereby certify to the following:
1. I have been provided a copy of the Title 5 PA technology Approval, the Owner's
Manual, and the Operation and Maintenance Manual, and agree to comply with all
terms and conditions.
2. I understand the Systems is being installed under a Remedial Use Approval and agree
to provide a Deed Notice as required by 310 CMR 15.2$7(10) and the Approval of
the I/A technology.
3. I agree to fulfill my responsibility to provide written notification of the Approval to
any new Owner, as required by 310 CMR 15.2$7(5)
4. I understand that the design does not provide for the use of garbage grinders,the
restriction is understood and accepted,
5. Whether or not covered by a warranty, I understand the requirement to repair, replace,
modify or take any other action as required by the Department or the Local
Approving Authority (LAA), if the Department or the LAA determines the System to
be failing to protect public health and safety and the environment, as defined in 310
CMR 15.303.
Signed this 20`" day of October, 2015
Rico Isidoro Karri Isidoro
RECEIVED
IMN OF NU'RTH ANDOVER
HEALTH DEPARTMENT