HomeMy WebLinkAboutCorrespondence - 351 REA STREET 6/19/1998 Town of North Andover RTH
OFFICE OF a2 0 tt t c o 4,O L
COMMUNITY DEVELOPMENT AND SERVICES
30 School Street ® ;
WILLIAM J. SCOTT North Andover, Massachusetts 01845 ��sSAC HUS���y
Director
MEMORANDUM
DATE: June 16, 1998
TO: Kathleen Colwell, Town Planner
FROM: Sandra Starr,Health Administrato
CC: Michael D. Howard, Consevation Commission Administrator
William Scott,Director of Community Development
RE: Calf Pasture Definitive Subdivision
This memo comes in response to Phil Christiansen's letter of June 4, 1998 concerning the setbacks
to a tributary to a surface water relative to Mosquito Brook. I am inclined to agree with Mr. Christiansen's
argument that the 325 foot setback to a tributary to a surface water supply in the local regulation does not
apply to Mosquito Brook since the Ipswich River is considered a Class B water supply. However, to date,
the Board of Health has held to the policy of disallowing the installation of septic systems, except in those
repair cases where there is no alternative,within the 200 foot buffer area to streams and rivers as
determined by the Rivers Act. As depicted on the definitive subdivision plan,Lot 2 is located entirely
within this 200 foot setback to the Riverfront Area of Mosquito Brook.
In reference to the memo from Michael D. Howard dated 6-11-98, concerning the statement no
feasible alternative the feasible alternative exists that Lot 3 only be developed. Therefore, Lot 2 remains
unbuildable without variances. There is, however, a limited area on Lot 3 that is available for soil testing
and possible septic system installation. The fact remains that as yet there have been no soil tests performed
on the site. Please be advised that soil tests were scheduled for today, June 16"', but were cancelled by the
engineer, as I understand it, at the request of Ralph Joyce, due to the fact that the area was under water.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Yr
COLANTONIOZ
ENGINEERS ANO 6CENT187g
May 29, 1998
Ms. Kathleen Colwell
Planning Director
120 Main Street
North Andover,MA 01845
RE: Preliminary Engineering Review
Calf Pasture
Definitive Subdivision Plan
Dear Ms. Colwell:
In response to your request, Cofer& Colantonio, Inc. has reviewed the submittal package for the
above referenced site. The project has been reviewed for conformance to the submission
requirements of the "Rules and Regulations Governing the Subdivision of Land" in North
Andover. The submittal package included the following information:
® Plan set entitled: "Definitive Subdivision Plan - Calf Pasture located in North
Andover, Mass." consisting of seven sheets dated 4/20/98, Prepared by Christiansen
& Sergi.
® Drainage Analysis—Calf Pasture Rea Street,North Andover, dated April 20, 1998.
® Driveway Covenant and Covenant Not to ,Further Subdivide, prepared by Milltown
Development Corporation, Old Yankee Realty Trust, dated May 21, 1998.
a A Notice of Intent for Calf Pasture, in North Andover, Massachusetts, dated May
1997, latest revision date August 6, 1997. Prepared by Wetlands Preservation Inc.
Received December 22, 1997.
a Wetland Impact and Mitigation Plan for Calf Pasture, dated July 24, 1997. Prepared
by Wetlands Preservation Inc.
a Wildlife Habitat Evaluation dated July 2, 1997. Prepared by Wetlands Preservation
Inc.
a Order of Conditions, Massachusetts Wetlands Protection Act dated September 11,
1997.
We offer the following comments:
Planning Board Regulations:
1. Section 3.) C.) 3.) c.) 50,ep49e Test Data —Two test pits have been indicated on the plans,
although no information has been provided for them. The plans indicate septic systems and
drainage basins, we recommend tests be performed in these locations to confirm suitability
for soil infiltration areas and retention facilities.
101 Accord Park Drive 781 982-5400
Norwell, .MA 0206-1685 Fax: 781-982.5490
/Y
m
2. Section 3.) C.)3.) d.) Drainage Analysis-The Rules and Regulations of the town of North
Andover require the drainage analysis to include analysis for the 2,10 and 100 year storms
for roads and lot drainage. Only the 2 and 100 year storms were provided. Providing the
retention ponds can adequately control the 2 and 100-year storms, the ten-year storm should
also be controlled. There is insufficient back up to verify the retention pond capacity. Data
on storm sewers should be provided. The proposed crossing impacts should be justified by
standard methods for river crossings.
