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HomeMy WebLinkAboutBuilding Permit #Exception - 227 GRANVILLE LANE 5/1/2018 f NonTh TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SS^CNUIS Permit NO: Date Received:- Date eceived:Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION a 7_ 677- r,3\J U LiZ Print PROPERTY OWNER ��A✓�nr.S Ci4A C E Print MAP NO.: Q�_PARCEL: (0_5 ZONING DISTRICT: 1�a TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE - Residential Non- Residential New Building One family V'Addition C Two or more family C Industrial Alteration No. of units: Repair, replacement C Assessory Bldg ❑Commercial [=1 Demolition L Movin (relocation) ❑Other E Others: J Foundation only DESCRIPTION OF WORK TO BE PREFORMED Ct-�o&)S NGT- A ;0e LJ ' ADD) 1 bkj (� s���� TO ,,;J C 1< i ci-IvY� Sc .: s rJ C�.�R`5 �cu. '[�r,�J SLPS \ Identification Please Tyne or Print Clearly) OWNER: Name: , . I m, , C 1\AC6_ Phone: q6Wk ,-T-37 ` Signature Address: �a1 p- tj1t,L it ,qhs CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/E,NGINFER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDLVG PERMIT.-$10.00 PER$11100.00 OF THE TOTAL ESTLNATED COST BASED ON S125.00 PER S.F. Total Project Cost :$ Go Li(�Q x10.00-FEE:$ Check No.: Receipt No.: TYPE OF SEWARGE DISPOSAL Swimmin�� Pools i j Tanning/Massage/Body Art Public Sewer Tobacco Sales Food Packaging/Sales Well Permanent Dempster on Site Private(septic tank,etc. NOTE: Persons contractingkith unregist red contractors do not have access to the gaarantp fund Signature of Agent/Owner Signature of Contractor Plans Submitted ❑ PI ns Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ / Ile COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ Planning Board Decision: Comments Conservation Decision:_ Comments. _ Water&Sewer connection signature&date _ � Temp Dumpster on site yes 4-1, Fire Department signature,'date5' G Building Permit Approved and Issued by: r �g KtT6AEA4 �vs��4-t tvtnl Cs 2ND ps �v > READING LIBER ' 110 MAIN STREET 0 -1 '+ NORTH READING,MA. DIN4 j ,�,� i bil Y--� r-� j7/7 f UL READING LUMBEfI 110 MAIM STREET NORTH RsEADjNr,, MA. 01864 Town of North Andover � s�yto •b.�6 Office of the Health Department s G� ip.j p Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01.845 t�s�cHu58t Sandra Starz Telephone(978)688-954( Public Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/28/03 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by F.P.Reilly&Sons,Inc. at 227 Granville Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Brian J.LaGrasse Health Inspector BOARD OF APPEALS 688-9541 BUIL DINCY 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The ndersigned hereby certify that the Sewage Disposal System ( ) constructed; ( repaired: by Iii l :e -161 t.�Y located t)V 6 L L L j was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# dated , with an approved design flow of 4*�'gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Represe tative Final inspection date: Z>'�3 Ogg Engineer Repr sentative Installer: Lic.#: Date: ►c)-\�-�T� Design Engineer: Date: . w--1 o , ZZ7 AWAONI iceL-E Ley F AS-BUILT CHECKLIST 4-fe T` �' ' ^.SF HE 202M LOTNUMBER, STREET NAME ASSESSORS 0 S MAP& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS& DIMENSIONS OF SYSTEM, Nom- a TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES& PERC TESTS —s� ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION ✓ LOCATIONS OF WELLS,DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER,GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX = ORIGINAL STAMP&SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW ✓ LOCATION&ELEVATIONS OF BENCHMARK USED TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES GRAVITY DISTRIBUTION ADDRESS: 227 Granville Lane MAP: 106 LOT: 65 INSTALLER: Mike Reilly DESIGNER: Merrimack Engineering PLAN DATE: 7/2/03 SEPTIC TANK Date & Initials INSPECTIONS ❑ Bottom of tank hole has 6" stone base Inspected 9/17/03 0 1,500 gallon tank has been installed Mill River Consulting (H-10 or H-20) (monolithic or 2 piece) Inspected 9/17/03 0 Water tightness of tank has been achieved Mill River Consulting -t] Visual Vacuum Test Water held for 24 hrs Inspected 9/17/03 0 Inlet tee installed Mill River Consulting Inspected 9/24/03 0 Outlet tee with gas baffle & effluent filter installed Mill River Consulting Inspected 9/17/03 0 20 inch cover to grade installed over outlet of tank Mill River Consulting Inspected 9117/03 ® Hydraulic cement around inlet & outlet Mill River Consulting Comments: Outlet side not plumbed yet 9/17/03. Effluent filter with manhole to grade installed. Septic