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Home My WebLink AboutBuilding Permit #Exception - 38 WELLINGTON WAY 5/1/2018 - 1 FORTH BUILDING PERMIT o` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' OR y � � of ^m« Permit No#: Date Received � :1.D "' ��e Date Issued: IMPORTANT: Applicant must complete all items on this page. �t.r .rraz^_n a ...lry '�,i � r :k" 1•'' ". r w k z rJ PROPERTrY01NNER � �!/�3 t 10phl77 �Af � ;� # Pr—Inti 9- i00 Year Structure �yesx r: -F - ` X35 x {tMA_P E `"'ZONING DISTRICT Historic District" t 'eyes Sg s �v.4+ ,y tx Li, Y.t r '� W'J t'� •71W.y n `� ^ Y i �,�- s ., Macf ine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential ' Non- Residential XNew Building )(One family ❑Addition ❑Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other - € Spt:c ❑❑Well ®° ryl'oodlain+ DWetntls Fe; /aters�hedl®istric _b at DESCRIPTION OF WORK TO BE PERFORMED: �t`�n�o�• 5��.t C deo�� '��..L�.�i��, �t11�� A�' Identification- Please Type or Print Clearly OWNER: Name: r ES5�Aicl Phon : fPe --3/ 0 Address S2 e4� c)0 CS I'0 I:Y- �.c 3e',.'r'.3's�^,�t ';tr"°�" �}r* k3, is i 4�`a p^- .` v k. rk�'^} . t ✓ `��r �Jwy�,, "g Y' '�.F v rr�,�'. K �' yYrr•J.' +1n t�-`�.: �n :a� �„ ,K € l.�.f7 ``'"'a t.r ^rr-..3�+;.r `t '�i•r N* s�� } a +�,5' �^x-+s J�r r sC{r'�..i� ,5.�, .�n'1�;��`,r r S � Contractor Name �� r f� ;Phone � wf � , .�� .� �•t�XG#'F �ivs: �y .,:,�. —_ �yyf,.,. .-�-„�.� .��.x ��,r s.- b� t+24'a• �+- q�y�t -.+t ¢i4�s. :. (0 i�; 1 }2 C,tyn C R'�'K •a` `�Y.jy . i#Adfe ,t P r c. s ,a�,-.• .k.c,.. ,rt a..,r.ryr �.�.+� r�. Ccs' 4r„5 .2 .r.. f-.�,y �{�r� ""S!"t`�'Frp F A;41 r`'> .✓ r '} 'F mac.. y:;d-+ J_+A: "+a .� fi • -. r Yid �� Saar, t'{ • • w Ptwi S lttz r v w• 4 r w Supervisor s Constructa (icei sem ;`��ss 5 4 z x'14``c �£ 'r,w w2� �` `+t °e ire � �r fi"Ak`.� n �'Kt+•r 2 `� 7"r�7`"�"""t -.. ,, Lr- �' �S��a"' }� r- -)* ri, �'�� L rq,�,e}�a+ �^�l '� x` r I"� ' +: # tr �, a '' "r, s e:�.t' ,. P ,s"b,.�'$ �p.p t. x•'.33 Y f 7 �t •i� ; fr yrtiJ r t ^� e ` -4r� w 4 `�srx, .� {Home lmprofvement'License � ARCHITECT/ENGINEER Z-40-q ��D�/�.� Phone:q-n-3s�2-- Y.318' Address- AM 0IF33 Reg. No 2:726x' FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ I Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund y e 4 rr Plans Submitted-W Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed Ong- ,zl Signature:_ p J COMMENTS '� Z xn l ti� t 6 CONSERVATION Reviewed on - Si nature G COMMENTS HEALTH Reviewed on 2Z Signature COMMENTS ��(� ��h�� S` �I �' ((�( 0 2D Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENTS empa®um � _ . � . Loeatecl at 124 Main S reeR Fire Departmen sigre/date . / b cuacm«a l• ��°Raren Apav North Andover Health Department Community and Economic Development Division March 17, 2016 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: (Lot 1) 38 Wellington Woods (Map 105C, Lot84) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated January 8, 2016 and received on March 10, 2016 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. The foundation drain location is not clearly indicated and the elevation is not shown on the design plan (NA 3.2). 2. Based on the ESHWT for TP-3C buoyancy calculations are required for the septic tank (3 10 CMR 15.221(8)). I Considering the shallow depth of TP-313 and the proposed depth of the leach field an additional test pit is required to be conducted prior to construction in the location of TP- 3B. A note needs to be added to the design plan to clearly indicate this requirement. The test pit shall be witnessed by the Health Department. 4. The profile view indicates only 6" of cover material above the.septic tank(3 10 CMR 15.228(1)). 5. An inspection port was not shown on the design plan(3 10 CMR 15.240(13)). 6. The slab foundation and the full cellar for the existing dwelling are not clearly shown on the design plan. This is important in order to confirm compliance with the setback distances to the proposed leach field. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.84.76 7. The finish grading around the septic tank and proposed dwelling do not match the profile view. 8. The breakout elevation for the leach field is not depicted on the design plan. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. .. i c rely, B Michele Grant Health Inspector cc: Messina Development Company File Page 2 of 2 North Andover.Health.Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 3/17/2016 Town of North Andover Mail-38 Wellington Woods NoRTAyA.NDOUER Lisa Hadge <Ihadge@northandoverma.gov> Massachusetts",- . 38 Wellington Woods Isaac Rowe <irowe@millriverconsulting.com> Thu, Mar 17, 2016 at 10:48 AM To: Lisa Hadge <Ihadge@northandoverma.gov>, Michele Grant<mgrant@northandoverma.gov> Cc: Pam Lally <plally@millriverconsulting.com>, Isaac Rowe <irowe@millriverconsulting.com> Lisa/Michele; Attached is the initial plan review disapproval letter for the above referenced property. They will need to conduct an additional test pit prior to construction for this lot to confirm the soil conditions due to excavator limitations. They conducted an additional test pit but the BOH did not witness. I spoke with Phil Christiansen about this and I feel comfortable with this requirement. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 I Fax: 978-282-1318 irowe millriverconsulting.com www.millriverconsulting.com 38 Wellington Woods -Disapproval letter 3-17-16.doc 396K https://mail.google.com/mail/ea/u/O/?ui=2&ik=46857787dO&view=pt&search=inbox&msg=15385Oc9O2aba4fb&siml=15385Oc9O2aba4fb 1/1 TOWN OF NORTH ANDOVER ; Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ► ,, " 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540—Phone ` 978.688.8476—FAX E-MAIL:healthdept@northandoverma.gov WEBSITE:http://www.northandoverma.gov SEPTIC PLAN SUBMITTAL FORM RECEIVED Date of Submission: ?Alli MAR 10 2016 / TOWN OF NORTHANDOVER Site Location: 4� — ,38 We 1 � 1 dQJ?w W HEALTH DF-P, Engineer: �nI/Is-fiowsoyt a-/CPlan New Plans? Yes Check.# (includes 1st submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes �� No Local Upgrade Form Included? Yes No Telephone#: q ff-3 7 3 -0 3 Fax#: E-mail: Homeowner l Name: SSI De Vel OFFICE USE ONLY When the submi cion is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD O F HEALTH RECEIVE® ?W � MAR 10 2016 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTIONJWRMIHTNDOVER HEALTH DEPARTMENT Application for a Permit to Construct Repair ( ) Upgrade ( ) Abandon ( ) - omplete System ❑Individual Components Location Owner's Name Q5�' o 277 LP/k5WIN6A Map/Parcel# p rP lu I q 7Y - FT/ -3if C��1 Lot# Telep ne# Installer's Name D ner's Na o ' Address If F J� Are Telephone# d Telephone# Type of Building: Woo R(L&K-E-7 Lot Size 074 ` Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Shower )Cafeteria ( ) Other fixtures �/ Design Flow(min.required) Li gpd Calculated design flow gpd Design flow provided q q 4d Plan: Date /SSG, Number of sheets / Revision Date Title 5CP7iG -5 V57_F64 I)E:5 10 Al f-al—I !,V&__1-Z 1 M H212&1 WQf1 A S Description of Soil(s) 4C S Soil Evaluator Form No. /I V-12 Name of Soil Evaluator ✓spate of Evaluation r l3 r DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued/by the Board of Health. Signed 4* Date r I � r Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 Commonwealth of Massachusetts City/Town of North Andover RECEIVED Percolation Test Form 12 MAR 10 2016 °M TOWN OF NORTH ANDOVER NRUENT Percolation test results must be submitted with the Soil Suitability Asses ent f6r 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. filling out forms Important:When A. Site Information on the computer, use only the tab Gordon Family Trust key to move your Owner Name cursor-do not 602 Boxford Street LOT 1 use the return Street Address or Lot# key. North Andover MA 01845 r� City/Town" State Zip Code Philip