3. Section 3.) C.) 3.) e,) Ownershiy/Encum bran ces -The subareas indicated on the Drainage
Analysis drawings do not indicate flow paths or control points.
4. Section 3.) C.)3.)f)Construction schedule-No construction schedule was provided with
the submittal_
5. Section 3.)C.)3.) g.) Soil Man -No soil maps were provided with the submittal.
6. Section 3.)C.)3.)j.),Erosion Control Plan-No erosion control plan was provided with the
submittal.
7. Section 3.)C.)3.)k.) 5.)The legend does not include hatching symbols. It is unclear what
each hatch indicates,
3. Section 3.)C.)3.)k.)9.)The proposed utility easements are not indicated on the plans.
9. Section 3.)C.)3.)k.) 16.)The profile does not include proposed water mains and
appurtenances thereto.
10. Section 3.)C.)3.)k.) 19.)It is unclear if the existing property is serviced by town water and
sewer.
11. The proposed span is over 200 feet long_ The]Planning Board may desire a specialized
review by the State I-Bighway Department or other bridge specialists_ Based on a discussion
with the Massachusetts Highway Department,there are additional requirements for bridges
that may not be addressed by this submittal.
We appreciate the opportunity to assist the PIanning Board on this project and hope that this
information is sufficient for your needs. We would be pleased to meet with the Board or the
design engineer to discuss this project at your convenience. If you have any questions please do
not hesitate to contact us.
Very truly yours,
COLER&COLANTONIO, INC.
John C. Chessia,P.E.
xc Christiansen& Sergi Inc.
Jim Rand
mee/JCC
MEMORANDUM
DATE: May 29, 1998
TO: Kathleen Colwell, Town Planner
FROM: Sandra Starr,Health Administrator
RE: Calf Pasture Definitive Subdivision Plan
I have reviewed the proposed definitive subdivision plan of Calf Pasture and have the following
comments:
1. No soil tests have been performed on this site.
2. Local regulations require a minimum of 325' between a septic system and a tributary to a surface
water supply, in this case Mosquito Brook and the Ipswich River. With this setback, lots 2 and 3
are entirely within the buffer and are not buildable without variances.
3. Title 5 states there must be a minimum of 200' between a septic system and a tributary. This
leaves one small potential area for a possible septic system. As noted above, however, there have
been no soil tests.
Based on these facts, I recommend that the definitive subdivision plan for Calf Pasture, dated April
20, 1998,not be approved.
MILL'TOWN DEVELOPMENT CORPORATION
®L® YANKEE REALTY TRUST
ELLIS BUILDING 95 MAIN STREET NORTH ANDOVER, MAO 1845
RALPH R. JOYCE dune 16 , 1998 (978) 685-4555
FAX (978) 685-3148
Town of North Andover
BOARD OF HEALTH
'120 Main Street
North Andover , CIA 01845
RE . CALF PASTURE SUBDIVISION
REA STREET
MAUREEN J . JOYCE , APPLICANT
Dear Sirs :
Please accept this letter as my request to be on the
agenda of the Board of Health for your meeting scheduled for
June 25 , 1998 . The action I request from your Board is as
follows :
1 . To withdraw 'the administrative memo of Sandra Starr
addressed to the Planning Board recommending
disapproval of the above-cited subdivision ,
2 . To dismiss Ms . Starr from further involvement with
the subdivision and to appoint a qualified individual
to review the plan and regulations and to further
advise your Board ,.
3 „ Upon receipt of such advice to make a proper
recommendation of approval or disapproval of the
sl.abdivision pursuant to the subdivision control
laws ,
4. To schedule appropriate testing of septic systems for
the lots shown on the subdivision .
5 . To direct such further action as the Board feels
appropriate for the circumstances .