tank will not have required 9" of cover which appears to be an issue related to the septic system design and would be difficult to correct during construction phase. D-BOX Date & Initials INSPECTIONS Inspected 9/17/03 ® Installed on stable stone base Mill River Consulting ❑ Inlet tee (if pumped or >0.08'/foot) Inspected 9/17/03 Hydraulic cement around inlet & outlets Mill River Consulting Page 1 of 2 CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: �� L 7 G���i���1 Name of Designer: Plan Date: / Zk),� Revision Date: Date of Review: 7A /0 Property Address: �a / �1� �f ��/� L, /� . Map: 16 A Lot: 46--� _ BOH Reviewer: Type of Plan(new or upgrade): Number of Bedrooms: /1U gpd) Garbage Disposal Allowed: General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot-220(4)(u) r/ Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility being served-220(4)(a) Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.02i Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 Holder and location of all easements.-220(4)(b) Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) All distances on site plan–NA 8.03a-c Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y / Location and dimensions of the system incl.reserve(new const.)-220(4)(e) PTT Limits of excavation of leach area on site plan-NA 8.02z 17— Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) _[ Locations and logs of deep holes-220(4)(h) 1/ Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests–N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w. elevation in the vicinity of the system-220(4)(n) Complete profile of the system -220(4)(o),NA 8.02c ✓ Cross section of leaching facility-NA 8.02w (Not to scale) t� Location of benchmark(s)within 50-75 feet of facility-220(4)(q) ✓,, Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(l) 2 Original R.S./P.E.stamp, signature&date- g p, nature g 220(1)&(2) P.E., discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies(w/in 400'),pub. wells(w/in 250'),pvt. wells(w/in 150')-220(4)( Location of watercourses,wetlands,wells, etc. w/in 150'of system—NA 8.02r 1/ Wetland disclaimer—NA 8.02s RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement ✓ Use approvals/standards checked for I/A system-DEP docs., �— Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) Perc rate> 60 MPI-must use modified tight tank or IIA technology-245(4) Proposed system qualifies as "shared" system-002(definitions) Flow is over 2,000 gpd-No R.S. allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 Leaching facility at least 1' above Base Flood elevation—NA 9.05 L7 All piping Sch 40 minimum—NA 10.01 / Basement floor minimum 1' above groundwater elevation—NA 5.04 r Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK/ Problem N/A Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(1) Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Idfentification Numbers: ground elevation el. acceptable soil el. Leach facilitv invert el. QA � ground water el. refusal el. �D bottom of leach facility el. thickness of acceptable soil before&after soil R&R separation to groundwater separation to refusal soil class ~ 2 2 . Original R.S./P.E. 1 stamp,signature&date-220 2 P g ()&( ) P.E.,discipline specified within stamp. MGL C. 112 s. 8 1 M sfc. supplies(w/in 400'),pub.wells(w/in 250'),,pvt.wells (w/in 150')-220(4)( Location of watercourses,wetlands,wells,etc. Win 150'of system—NA 8.02r Wetland disclaimer—NA 8.02s Y RLS plan reference&certification required(prop line setbacks)-220(3) Plan contains designer's certification statement. ✓` Use approvals/standards checked for I/A system-DEP docs., Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3) i/ Perc rate>60 MPI-must use modified tight tank or IIA technology-245(4) L-- Proposed system qualifies as "shared" system-002(definitions) �--- Flow is over 2,000 gpd-No R.S. allowed-220(1) Design flow was set in accordance with code-203 Existing system location and note on proper abandonment-354 n� Leaching facility at least 1' above Base Flood elevation—NA 9.05 C7 All piping Sch 40 minimum=NA 10.01 r Basement floor minimum 1' above groundwater elevation—NA 5.04 Foundation drain present with elevation—NA 8.02y On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests—NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) n/ Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4) Deep hole testing conducted within two years—NA 7.05 Hole Identification Numbers: ground elevation el. �" J acceptable soil el. 2, / e / Leach facilitv invert el. cs lLcS OA,L5 ground water el. ` }} refusal el. z bottom of leach facility el. ��✓, thickness