Christiansen 978.373.0310 Contact Person(if different from Owner) Telephone Number B. Test Results 1/13/2015 1:49 1/13/2015 2:30 Date Time Date Time Observation Hole# 3-A 3-B Depth of Perc 31 + 14 =45 4 + 17 =21 Start Pre-Soak 1:49 2:30 End Pre-Soak 2;04 2:45 Time at 12" 2:05 2:45 Time at 9" 2:30 3:07 Time at 6" 2:52 3:31 Time(9"-6") 22 24 Rate (Min./Inch) 8 min/inch 8 min/inch Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ Philip Christiansen Test Performed By: Isaac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 _<LN Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal posal A. Facility Information j Gorton Family Trust 11 Owner Name 602 Boxford Street LOT 1 Map 105C Lot 84 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ® New Construction ❑ Upgrade ❑ Repair 2. Soil Survey Available? ® YesNRCS 421 B&C ❑ NO If yes: Source Soil Map Unit CANTON LARGE STONES Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Year Published/Source Publication Scale Map Unit Geologic/Parent Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): Month/Year Range: ElAbove Normal ElNormal F1Below Normal 7. Other references reviewed: tp lot 3•rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover _ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal w„ C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: 3-A 1/13/2015 1:15 PM 15 SUNNY Date Time Weather 1. Location Ground Elevation at Surfaceof Hole: 141.00 Location (identify on plan): 2. Land Use WOODS NO 3-8 (e.g.,woodland;agricultural field,vacant lot,etc.) Surface Stones Slope F/. OAK W PINE TILL RIDGE TOP Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100 Drainage Way >100 Possible Wet Area >100 feet feet feet Property Line >50 Drinking Water Well >100 Other feetfeet 4. Parent Material: GLACIAL TILL Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 131.00 inches elevation tp lot 3•rev.3/13 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts Affim City/Town of North Andover -- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal w C. On-Site Review (continued) Deep Observation Hole Number: 3-A Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix: Color- (mottles) Soil Texture %by Volume Soil Depth(in.) Soil Layer Moist(Munsell) (USDA) Cobbles& Structure Consistence Other es Depth Color Percent Gravel (Moist) Stones 0-3 A 7.5YR3/2 FSL 3-27 BW1 7.5YR5/6 FLS 27-100 C 2.5Y5/6 LS Additional Notes: tp lot 3•rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: 3-B 1/13/2015 1:15 PM 15 SUNNY Date Time Weather 1. Location Ground Elevation at Surface of Hole: 140.50 Location (identify on plan): 2. Land Use WOODS NO 3_8 (e.g.,woodland;agricultural field,vacant lot,etc.) Surface Stones Slope(°/a) OAK W PINE OUTWASH PLAIN BOTTOM Vegetation I Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100 Drainage Way >100 Possible Wet Area >100 feet feet feet Property Line ee0 Drinking Water Well ee00 Other feet 4. Parent Material. GLACIAL TILL Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 135.16 inches elevation I tp lot 3•rev.3/13 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: - 3-B Redoximorphic Features Coarse Fragments Soil Horizon/Soil matrix::Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Munsell Consistence Other Moist Layer Y (Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel Stones (Moist) 0-5 A 7.5YR3/2 FSL 5-37 BW1 7.5YR5/6 FSL 37-64 C1 2.5Y5/6 LS REFUSAL Additional Notes: tp lot 3•rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: 3-C 1/13/2015 1:15 PM 15 SUNNY Date Time Weather 1. Location Ground Elevation at Surface of Hole: 142.5 Location (identify on plan): 2. Land Use WOODS NO 3-8 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) OAK W PINE OUTWASH PLAIN BOTTOM Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >100 Drainage Way >100 Possible Wet Area >100 feet feet feet Property Line ee0 Drinking Water Well ee00 Other feet GLACIAL TILL 4. Parent