A brief description of events preceding this letter is as
follows Approximately a year and one half ago Mrs . Joyce
approached the Planning Board and Conservation Commission to
subdivide her eight acre parcel on Rea Street . The Planning
Board procedures were deferred until the Conservation
Commission reviewed a Notice of intent and the Commission
subsequently issued an Order of Condition to allow the
development of the parcel the principle feature of which
provided a limited access crossing of Mosquito Brook as it
flows through the parcel to access and develop the uplands ,
During this process a request for septic testing dated
April 17 , 1997 ( copy enclosed ) was filed with your Board and
despite several telephone messages to Ms . Starr , none of which
where returned , an office visit by me , and several inquiries by
my engineer , Mr . Christiansen , no scheduled testing was
forthcoming .
The first time Ms . Starr- broke silence was at a. Technical
Review Committee meeting on May 28, 1998 . At that time she
indicated that she was going to apply a 325 ' set back
requirement from Mosquito Brook because it was a tributary to a
water supply, Mrs Christiansen advised her of the Massachusetts
Surface Water Quality Standard 310 CMR 4 . 00 . Ms . Starr
indicated she would review a formal submission by Mrs
Christiansen before further action which was submitted on ,June
4, 1998 (copy enclosed ) but , not withstanding the same , Ms .
Starr issued here memo dated May 29 , 1998 ( copy enclosed )
recommending disapproval of the subdivision . This memo is
without statutory authority as recommendations for subdivisions
are required of the Board of Health and is a gross
misapplication and disregard for regulations and our property
interests . It constitutes gross negligence and unprofessional
conduct by the Board ' s agent and subjects us to substantial
risk .
When this scheme did not work , Ms „ Starr next tried to
invoke the Rivers Act , so--called , and informed various parties
that a 200 ' set back from Mosquito Brook was now the standard
to he applied . T spoke to Mr . Howard and brought to his
attention (with the understanding that he was to meet with Ms .
Starr ) the provisions of 310 CMR 10 . 03 ( copy enclosed ) which
define that the Givers Act ( in conjunction with Title V)
requires a. 50 ' set back from the brook . When local regulations
are applied , the proper set back requirement for this
subdivision is 1001
,
As of the date of this letter , there has been no
acknowledgement from Ms . Starr regarding her intent to apply
the proper regulations or agreement to test two and not the one
lot she in her sole discretion feels is allowed . Her gross
misapplication of regulations and lack of responsible
administration has undermined any confidence that our property
interests are being properly addressed and , accordingly, I
request the Board ' s intervention as described in the beginning
of this letter before any irreparable harm is suffered .
Ve t rr- y you ,
Ralph Re J c f`
cc ; Robert Halpin , Town Manager
William Scott , Community Development Director
Kathleen Colwell , Town planner
Philip Christiansen , Engineer
Sandra Starr
Memo
To: Sandra Starr, BOH Agent
From: Michael D. Howard, Conservation Administrator
CC: Kathleen Colwell,Town Planner
Date: 6-11-98
RE: Calf Pasture.
You have requested from this Department an opinion specific to the placement of new septic
systems within the Riverfront Area. I have reviewed the Massachusetts Wetland Protection Act
and Regulations and, in summary, it appears as though a subsurface sewage disposal system
could be constructed if the following performance standards are satisfied:
1. There is no feasible alternative whereas the system could be located outside the
Riverfront Area (3 10 CMR 10.58(4));
2. Assuming the above has been satisfied,the soil absorption system must be set back
at least 50' horizontally from the boundary of a Bordering Vegetated Wetland (301
CMR 10.03(3) or a greater distance as may be required by more stringent local
ordinances...
3. In addition,the soil absorption system must be greater than 1 00'from the bank(or
mean high water elevation—whichever is greater) of the perennial stream in
question ... (310 CMR 10.03)(3);
4. Total Riverfront Area alteration forth e site is less than 5,000 s.f. or 10%of the
Riverfront Area.
® Page 1
If the applicant submits a plan which depicts a proposed location for the septic system that
would meet these above referenced performance standards,than I would suggest we coordinate
soil testing in the field. I would not, however, encourage the Board of Health to grant variances
of the local ByLaw as Mosquito Brook is perhaps North Andover's greatest riparian corridor and
in need of stringent protection. Furthermore,the applicant' site exists within the limits of
Estimated Habitat for Rare Wetlands Wildlife and it is vitally important that we proceed cautiously
with additional septic systems.