of acceptable soil 'z before&after soil R&R separation to groundwater separation to refusal soil class 2 3 pert rate loading.rate ' septic tank below g.w.table (yes or no) pump tank below g.w.table (yes or no) l.f in fill -255(l) Setback Distances(Given in feet) 15.21 1 YES (:NO) Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility / Property line 10 10 ✓/ Cellar wall 10 20 t/ Inground pool 10 20 t/ Slab foundation 10 10 V Deck,on footings,etc. 5 10 Waterline 10 10 Private drinking well 75 100 "igation well 75 100 Wetlands 75 100 v Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib.To Surface Water supply 325 325 V Reservoirs 400 400 Tributaries to reservoirs 200 200 bl Drains(wat. supply/trib.) 50 100 t/ Drains(intercept g.w.) 25 50 V/ Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope 3 4 - w/o barrier Building Sewer OK Problem N/A/ L/ Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4" minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) ✓ Cleanout provided every 100 feet-222(8) Manhole at any 90 degree align ent c ange-222(8) Invert elevation at building: Invert elevation at septic ' E_ Length of run: D Slope: •O7� (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK✓Problem N/A Tank is accessible-228(3) No structures above tank—(228(3) Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f) &223)(1)(a) 2-3"drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 3„air space above teesibaffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6" above flow line-227(1) Inlet tee extends 10" below flow line(minimum)-227(6) Outlet tee extends 14" below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover,above center of tank*-eaek-tee-(except 2 compart) ✓. 228(2) 3-20" manholes-228(2) 1 childproof,24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) 6" of<=3/4"stone beneath tank specified-221(2)&22 8(1) If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank-223(1)(c) ✓ Buoyancy calcs.required if tank at or below water table-221(8) Tank is watertight-221 (1) ✓ 9" of cover over tank(minimum)-228(l) H- 10 loading(min.)-H-20 if traffic-226(3) Top of tank<=36"below grade-221(7) V" All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 4 w/o barrier Building Sewer OK Problem N//AA - Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) �✓ Pipe cast iron or Sch 40 PVC—NA 11.02 Watertight joints specified-.222(3)&(4) Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) ✓ Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment c ange-222(8) ✓ Invert elevation at building: . Invert elevation at septic tank: Length of run: AD ` Slope: .07m (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK Problem N/A Tank is accessible-228(3) No structures above tank—(228(3) lz . Tank can accommodate both primary&reserve—NA 9.04 ✓ 200%of flow(required&provided given. 1500 min.)-220(4)(f) &223)(1)(a) 2-Y drop from inlet to outlet-227(5) Minimum of 4 liquid depth-223(2) 3"air space above teesibaffles(minimum)-227(4) 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) I� Tees extend 6" above flow line-227(1) Inlet tee extends 10" below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover,above center of tanklk-eeek-toe-(except 2 compart) 228(2) 3-20" manholes-228(2) 1 childproof,24"riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) / 6" of<=3/4"stone beneath tank specified-221(2)&22 8(1) / If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank-223(1)(c) i� Buoyancy calcs .required if tank at or below water table-221(8) Tank is watertight-221 (1) ✓ 9" of cover over tank(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(3) Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 i f 5 Tight Tank(Check here if not present: OK Problem N/A 500%of design flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified(if soil non-native)—221(2) 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) Tank is watertight—221(1) 9"of cover over tank specified(minimum)—228(1) H-10 loading(min.)