Material. Unsuitable Materials Present: ❑ Yes No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water'kn Hole Estimated Depth to High Groundwater: 136.16 inches elevation tp lot X•rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of North Andover, Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Continued) Deep Observation Hole Number: 3-C Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Consistence Other Layer Moist(Munsell) (USDA) Cobbles 8 Structure Depth Color Percent Gravel (Moist) Stones 0-4 A 7.5YR3/2 FSL 4-27 BW 1 7.5YR5/6 LS 27-88 C1 2.5Y5/6 LS RFUSAL Additional Notes: tp lot 3•rev.3/13 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page'5 of 8 Commonwealth of Massachusetts City/Town of North Andover` s. Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing;water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ❑ Depth to soil redoximorphic features (mottles) A. 131.001 B. ?3 . j f inches inches El Groundwater B.Groundwater adjustment(USGS methodology) inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches f r tp lot 3-rev.3/13 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 1 17. urther certify that the-results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in a or an with 31 15.100 through 15.107. 1/13/2015 ignatur valuator Date Phili Istiansen #378 11/1994 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Isaac Rowe North Andover Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. tp lot 3•rev.3/13 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 r • tTY3:n""� I TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT �R 1600 OSGOOD STREET; SUITE 2035 NORTI t jt6IASSACHUSETTS 01845 MAR 31 2016 978.688.9540—Phone 978.688.8476-FAX I TOWN OF NORTH ANDOVER healthdept@northandoverma.gov HEALTH DEPARTMENT www.northandoverma.gov APPLICATION FOR SOIL TESTS DATE: 1 VJ MAP&PARCEL: LOCATION OF SOIL TESTS:-'e3g 1el�wg1 `Lmj JV 6, 6 1 OWNER:' E5�f - D&V 6oa Y�JC—. Contact#: APPLICANTI�6-f ly Contact#.�;I-S d � ADDRESS:?4,77(,4)")A) /l) Ste( �yt�CX l�I C/)/9!3' ENGINEER:�✓� 1' �Sl�P� Contact#: ?-3,73 `d ,�P1�C r CERTIFIED SOIL EVALUATOR: 1��/� Intended Use of Land: Residen ial Subdivision ingle Family Hom Commercial 'f e5-f fly— Is jIs This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan) ➢ Fee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. �paymentwill be required for all additional tests within two weeks of testing. ➢ s of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health tion of all tests(including aborted tests). ➢ Within 60 days o ting soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date. Signature of Conservation Agent: Date back to Health Department: (stamp in): i , A010 ► I i Iz JL j ( R i i -IT i 3 F x i w TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH-ANDOVER; MASSACHUSETTS-01845 ---- -- Susan Y.Sawyer,REAS,RS 978.688.9540-Phone , Public Health Director 978.688.8476-FAX - _- healthdept(a;toNvnofnorthandover.com www.townoffiorthandover.com APPLICATION FOR SOIL TESTS �a DATE: 11/24/2014 MAP&PARCEL: 105C.22 I 602 Boxford St, NA Lot I NOV ,Z.,,6 2014 LOCATION OF SOIL TESTS: I NUK-I rt ANDOVER Gorton Famil t.Trusf--_ ��A ;HDE?ARTMENT OWNER: Y Contact#: I APPLICANT:Messina Development Contact #:978-837-95 � ADDRESS: •277 Washington -St,--Groveland,-MA 01834 it N Christiansen-&-Serg i, Inc------ ENGINEER: Contact#: CERTIFIED SOIL EVALUATOR Philip Christiansen Intended Use of Land: . Residential-Subdivision Single Family Home. Commercial Is This. Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ 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$360.00 per lot for repairs or upgrades. - GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests).' ➢ Within 60 days of testing soil evaluation forms shall lie submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approva Date: Signature of Conservation Agent: L , Date back to Health Department: (stamp in): - -SU �'6 Jib a l 6W Q_