HomeMy WebLinkAboutApplication - 239 GRANVILLE LANE 6/12/2009 TOWN OF NORTH ANDOVER "ro–MV17
04"
_0
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH ANDOVER, MASSACHUSETTS 01845 U�o
978.6889540---Phone
Susan Y.Sawyer,REHS/11S 978.688,8476- FAX
Public Health Director E-MAIL: heal flidept@,towno 1)1 orth an(lover.com
WEBSITE: littp://w\vw.towtiofiiortliaildovei-.coiii
SEPTIC PLAN SUBMITTAL FORM ..........
RECEIVED
Date of Submission: JUN 1, 7 '91009
'l-OWN OF I,I�1 ANDOVER
V,0-V,V') HEALTH()EPAIRTIMENI-
Site Location:
Engineer /–I't J , /'2&1�&'-
New Plans? Yes 'j $225/Plan Check 4(/�"/
includes I" SUbrnis�i&i and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes V No
Local Upgrade Form Included? Yes No
Telephone 4: �4 00 1 [4 Fax 4:
E-mail:—
Homeowner
Name: 0 A c1' ('°?o 0
V,
OFFICE USE ONLY
When the submission is complete(including check):
o Date stamp plans and letter
Complete and attach Receipt
'Copy File; Forward to Consultant
Enter on Log Sheet and Database
rr:
LU
mi II f C4" 1 $ O
Z z or
s ) C. s
-o a
v
0
� d„.�
L U) v v
o
CL
�n i0 v n B z z in
U r•
f) ° m o
L � _
R7 n 0 V1
O
�
QJ QJ L e, L
= U g 9.i a oc
BOA p�pp��
,. } u> '^ (n
td _
L .F CL CL
nl O
wv �” .
..
m CL
o ai 0) '`DPW M
CL E
°-
70 ,�, O
o a
CL
c >,
v v
❑ c
to to m
w
o
o i J . h CI r can
E° a- ' 0 -Z CI. ro . ��� 0 c
>. ,,, a
v ay c c Q
N w
.®
.® L L E f7 v v a a
s
m w
® cn 0 CD
o v as C p�� °
o u)w - - v v
L
m o n
G 0 - o
06 LL mot° Sri
v
U
0
0
co
= o
!t Y C N
(0 O U
al
O
Z
3 (LS n m i s
N O ��� w n
Mn
U) 0
W[� Q Q r
U N N
6
a U w+ a)
U) O O 0 3
C } N
0
O O L C U) a) U C
Z m o 0 Y N O
N « 'N d O u o IL
0 El a E c
c o m
a)
cU U w a
In
o ` 0 k L
U) to Y
> Q `- C
Cl) Q @ _ U)
❑ r Q a) Q } o
CL
O v i
c @ > E
Of O N a) ❑ J = a� o
O-
O
O } ca O m
t 0 J -j 0 El
E� m
❑ L
w
++ a O p
DN
3
C O O a) _ J } 7C3
a) 0 (0 n c O O
cE C v a) 3 0
E O
m 4— O @ m
O r = a.) NC c W N aNi N
a� O O U -p
O a r O m N a c��a E
O = = C y o o w ca } ° in
E T L. V) U O O ❑ J C� J n- w CD W o
0 O o
U U
LL m 6 V N cli
U
OD
d
0
z m
w
0
a
U <6
C N
a0+ N O
O N'p Mn
O
U
3
N 0 0
O cn °
CL n ' o
0_N o
U) c,\ W
-0 Q N
m o U !, U)
3 T
y T
Q� e a m a
CO mo > :6
o g
U (7 to
o
v/ N
X°
O 0 LL
CL Ca
O
m
E U-
u y c RiC
W `
y/ X
°
V O U U) O
o '0 o 0
N
d 4- =J z
3 ° r = -0
O N O — o
O Q
o O CL C� ¢ o
U U LL U °
�� 0
o °o
= o
O Y C 1)
\
z U O 0)
4.
L m O
.,,✓ U C (0
a (D ❑ m
o
rL
N O
n L d
Q
(L)
CL ani ca
J -p
® c El N
0 (�
0. •.] w p N N U c
0 O C N O
o d O Li a a
to
� o �
o �
� c •ab a� a� � �
❑ L
co c�
a Ali a� o
'^ c�
® °' J !! °
LL
L C C Y O
�� ❑ O a
_ .S} o
cc
E °
N o a a o
N
ca
�I
+�+ m 7C30 ❑ N
U c
a
c m m m in a) 0
+� o
O a
Z > o ❑ a�
d " d o �? ❑
t O o ai a°i
N _ C: ° iu
_ m o ca o
T En
o O
U U LL C) N M L6
- a
d o
° N
c
a
a�
U
c r N
O N O
a
o
U rn
m
a)
® 0 u !
cn��A/� � C
N O
5 CD
W
rz
d
E no N
3 M= O ti
ti> U Q
o`
U j C�
CD m
CO I
® o� I LL
i
W O N
m a
E LL
U �
(n ?o m
o E `o
vii c� E` v
� � r
N U °
Qj
cn
t
=J \ `✓`+
- A Z
° 4® _0 O /1
0 3 r N O o
° _ �,
o
CD
U U LL L) °
0
U
0 0 oo
f = o
I J a O
Y
z o
a m
r
o m ❑ d o
lu CL
a
CL
y
V N Y d m
O N O Q N
Rj m r m
N S � o ❑ � �
® a ° ° in
Pi = C N U C
®/ > O O LL. Q. O
6 m m
ry- c N Q 4 Q. y
O N l (n a)j Q
3 :0 co El a
v C =
M >O j
t U)
CO O T v p 1
N
1 j N vii N >
>
0 c' L
Q
4® a p D a
++ @ a E
E ❑ m
O "m
R
U �p F-I C
> _
N 9 u-
cn
ca 70
O El N
m I
C O
m m O = N _° v _ 3p
U) + U Z S@ n
R N t o o Q a
a)
v- ®_
C (6 Q7 O
Cl) Wf6 m E m ❑ O
Z o
d 4- 1 y °� a) - �' a� p
3 m is
O 3 N O o _0 m
E >., L' ® ® J (� J p w U W ro
O � ® o
V C) LL U N M 4 LO
0
U
o
I
d �
,C 117
Y �
o �
d
U
N
O N a O 1 N
O N
U m
N _ �
U)
o �
� N
0
C C
A' N
W N U
E a N
E a w
3 > U N
LL �
T
U
0
v!