—H-20 if traffic—226(3) Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 AN alarm set at 3/5 tank capacity—260(2)(c) Min. 1-24"frame w/cover at finished grade—228(2)(f) Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: ) t/ Problem N/A /l Inlet elevation: Outlet elevation: 2 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) y All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft. -232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: Size of outlets: Z/y Inlet baffle/tee min. 1" over outlet invert for all d-boxes-232(3)(a), ✓` Soil compaction below distribution box specified(if soil is non-native)-221(2) _ 6" of stone beneath distribution box specified-221(2) Box is watertight-221 (1) t% Top of box<=36"below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber(Check here if not present:---` ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) Minimum 2" delivery line to d-box if gravity-254(1)(c) Pressure dosed Lf. if flow>=2,000 gpd-254(1)(a)&254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 5 6 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)- 231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 1 childproof,24" riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)- 221(2) 6"of<=3/4"stone beneath chmbr.specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36" below grade-221(7) Leaching Facility(general-complete for all designs) !K�roblem N/A 50%larger if garbage disposal-240(4) _ Trenches to be used whenever possible-240(6) / No vehicle or imperv.area above l.f.unless unavoidable-240(7);NA 13.02 —1� Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9" cover over peastone-240(9) Reserve area provided(new construction)-248(1) ✓ Reserve 4' from primary leach area—NA 9.04 c/ 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a) &(b) 4'(down to 2'with variance or I/A-upgrades only)of natural soil under l.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) Require 5'removal and replacement if in fill-255(5) / Top of leach facility<=36" below grade-221(7) Final grade over l.f. minimum 0.02 ft/ft-240(1 0) Surface&subsurface drainage away from I.f. -240(1 1)&245(5) A/ Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) / Toe of fill slope stops 5'from property line or Swale installed-255(2) !/ Impermeable barrier if<3:1 slope or< 15 feet to—3:Islope-255(2) Ji Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) Pere test(s)done in most restrictive layer- 104(2) Pere test 4' below leaching elevation—NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) —� Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4" diameter except for dosed system—NA 14.04 6 6 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve,bleeder hole-NA 12.01 1 childproof, 24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr.specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete for all designs) OK roblem N/A 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) . No vehicle or imperv.area above l.f.unless unavoidable-240(7);NA 13.02 Vented if under impervious cover-241.(1) Vented through same pipes,as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) Vent isplaced beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9" cover over peastone-240(9) Reserve area provided(new construction)-248(1) Reserve 4' from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w.-212(a)&(b) 4'(down to 2'with variance of UA-upgrades only)of natural soil under 11 ' GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36"below grade-221(7) Final grade over l.f.minimum 0.02 ft/ft-240(10) Surface&subsurface drainage away from 11-240(1 1)&245(5) Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E.-255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) Perc test(s)done in most restrictive layer- 104(2) Perc test 4' below leaching elevation—NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) !✓, Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4" diameter except for dosed system—NA 14.04 6 r 7 Leach lines capped, vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(c), Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) Leaching Trenches(Check here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) In fill or reserve between trenches, 10' min. -NA 14.01& 14.03 Available leach area given(Min. 500 s.f.)-NA 9.01(2) Bottom=L x W x# — s.f. Sidewall=L x D x# x 2= s.f. Effective leach area given Loading factor: Effective area=total area s.f. x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.-247(2) Trench depth of 3/4"to 1.1/2"double washed stone-247(1) Leaching Pits(Check here if not present:) OK Problem N/A #of pits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D Depth of pits(max eff. 2'): -253(l)(a) Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall — s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR =-----g/day Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X16'—NA 9.01(3) Distribution for galleries/chmbrs.in trench config. -pipe every 20'-253(6) Distribution for galleries/chmbrs.in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2" 2x washed peastone.-247(2) 3/4" to 1 1/2" double washed stone-247(1) Each pit has at least one 20" access cover. 