Your attention to this matter is appreciated.
®Page 2
TO: Ms. Kathleen Bradley Colwell, Town Plan e
FROM: James Rand, Jr., Director of Engineering
DATE: June 11, 1998
SUBJECT: Calf Pasture Subdivision
This departments has the following comments:
1. Bridges-A major portion of this proposed roadway is made up of a series of
arch bridges. This Department does nor recommend the construction of
bridges for town roadways. The proper maintenance is very expensive and
the potential liability is very high. There is also the question of design
standards and who will review the plans. This proposal may require both
State and Federal review.
2. Road Grade - The slopes for a major portion of the road are 1%. The
developer has connected a series of 1% slope. This type of design results in
an actual slope of 0.05% and does not work in in the field. We are currently
having problems on another subdivision that has this same type of design.
3. Water Main - The water main is not shown on the plan. Also, there is
insufficient vertical height over the proposed bridges for a water main.
4. "Scupper Detail"The scupper proposes a 4" in size pipe as a discharge. The
minimum acceptable size is 12 inches.
5. Drain Manhole & Catch Basin - need revisions.
6. "Vortex"type unit- This type of unit has NOT been approved for general
acceptance as part of the Town's drainage system. We are beginning an
evaluation of these systems and will not have the results for over one year.
This proposed subdivision does not meet our minimum requirements and is
unacceptable to this Department.
cc: J. William Hmurciak, P.E.
Michael Howard, Conservation
John Chessia, P.E.
C;\AMIPR0UVIISCCALF\MEM01
CHRISTIANSEN
F'ROFE'SSIONAL ENGINEERS AND LAND URVC;:`7'(R,`)
.SUMMER STREET HAVEMI I LL, MASSA(:f-USE'IS 01830 6318 (978)3'73.f 310 FAX: (978)372 3960
June 4, 1998
Ms, Sandra Starr
Town of North Andover Health AdministratorlflY
30 School Street
North Andover,MA 01845
Re: "Calf Pasture" Definitive Subdivision Plan
Dear Ms. Starr:
In response to your May 29, 1998 memorandum to Town Planner Kathleen
Colwell regarding the above referenced project, I would like to clarify certain points
regarding the issue of the required setbacks from a Tributary to a Surface Water Supply.
Specifically,the setbacks should not be applied to this project because Mosquito Brook is
not, according to the applicable regulations, a Tributary to a Surface Water Supply.
According to the Town of North Andover Minimum Requirements for the
Subsurface Disposal of Sanitary Sewage (April 1997), a Surface Water Supply is defined
as "Any lake, pond, reservoir, or impoundment designated as a public water supply in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00 and Lake
Cochichewick."
Likewise, Title 5 defines a Surface Water Supply as "Any lake, pond, reservoir, or
impoundment designated as a public water supply in the Massachusetts Surface Water
Quality Standards, 314 CMR 4.00."
According to the Massachusetts Surface Water Quality Standards, 314 CMR 4.00,
the Ipswich River, from its source to the tidal portion of the river, is designated as a Class
B water. As defined in 310 CMR 4.05 (3)(b), Class B waters "are designated as a habitat
for fish, other aquatic life, and wildlife, and for primary and secondary contact recreation.
Where designated they be suitable as a source of public water supply with appropriate
treatment. They shall be suitable for irrigation and other agricultural uses and for
compatible industrial cooling and process uses. These waters shall have consistently good
aesthetic value."
