HomeMy WebLinkAboutSoil Testing Results - 305 BOSTON STREET 12/6/2011 TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SE RVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 " F�•� �
NORTH AND h S 01815 "SsACHUSBi`%
Susan V.Sawyer,RE, RS 978, 88.9540--Phone
Public Health Director �„ 978, 88.8476—FAX
}kcal rde)t a townot'horthandover,com
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HEALTH t)EPAt`t"tVE6
APPLICATION FOR SOIL TESTS
DATE; # r Q.r # b -- MAP&PARCEL,
LOCATION OF SOIL TESTS
OWNER: ,.�� � " :- -Contact#:
APPLICANT,__ 6
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ADDRESS: ... al a" #:" „ ^ „ :m ,. " W : -fit _
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ENGINEER:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision ''Single Family Ilonn,) Commercial
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochiclnewick Watershed? Yes No ,
THE FOLLOWING MUST RE INCLUDED WITH THIS FORM
Y Proof of land ownership(Tax bill,or letter from owner permitting test)
8.5”x Il"Plot plan&I ocatlou of Testiu juplease indicate test pit sties ou the plan)
Y Fee of$425.00 per lot for new construction. This covers the minimum two dcop holes and
two percolation tests required for each disposal area. Fee of$160,00 per lot for repairs or upgrades,
GENERAL INFORMATION
Y Only Certified Soil Evaluators may perform deep hole inspections,
> Only Mass,Registered Sanitarians and Professional Engineers can design septic plans,
9 At least two deep holes and two percolation tests are required f'or each septic system disposal area.
> Repairs require at least two deep holes and at least one percolation test,at tine discretion of the HOH
representative.
> Full payment will be required for all additional tests within two weeks of testing,
> Within 45(lays of tasting,a scaled plan(no smaller than I"-100")shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
Y Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
NA. Conservation Commission Approval Date,"_ ) �
SIgnature of Conservation Agent:,
Date back to Health Department: (stamp in):
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TOWN OF NG11.2.TH ANDOVER Permit Number
NORTH ANDOVER,MASSAC;HUSE77S 01845
%%0RY0f Date Issued
.7`��p�d4ap w` a�QOG
M � M1 jf
Expiration ion Date ,
�A nnAYip AYP,�}
ss,►c{►us ` RECEIVED
TOWN OF NORTH A"MMA
"EA U"DEPARTMENT
Jackie' Lave — Perinit Application
Porsuant to G.L. e. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST RE VULLY COMPLETED PRIOR TO eONSIDERATION
Name of Applicant Phone
Street Address "
ityrroven MA ZIP
Name of Excavator(if different from applicant) Phone Cell,)
Street Address
y A ZTP
r
Name of Owner(s)of Property '1►one -' Cell
Street Address ;
City"Town MA ZIP
Other Contact Permit Fee Received No Yes
Description,location and purpose of proposed trench:
Please describe the exact location of t1re proposed trenel►and its purpose(include a description of what is(or is intended)to
be laid in proposed trench(eg;pipes/cable lines ote.)Please use reverse side if additional space is needed.
-
.
Insurance Certificate t/;
Name and Contact Information of hisurers mmµ
a �
Pope Es iration Date: 77T d „
Dig Safo#-.
Name of Competent Person(as defined by-520 CMR 7.02):
Massachusetts Hoisting License dt 1
License Grades " w Ex tration 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 WORT{ 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 CONSTRUCT"ION,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.
TAE 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 CONVECTION WITH THIS PERMIT AND THE WORK CONDUCTED
THEREUNDER,INCLUDING BUT NOT LIMITTA)T"O VNFORCING TT7I'P REQUIREMENTS OF STATE
LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE,
THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT TIIE 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,INDEAINIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS
AND EMPLOYE IN, FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES
RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, Olt DAMAGE TO ANY
PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNATURE
DATE
EMXCAVATOR SIGNA0RE(IF DIFFERENT)
R
*p
.. s ..t —DATE .
OWNER'S SIGNAT RI: IF D +,FERENT r
DATE. /
2JPa6e
® Ladders must be used in trenches deeper than 4 .
o Ladders most be inside the trench with workers at all times,and located within 25'of unobstructed
lateral travel for every worker in the trench,
o Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the
ladder.
Inspections of every trench worksite are required:
o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm,
o bispeetions must be conducted by the competent person(see below).
® Competent Person(s)Is:
• Caaable(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the
trench,and other working conditions which may pose a hazard to workers,and
• Authorized by management to take necessary corrective action to eliminate the hazards. Employees
must be removed from hazardous areas until the hazard has been corrected.
® Underground Utilities must be:
• Identified prior to opening the excavation(e,g.,contact Dig Safe),
• Located by safe and acceptable means while excavating.
• Protected,supported,or removed once exposed.
e Spoils must be kept back a minhnum of 2'from the edge of the trench.
Surface Rnaumbrances creating a hazard must be removed or supported to safeguard employees, Keep
heavy equipment and heavy material as for back from the edge of the trench as possible.
o Stability of Adjacent Structures:
• Where the stability of adjacent structures Is endangered by creation of the trench,they must be
underpinned,braced,or otherwise supported.
• Sidewalks,pavements,etc,shall not be undermined unless a support system or other method of
protection is provided.
O Protection from water accumulation hazards:
o It is not allowable for employees to work in trenches with accumulated water. If water control such
as pumping is used to prevent water accu mulation,this'must be monitored by the competent person.
o If the trench Interrupts natural drainage of surface water,ditches,dikes or other means must be used
to prevent this water from entering the excavation.
a Additional Requirements:
• For mobile equipment operated near the edge of the trench,a warning system such as barricades or
stop logs must be used.