24" Cl to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary,extend under covers of pit(s)-241 (e) Leach Fields (Check here if not present: ) OK Problem N/A L11 Number of fields: _ (need dosing chamber if> 1,231 (1)) 7 8 , Length(100'max): 252(2)(b) Width: 63a Total area: L I�Qs— x W --k6 — _ 6 Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: Effective area=total area 1?100 s.f x LTAR _ Odav Effective area is>=design flow of facility being served ✓ Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) s� 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) Between 6" and 12" of 3/4- 1 1/2" stone beneath field-252(2)(g) &247(2) [/ 2"of 1/8"-1/2" 2x washed peastone.-247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot—240(10) Grading shall divert drainage away from leach area—240(l 1) Grading slopes away from dwelling 5/24/01 8 8 Length(100'max.: -17/S -252(2)(b) ✓ Width: Az Total area:L 4�5— x Ws. f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: 1136 �f� y- Effective area=total area � (3:6s.f x LTAR R = 0 g/dav Effective area is>=design flow of facility being served Z/ Minimum of two distribution lines-252(2)(a) 6line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) Between 6" and 12" of 3/4- 1 1/2" stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2" 2x washed peastone.-247(2) Final Gradin OK Problem N/A Slope over leach area minimum of 0.02 feet/foot—240(10) Grading shall divert drainage away from leach area—240(l 1) Grading slopes away from dwelling 5/24/01 8 Town of North Andover, Massachusetts Form No.s • � NORTH BOARD OF HEALTH • O tt�to 6,Q•G 3� .4, ,° OL Y '� "00219 • O A , F A • °Y•«.�:i..K;`moi' � '°•,�.e:� f DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME ADDRESS TELEPHONE Site Location : Permission is hereby granted to Construct ( ) or Repair Individual Soil Absorption Sewage Disposal System as shown on the Design Approval o. AIRMAN,BOARD OF HEALTH A M1 Fee ' fly D.W.C. No. t- .1 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: S')__�-03 CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE:--, TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION,PLEASE ATTACH FOUNDATION AS-BUILT. 1�b Admi istrative Use Only 15+0 Fee Attached? Yes No Foundation As-built? Yes No FloorP lans on 'le? Yes No7 Approval C Date: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North.Andover licensed installer for the construction of the septic system for the property at C-s�w,11�. relative to the application of FV 'Qe,1I j dated 12-0 for plans by I"1- �r•�'�,ee(`and dated-') with revisions dated . )-c I-Q I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. 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 inspection,. without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally fust inspection unless there is a retaining wall which should be done first. Instalkri must request the inspection but does not have to be present. b) Final inspection — Engineer must.first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all gradifig is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the, system,"and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,- D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date:. Disposal Works Construct' errmt# 227 GRANVILLE LANE V ``, JS-2003-0800 Proiect Detail Report Printed On:Tue Jun 24,2003 GIS#: 17184 Project No: 1JS-2003-0800 Owner of Record MCCAFTHY,FRANCIS J& Map: 1106.0 Date Submitted: ;Jun-19-2003 227 GRANVILLE LANE Block: 0065 Status: ;Open NORTH AND"OVER,MA 01.845 Lot: Work Category: Work Location: 227 GRANVILLE LANE Zoning: - Proposed'Use: District. land Ilse: 101 Proposed Use Detail Subdivision ;Description Soil Testing jof Work: Department Status GeoTMS Module: Status File No. Comments: LCDate• Board of Health GREEN FLAG BHJ-2003-0060 6/24/03-Tues.Date changed to July 2nd @ 1:30 p.m.Schedule updated. Bill Dufresne notified per Sandy.--p.d. 6/24/03-Tues.-Received file back with Soil Testing sign off and test date of Wed.,7/9/03 @ 10:30 a.m.Faxed to Engineer,Bill Dufresne. Schedule updated--p.d. 6/24/03-Tues-Allison brought over Conservation sign-off on Soil Testing. Placed in File. 6/18/03-Received an application for Soil Testing from Merrimack Engineering. Prospective h/, has calied 2x already on this property. His name is Jake Chase,and he is hoping to close on the property by 7/15/03. He has two small children,and is trying to coordinate everything for a mo,, in date. He is requesting that the site testing be done next week,if possible,so that if there are ai problems they can be taken care of before closing. Mr..Chase's number is:C:61.7-293-3256. Sc Test application placed in Sandy's Soil Test inbox for review. Copy was given to Conservation, but Sandy may want to call and setup tentative site testing and call Mr.Chase or Bill Dufresne tc arrange a testing date.