In order for a surface water to fall within the local bylaw or Title 5 definition of a
Surface Water Supply, it would have to be designated as a Class A water in the
Massachusetts Surface Water Quality Standards. Since the portion of the Ipswich River
Basin in which Mosquito Brook lies is designated as Class B water,the "Calf Pasture"
project falls outside of the jurisdictional requirements for the more stringent offsets
between septic system components and Tributaries to Surface Water Supplies. The
project, as designed, leaves ample space available for the construction of the septic
systems outside of all of the applicable setback distances required by local bylaw and Title
5. No waivers or variances from required setback distances would be necessary.
It should also be noted that if this portion of the Ipswich River Basin was
designated as Class A waters, a large portion of the Town of North Andover(all of the
town that is drained by Mosquito Brook,Boston Brook, and the Skug River)would be
subjected to the more stringent setback requirements. When these areas are combined
with the Lake Cochichewick watershed, a vast majority of the town's area would be
subject to these requirements. We do not believe it was the intent of the Board of Health
to subject a vast majority of the town's area to the more stringent setback requirements,
nor are we aware of any instances where these more stringent requirements have been
enforced within the Ipswich River Basin.
Enclosed are copies of the portions of the Massachusetts Surface Water Quality
Standards that define the surface water classifications and describe the Ipswich River
Basin, You will note that in Table 27 none of the designated Public Water Supplies in the
Ipswich River Basin are fed by Mosquito Brook. I hereby request that you review this
information and reconsider the comments you made in the afore-mentioned memorandum
to Ms. Colwell. I would appreciate it if your revised memorandum to Ms. Colwell could
be completed by June 12, 1998.
Please contact me if you have any questions regarding this matter, or if you require
any additional information.
Additionally,we should schedule the soil testing for "Calf Pasture" for two lots,
rather than only one, as we had previously planned.
Very l
. Christiansen
C.C. William Scott,Director of Planning and Community Development
Kathleen Colwell, Town Planner
Ralph Joyce
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MEMORANt)UM
t _
DATE Ma;29. 19,98 -
TO Kathleen Cplwea,Town P,anner
FROM Sandra Starr. Ilcal:bl—M ',inirrato=
Cali PLAUre Definitive Sub&wvon Plan
I have reviewed the prcposed definiti\a subdivision plan of Calf Pasture 8rc have the following
comments:
1 NO soil tests have been performed on'his site.
2. Local rqulatiora require a minimum of 325'between a septic systern and a tributary to a surSace
water supply, in This case Mosquito Brook and the Ip'v'ich R ver With this setback,lots 2 and 5 6
are entirely within the buffer and are not buildable without variances -
Tlrle 5 states There must.t;e a minimum of 200'bwr-c-en a septic system and a-ii tar This
Ieaves one Small potcntiai arcs for a possibic septic system. As noted abovr,however,there have
- otgn rw E011 trstr. _
Based on these facts, 1 recorrmend that the dttinitivesubdiv,sicn plan for Calf Pasture,dated Apri: _
20, 1998, uut In applovrd. - -
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• M
Town of ort Andover * �koRTho
OFFICE OF o
COMMUNITY DEVELOPMENT SERVICES -
27 Charles Street x
�A oq
North Andover, Massachusetts 01845
WILLIAM J. SCOTT SSAC wus�
Director
(978)688-9531 Fax (978)688-9542
February 23, 1999
Christiansen& Sergi
160 Summer Street
Haverhill, MA 01830-631$
Re; Lot 2, Rea St
N. Andover, MA 01846
Dear Mr. Christiansen,
This is to inform you that the proposed plans for the site referenced above have been
approved for a dwelling with a maximum of 9 rooms.
If you have any questions, please do not hesitate to call the Board of Health Office at the
number below.
Sincerely, -�--
Sandra Starr, R.S.
Health Administrator
SS/rel
cc; Maureen Joyce
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
I ' ,
PROFF`S&1'w1F^AL, ENGINEERS AND LAND SURVEYORS
3,60 SUMMER STREET REET HAVEF0 9VU, MASSACHUS rrs 01830-6318 0478)373-0310 FAk (978) 372-3960
d,'wN E E d�F�3)�) �
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.
L E3 E �February8, 1999 .,.
Ms. Sandy Stair, R.S.
Health Administrator
North Andover Board of Health
30 School St.
N. Andover, MA. 01845
Re: lot 2, Rea St.
Dear Ms. Starr:
Per a phone conversation with your office on Jan. 27, 1999,we have revised the SSDS
design for the above referenced lot per the recommendations of Port Engineering's
review. Please find enclosed a revised plan which includes:
1. The finished grade over the septic tank has been lowered to 6" above the tank
thereby not requiring a manhole to grade. reg. # 15.228 (2).