®
L
N LL
l0 a�J
� y m
LL
V N
CL
G1 ° o
E
'x
y
t0 Y
O
o
02
O
O T® aj U)C/) O
O Q
O
.o
Q C ®
® N 'a~ D
Q
U U
LL
r
0
00
x o
o
m
N �
a)
o N ® m a
O
N L
Q fn Y Q a)
U � N
J
O ❑
C
O p U) O U C
O
_ o d O LL a o
N a3
Q
3 w m F-I
E — kj ci
M co
~ O o
O @ v s
Q)
O 0) En LL
C c � o
C g v9 E m ;_>
o p p a
_ �U a
c c
O J
ca ❑
El
o
VV^I > G
Q _ t
C y = U v C r
CL
O y O L
CO S 2
c is m m o
Cl)
2 El O
4- m
3 0 r = w a) au'i o 3
a a (n E
E 0 E C O U O C O Lp
~ i O o (D p a U`' w o
U U LL U
�- C-i ai Lci �
0
✓: �� C
I '
d
0
t
o o)
m
U 5
C Y N
-
O
e0 N+ N
O 'p N
W
O
U m
0 � I
0
CL
P p
to V O
N `o
N C
C y •+
E E an U a)
M o N
3 @5 Q
U
LL T
On
T
va
a
mo @
o
U
co h
=
o ~
0 LL
L N F'
m y
N o
Q � r
U It
m An
o 2
r
[� N
—I O T
3 ° r
cn
0 3 r N
0
: 0 C
E
0 Q
« v o
U U LL U °
C a
_I.E
o OD
to o
a>
Q)
o a
al N m
° U
❑ -° = n w
O N
(6 �
(ll @
N N N N (n
N L L L L N
O m m C
m C m C
N _ :) D
O
x O O =ai
a J E
C: N
a a�
N y
5 N _T
-0 L
co o
o
Cl) ° N
O C V'
is
p
4-0 � 3 (d 0
°
W o o (D
L N
N N N
Q (n C O U
UO N
« (n L O N
U1 N -0 U ° cn
O U � N °
ii � � O .0 C � C •=
C C C O
E E °� cl• r
U) 0 o =3 O E v � El �
O p
4- �� Q O O
O � CO
cn
''^^ (6
+�+ toil tll (6 o a �5 C
N N O m 4 (6 w '0 O (0
4-
3 0 � E � L Z O Z U) o }
r, L _0 D.. a a O m a=i O N to N
c 0 +O+ L 0 0 x y Q Q 0 (6
E 0 0 ❑ ❑ Li = Q 0 cd no
O o
U U LL ci W
U
o
U U- co n
0 C 0)
V1 N 0 m
C •— U d
"C W m a N
0 70 W w CL
0 0
m '�
O L N
ui 0. w CO
N 0 :?
O
ai
fn U •E � 'D o
O . p o
<C c
O p a y E
_
3 � W �.
_ a) �
a,
Cl r- m
L) w
0 � > S cn ` o a
cn o a
1 •� r1.
C `ti`��'11 m is /- o w E
O � 0 w O O m 0 o
E a) C) a
L.. C E (U
O 0E � LO
> U) _
LL1 a) ' u) E
En 2
Q� 0 0 L f li
u O
c m
L6 �' E
cl < o •°
a) MQ) � m
N ° (n � � w
a a) m
n NrM C Cp� aoC
d a M w= � 3
0 C �_ a) C
O 3
dad U � m °' 0
CL o U >
0 0
(0 L O W M d
m a)
•O O E -p C) ca m a) C �
M C co W Z -p
ay. U C
m 0
E j, �- (� � aa) a `m '.,,S F z Z o 0
U U LL LL
0
o
a
\.
0
00
Q)
m
m
N
a
CL
N
0
3
O C15
C O
N o
6
N
N
N
N
N
3 Q
VJ �
W �
V+
OLL
L
O
N
N
° E
CO m
L
3 O r N
c
o 3 r
E ~ L Z) o
O� O
O U LL LL °
U
O
Commonwealth of Massachusetts
City/Town of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. 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
the local Board of Health to determine the form they use.
Important:
When filling out A. Site Information
forms on the 7
computer,use r -o-e. U,�y--, a F3, kA 0
only the tab key Owner Name
to move your €^ '
cursor-do not
use the return Street Address or Lot#
key. �j , O'V, fi ! 14 r E ,
City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
Date Time Date Time
Observation Hole# t�/q
Depth of Perc
Start Pre-Soak —
End Pre-Soak
Time at 12"
Time ate"' �-
Time at 6" lAci�t✓
LA V
Time(9"-6") — — -- --VAP
Rate(Min./Inch) - ---
Test Passed: ❑ Test Passed:
Test Failed: ❑ Test Failed: ❑
Test Performed By
n ,elv
Witnessed By: — - "- "--"--- —
Comments:
t5form12.doc•06/03 Perc Test• Page 1 of 1