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Project No: Description of Work: Repair Soil Tests 1096 Jun-24-2003 Signed Off JS-2003-0800 Soil Testing tan evc�� ezZ9 �fq�b.3 AffrNv l 55�S GeoTMS@ 2003 Des Lauriers Municipal Solutions,Inc. Page l of 1 July 11, 2003 @ 3:45 p.m. Sandy, Please call Peggy Patenaude from Prudential Howe&Doherty re: 227 Granville Lane. The Title 5 failed, and the bank/lender will not close on Tues. unless they have a letter from the Health Dept. saying that the system can still be used by the new owner until it is fixed within the two years. This is the same address that Beverly McCarthy asked you to do a letter on regarding the new plans that Bill Dufresne designed. Please call her at 978-269-2266 asap please. Thanks, Pam CI 7�i� d 3 PCI e 11017 Oulne.� GJGj /qj/ �ir � s TOWN OF NORTH ANDOVER HEALTH DEPARTMENT F 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �9 sAC eta Sandra Starr,R.S.,C.H.O. (978)688-9540-Telephone Public Health Director (978)688-9542-Fax fAX TO: From: Fax: Pages: Phone: Date: Re: �LC� A JJ '67CC: c.2 A67 c�D5--JC-fie. . 1,e4' ❑ Urgent ❑For Review ❑ Please Comment ❑Please Reply ❑Please Recycle Please call 978-688-9540 for assistance with any questions. Thank you. xc: Address File Chrono File HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Jul 10 2003 11:20am Last Transaction Date Time Tie Identification Duration Pages Result Jul 10 11:18am Fax Sent 89784755066 1:36 3 OK 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.305: continued (2) If a system serving a facility with a design flow of 10,000 gpd or greater but less than 15,000 gpd is a significant threat to public health and safety or the environment as set forth in 310 CMR 15.304(2),the owner or operator shall upgrade the system within five years of discovery in accordance with the provisions of an enforceable schedule unless: (a) a shorter period of time is set by the Department based upon the existence of an imminent health hazard; (b) the continued use of the system is permitted by the Department because it is 9 necessary to allow implementation of an environmentally superior solution. An enforceable commitment by the owner to perform interim measures (e.g., regular pumping,addition of fill)shall accompany any such approval by the Department. Such approval shall expire in seven years or upon the failure of the applicant for such approval to meet interim deadlines set forth in the enforceable schedule for upgrade. -V/(3) The owner or operator shall take appropriate measures throughout the period between discovery of the condition requiring upgrade and completion of the upgrade to ensure that there is no backup or direct discharge of sewage or effluent to buildings,to the surface of the ground,or to surface waters. The local approving authority or the Department may order the owner or operator to take any measure necessary to ensure the protection of public health and safety and the environment during such period. (4) All systems shall be abandoned in accordance with 310 CMR 15.354 and the buildings served by the systems shall be connected to a sewer when a sewer becomes available,unless: (a) the system is an alternative system approved for such use pursuant to 310 CMR 15.280 through 15.287 (b) the Department has made the determination in approving either the remedial use of an alternative system pursuant to 310 CMR 15.284 or in certifying an alternative system for general use pursuant to 310 CMR 15.288 that any person using such system need not connect the facility to a sanitary sewer if such connection is feasible;or (c) the owner of an existing system has obtained a variance from this requirement pursuant to 310 CMR 15.410 through 15.415. All systems shall be abandoned in accordance with 310 CMR 15.354 and the buildings served by the systems shall be connected to a sewer when directed to do so by the Board of Health pursuant to M.G.L. c.83,§ 11,by the Department pursuant to 310 CMR 15.000,or by court order. 