2. slope of pipe from tank to D-box has been changed from"s=0.02"to"s-0,015"
3. spot elevations for proposed driveway grades have been added.
Should you have any further questions in the above matter, we are available at your
convenience and can be reached by phone at, 978-373-0310.
Vy,
. ristiansen, P.E.
PGC/epw
cc: File#96063
Jan- 14-99 10: 02A Paul D. Turbide , PE/PLS 508-465-0313 P -03
January 14, 1999
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover,MA 01845
RE: Title V review for Lot 2, Rea Street
Dear Sandra,
Enclosed find the"Checklist for North Andover Septic System Plans" for the above-
mentioned site. The following minor notes and observations are offered.
• The design of the septic tank must include one childproof 24-inch riser/manhole
raised to final grade. 310CMR228(2)
• The elevation of the proposed driveway must be shown. NA 8.02(t)
The following minor point is noted:
® In the Profile, the slope of the pipe between the septic tank and d-box is listed as
2%, however the invert elevations indicate that it is in fact a 1.5%slope. This is
also an acceptable slope, but should be clarified on the plan so there is no
misunderstanding.
The following observation is offered:
® General Note 10 states that if the reserve area is constructed, an impervious barrier
must be designed in accordance with 310 CMR 15.255(2). It appears that there is
room for the fill and impervious barrier if the building and driveway are built
according to plan, and therefore this statement would be adequate.
If these minor changes are made on the plan, then I do not need to review this system
again.
If you have any questions or comments please feel free to contact me.
Sinter
FORTCarlton A. Brown,PE/PLS
ENGINEERING
Civil Engineers&
Land Surveyors
One Harri8 Street
Newburyport,MA
01950
(978)465.8594
LAW OFFICES OF RAI-PH R. JOYCE
ELI-IS BUILDING
95 MAIN STREET
NORTH ANDOVER, MA 01845
RALPH R. JOYCE (506) 665 4555
FAX 685 - 3148
April 17 , 1997
Town of North Andover
BOARD OF HEAL`T'H
156 Main Street
North Andover , MA 01545
k
RE : 351 RDA STREET
Dear Sirs :
Enclosed please find the :following items required to
perform water tests on the above-cited property
1 . Check in the amount. of $Vi�O
2 . Copy of deed
3 . Plot plan
Kindly contact:, my office with a. test dr-t-c. .
Very tr 01 ,
l p h R. o ry -°
RR,T .mJ.7
enc .
AUTHORIZATION
I hereby authorize Ralph R. Joyce and the North Andover
Board of Health to conduct water tests on my property at 357
Rea Street. .
r �
M a s e e n J. J
SEP'T'IC PLAN SUBMITTAL FORM
LOCATION: fro f I&L 6-71 3J-
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES NO
DATE: l zz3 0
DESIGN ENGINEER:
DATE TO CONSULTANT: -Y
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
Town of North Andover, Massachusetts F°'"' °•a
NoRTM BOARD OF HEALTH
o'�t�ae ,x,10
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DESIGN APPROVAL FOR
'SSMC"USE`S SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant J. Test No.
Site Location 1,67 3 IC6P 57 &°�T
Reference Plans and Specs. e"1'5%11-91V5&A)
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN,BOARD OF HEALTH
Fee Site System Permit No. `�
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
ti VV ft� o f )V(,)/�
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PE IT
Application for a Permit to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components
Lor lion O�ne s Nam
Map/Parcel# j Address
Lot# Te¢phone#
� �
Installer's Name Design¢'s Name
Address Address.
1-7 V a3 _ -3 �� �c
Telephone# Telephone#
G
Type of Building: (/s"Y}d Lot Size �� � Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title c - � ' at Z
Description of Soil(s) � LL�I ,CGiVI,& �'rV
Soil Evaluator Form No. It /J Name of Sotl Evaluator A ' Date of Evaluation /D/1/4'
DESCRIPTION OF REPAIRS OR ALTERATIONS
Th unders' d r e nstall the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE nd f r e m eration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date I��� 7a,,
Inspe6ions
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
1 I
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