• Employees are not permitted to work underneath loads. Operators may not remain in vehicles
being loaded unless vehicles are equipped with adequate protection as per 1926.601(6)(6),
• E►iiployees must wear high-visibility clothing in traffic work zones.
• Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous
atmosphere exists, If a hazardous atmosphere is found to exist(e.g.,02<19.5%or>23.5%,20%
LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space.
• Walkways are required where employees must cross over the trench. Walkways with guardrails
must be provided for crossing over trenches>6'deep.
• Employees must be protected from loose rock or soil through protections such as scaling or
protective barricades.
5 Page
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Friday, December 09, 2011 10:46 AM
To: 'Daniel Ottenheimer'; 'Isaac.—Rowe; Peters, Marianne; 'Randy Burley'
Sawyer, Susan
Subject: FW: Soil Test Application-
305 Boston Street, N�rth Andover
Attachments: 20111207145006877 (2):pdf
Hello,
Fllea,sc schedule soil testing for 305 Boston Street. Engineer is Phil Chritiansen - 978371031.0.
Comments from 1.2/8/2011 - Heidi in C;onservat:ion: than 50.h,%et corn the wc:dan( , g
'Flianl< yot.t.
a
Pamela DelleC biaie
Departmental Assistant I Community Development I Health Department
Town of North Andover
1600 Osgood Street I Bldg 20 1 Suite 2-36
North Andover,MA o1845
Office-978-688-9540
( Fax-978-688-8476
C'l Emait-p(:,:Qlj tii tteCCA�to"�.xtG.ktl,ot tkt_1tictot c r ca_t_x.1t
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Web site httpp.f./1vwv,icywrtrrftreatfhzttc le�e,x.cc>t2tf& �gct/txwcgx;
"We can never see the path q our dfGve Ott"e too busy,fi civsing on the pebbles under our fiw."--Anon nous
From: DelleChiaie, Pamela
Sent: Wednesday, December 07, 20113:15 PM
To: Gaffney, Heidi
Cc: Hughes, Jennifer
Subject: Sail Test Application - 305 Boston Street, North Andover
Hello,
Please let me know your feedback with regard to wetlands for Soil Test Application-305 Boston Street, North
Andover. I will leave a hard copy in your inbox. Thank you! O
Pamela De le(llhiaie
Departmental Assistant I Community Development i Health Department
Town of North Andover
1600 Osgood Street i Bldg 20 1 Suite 2-36
North Andover,MA o1845
Office-978-688-9540
I Fax-978-688-8476
C=7 Ismail-1x&llr th en(±x>tcrwzlaak=b�r tlr tttclo a t cta,trx
2J Website %xtti.lz�fWvww 1.arsvrto9ta. tltrztldasl .cazm/Izgay
"We can never."z`ee the Inah ol'o r 1IJ w Y we are too hil,. yfi)cusing on the pebbles under ouY"ftet ' ,,.,,Anon.yN'Iwus
1
DelleChiaie, Pamela
From: Marianne Peters [mpeters @millriverconsulting.cam]
Sent: Wednesday, December 14, 2011 9:48 AM
To: DelleChiaie, Pamela; 'Randy Burley'; Grant, Michele
Cc: Sawyer, Susan
Subject: RE: Soil Test Application -305 Boston Street, North Andover
Phil just got back to us; this has been scheduled for next Tuesday, December 20t @ 9:30 with Randy.
From: DelleChiaie, Pamela ,L rrraultcrmtadQll h.@tQ nofnorthandov r.cornJ
Sent: Friday, December 09, 2011 10:46 AM
To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley'
Cc: Sawyer, Susan
Subject: FW: Soil Test Application - 305 Boston Street, North Andover
[-i cl.l.o,
Please schedule soil tcsting for 305 Boston Street. E,ngineer is Phil.C:h iti.anscn - 9783710310
Comments rents frorn 12/8/2011 - Heidi in Conservation: "y c stp—iz-,q wcz more than_ 0./ect lio..ni Me wetla.nc ."
Than l<yott.
P
Pamela L elleC biaie
Departmental Assistant I Community Development I Health Department
Town of North Andover
1600 Osgood Street I Bldg 20 1 Suite 2-36
North Andover,MA 01845
2 Office-978-688-9540
R Fax-978-688-8476
i-1 Ismail-pcPckchi as,(x tarwzi mire flth extda.�vc,r.c;t rlr
�] websitcM 11ttt�:f�twsvw.tacwpxaa�tn xs .ft;ttzdcr�cr,a aatltf k'ag_esjj�,ciex,
"1417(e � f � � .�,l �k �a��,�. "
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From: DelleChiaie, Pamela
Sent: Wednesday, December 07, 20113:15 PM
To: Gaffney, Heidi
Cc: Hughes, Jennifer
Subject: Soil Test Application - 305 Boston Street, North Andover
Hello,
Please let me know your feedback with regard to wetlands for Soil Test Application-305 Boston Street, North
Andover. I will leave a hard copy in your inbox. Thank you! (D
Coe Ref ,
Pamela )elleChiale
Departmental Assistant I Community Development I Health Department
"Town of North Andover
1600 Osgood Street I Bldg 20 1 Suite 2-36
North Andover,MA 01845
Office-978-688-9540
Cl Fax-978-688-8476
1
DielleChlaie, Pamela
From: Randy Burley[rburleyL7a millriverconsulting.com]
Sent: Tuesday, December 20, 2011 3:54 PM
To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela;
Sawyer, Susan
Subject: Emailing: 305 Boston St soils.pdf
Attachments: 305 Boston St soils.pdf
Please find attached the results from soil testing today with Phil Christensen;good soil and a fine engineer.
Sincerely,
Randy Burley
The message is ready to be sent with the following file or link attachments:
305 Boston St soils.pdf
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