15.340: Approval of System Inspectors (1) System Inspectors who perform inspections pursuant to 310 CMR 15.301 shall be: { (a) Massachusetts Registered Professional Engineers with a concentration in civil, sanitary or environmental engineering;Massachusetts Registered Sanitarians;or Certified Health Officers;or (b) Board of Health members or agents,Engineers in Training(EIT certified)with a i concentration in civil, sanitary or environmental engineering, professional home inspectors, licensed septage haulers or system installers, or other individuals with a minimum of one year of demonstrated experience in septic system inspection,who have attended training provided or authorized by the Department; and who have passed an examination prepared and administered by the Department or an agent authorized by the Department to qualify as an approved System Inspector pursuant to 310 CMR 15.340(2). (2) The Department may approve System Inspectors who attend training provided or authorized by the Department and pass a standard examination prepared and administered by the Department or an agent authorized by the Department.Said examination shall be designed to establish the fitness of the applicant for certification to assess the condition and function of on-site systems and to determine whether maintenance,including repair or replacement of system components,is necessary. (3) The passing score for the examination shall be 75% correct answers to all questions posed. Any person who is denied approval as a System Inspector based on his or her failure to pass the examination given by the Department may request,and is entitled to receive,a written statement of the Department's basis for denial. 11/3/95 310 CMR-549 A 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION • 15.304: continued 6. if size and use of the facility is relevant to the demonstration that an equal level of environmental protection has been provided,appropriate use restrictions shall be granted to ensure that such conditions are not changed. (c) An applicant for a determination pursuant to 310 CMR 15.304(3)shall file a request for such determination not less than two years prior to the date by which the owner would otherwise be required to obtain the groundwater discharge permit pursuant to 310 CMR 15.305(2). (d) In making any determination pursuant to 310 CMR 15.304(3),the Department shall impose such conditions as it determines appropriate to ensure protection of public health and safety and the environment. At a minimum,such conditions shall include upgrade of the system to the standards described in 310 CMR 15.304(3)(b)4.,and a maintenance, monitoring and reporting plan as described in 310 CMR 15.304(3)(b)5. (4) Any system serving a facility with a design flow of 10,000 gpd or greater but less than 15,000 gpd shall be upgraded upon the order of the Department or the local approving authority when a specific circumstance exists by which the system threatens public health, safety or the environment or causes or threatens to cause damage to property or creates a nuisance as determined by the local approving authority or the Department. Where necessary to protect public health and safety and the environment, the Department or the local approving authority may require the owner to install a recirculating sand filter or equivalent alternative technology in accordance with 310 CMR 15.202 or to obtain a groundwater discharge permit in accordance with 314 CMR 5.00 and 6.00. 15.305: Deadlines for Completion of Upgrades VI(l) If a system is failing to protect public health and safety or the environment asset forth in 310 CMR 15.303(1)or 15.304(1),the owner or operator shall upgrade the system within two years of discovery unless: (a) a shorter period of time is set by the local approving authority or the Department based upon the existence of an imminent health hazard;or (b) the continued use of the system is permitted by the local approving authority in accordance with the provisions of an enforceable schedule for upgrade. Bases for continued use include,but are not limited to,proposals to connect to a sanitary sewer or shared system. A fiscal commitment to the sewering plan or shared system plan,together with an approved facility plan where appropriate,proposing connection or replacement of the failing system within five years,and an enforceable commitment by the owner to perform interim measures(for example,regular pumping)shall accompany any such local approval. Such approval shall expire in five years or upon the failure of the applicant for such approval to meet interim deadlines set forth in the enforceable schedule for upgrade and the plan. The Department may by specific written approval authorize the local approving authority to allow a longer period of time,where the municipality has provided the Department a proposed implementation schedule for design and construction and has made a demonstrated financial commitment to the construction schedule. The Department may revoke any such approval if the approved schedule is not met. 11/3/95 310 CMR-548.3 I I Town of North Andover, Massachusetts Form No.2 MORTFBOARD OF HEALTH p',•`•o I•,gyp �W �: •_fir. --•..,. p O � 9 DESIGN APPROVAL FOR ,SSAC"U SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM &' EZ/6C l Applicant C�!�`.� � Test No. 407 V"'1711 Site Location 4a /J��/iC L� ✓� Reference Plans and Specs. E GINEER 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 Fees/ Site System Permit No. f _ SEPTIC PLAN SUBMITTAL FORM LOCATION: Z2� C izAoy i U— L-,A 4�t= NEVA PLANS: XE $225.00/Plan � Check#:7.63?� (Includes I"Re_ Revi nly) REVISED PLANS: YES $60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: S NO LOCAL UPGRADE FORM INCLUDED: YES NO DATE: 0DATE TO CONSULTANT: DESIGN ENGINEER: W gfaK I Vj 1EL"elephone#:, OFFICE USE ONLY When the submission is complete(including check): 1. _Date stamp plans 2. _ Complete the=, DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM form 3. Attach file and route to the Health Director for review Location: ,✓7.r7 6 f't.It N owner's Name: �-l eC�,1��`tf4' Map/Parcel: Address: 1.`27 /.� V/s� ��►► 1 tc (�,J Installer. Tel 9: 6.05 t".Kl• New tstsol Repair I Date:—!: ?J#0 -�' Wetlands 7 ne II'— Soll Symbol . � Stiil Rime it CI ass Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color SOD Mottling % Gravel,Stones,etc: ,=71-7re, iv 1✓ 1=w�� Y�'�/t 1'14O�P-Fw► Parent Material_ 4-1 LL Depth to Bedroc`JQ561and1n=Water in the Hole: Beeping front Pit Face ' ESHG'�V�,.0 �t�t Pareat Material 0+!4<✓ Depth to Bedrock-!shading Nater iA the Hole Weepin;from ft Face Date 7'Z,C-2t ___ Percolation Tests Observation Hole# Depth of Pem Start Pre-soil: W Time at 12" ;.n Time at 9" Time at 6" Time(911-6")— .P Min/Inch Performed B�•;_ (")f j ��� Witnessed Bi•: E NORTH TOWN OF NORTH ANDOVER sr°.�+�";•�"oo� HEALTH DEPARTMENT F . . 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �,ss^CMUS<{' Sandra Starr,RS., C.H.O. Telephone(978)688-9540 Public Health Director FAX(978)688-9542 July 10, 2003 Merrimack Engineering Services Attn: Mr. Bill Dufresne 66 Park Street Andover, MA 01810 Dear Mr. Dufresne: This letter is to notify you that the"Upgrade Subsurface Sewage Disposal System Plans" dated July 2, 2003 for 227 Granville Lane, Map#106, Lot 65, Subdivision Lot# 18 have been approved by the North Andover Health Department as of July 9, 2003. Please call the office at 978-688-9540 if you have any questions. Sincerely, Sandra Starr, R.S., C.H.O. Health Director /pfd Xc: Homeowner—Beverly McCarthy Lillian Montalto Real Estate—Fax:978475-5066 Address File Chrono File Town of North Andover, MassachusettsForm No. 1 NORTH BOARD OFHEALTH � I 0 r^ APPLICATION FOR SITE TESTING/INSPECTION ONTED SAC US Applicant TELEPHONE T*AME A DRESS Site Location- Engineer ocation En ineer g NAME ADDRESS TELEPHONE 1 Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH cy Fee Test No.14i 6- S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. LvPvxW yr 1-MALIII NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS ��` I �` DATE: MAP &PARCEL: i d G (p 5; LOCATION OF SOIL TESTS: &i&A N v t L-L-G OWNER: CA; iv-ru j TEL. NO.: ADDRESS:_ _2c�- 0 itAsJV I L L,� ENGINEER: i h--I4 C,lc,, TEL. NO.: CERTIFIED SOIL EVALUATOR: PJ t L L PU I¢ee,Q C Intended Use.of Land: Residential Subdivision in -ieFamily Ho ,� Commercial Is This: / Repair Testing: v Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic pi 3. At least two deep holes and two percolation tests are required for each septic system disposal area.ans. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, 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). O HF HEALTH 7. Within 60 days of testing soil evaluation forms shall be submitted. a�'1�d OF BOARDON R% ALTH s Please Do Not Write Below This Line l�li 2 4 2003 a N.A. Conservation Commission Approval: Date Received: Check Amount: D Check Date: r a }- .Ny. -+v. r n �' x4 'E' �t f` `•' +:c- v:. -re r' rf' r��'•hF • �; i } I, �"� :. r��-X�.r,y ,w v t 7 �' �� �• ' �•tI ti' -�r�;tl .1`i'- .'` Z S✓>.� ,. I..,K�Vw-. Gr�•s ^�'+ f; � '�_ _ 3 \' - I a _ ��; Me _�•.�N4fj..e}r�<Y-' r k.} .f! 1�� �Ci4}.O t��}'G� 'tiAd.� -I. � r � '.(. J i- � i+C .'Mi��y:,, �Gs�i�. „_.#-t� �� x L �.0 .�". rb p..+ �.k a•' Loi-' (g I Lh m #227. I gs ; . _ • - � - - ►�-3 30' � �g7' � f 6 t< • C--`�"`+�o�,e-�l - IBES: .� - rr'y cam:. t...JcOi:.►-C.o.u-�o.�..1_ - a^I �� �" ,.-., r=-•� •E�C.J'CC.-r; c�iar, G't— - �.. �LANO s i i- r� �. IINII r- � � � � � ,� 1 ,.. ,� � ,► . � _ i ` " � J 11� 1 ..., ` ` `. " " NII 1 , 1 11 � r.. � 1'i 1 � �,► /� �, � i • � 1% / ,, .� j . IN 1 11 � 111 1 111 11 � _ NNINI 1 N �� . ... � . .�. _ _