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Miscellaneous - 101 SPRING HILL ROAD 4/30/2018 (2)
atm �wv� MA-, j,,ln rn e co O-uJ,e a:) nyv PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of 11/16/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On -Site Sewage Disposal System By: Robert Daigle At: 101 Suring Hill Rd. Map107.A Lot 0241 . "ANprth Andover, MA 01845 The Igsuanre of this certi�ficate shall not b construed as a guarantee that the system will function satisfactorily. i f 1 Michele Grant � Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION RECEIVED NOV 0 6 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT The undersigned hereby certify that the Sewage Disposal System W constructed;W repaired; (Print N Located at: /cq/ 5ir-'17-/.v &- J41 L(_ izY-> (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated ' 2 2 —1 S and last revised on 7—)- 3— ), with a design flow of /_i `-L (J 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. Bottom of Bed Inspection Date: ✓�'st Gi tom-• � � t�Sci d��Y cJ l/L.� And — Print Name Final Construction Inspection Date: �� �r Cf y'1c 'ti � V 5lJ CiJv CJ 1(/ And — Print Name , J Installer: (Signature) Engineer Representativ ignature) Engineer Representati (Signature) Date: {{ And — Print me Engineer: (Signature) Date: nd nt Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. few Commonwealth of Massachusetts City/Town of ANDOVER Certificate of Compliance Form 3 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. Q This is to Certify that the following work on an On -Site Sewage Disposal SysteRECE IVED ❑ Construction of a new system NOV 0 6 2015 ® Repair or replacement of an existing system TOWN OF NORTH ANDOVER ❑ Repair or replacement of an existing system component HEALTH DEPARTMENT Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP): DSCP Number Daniel McDuffie Facility Owner 101 Spring Hill Road Street Address or Lot # North Andover City/Town Designer Information: Benjamin C. Osgood, Jr., PE Nam Sig "a ure Installer Information: Rob Daigle Name Signature DSCP Date MA 01845 State Zip Code None Name of Company October 29, 2015 Date Name of Company Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 Andover — Sev is Svstem - AS -BUILT 1)All changes to the design plan have been reflected and noted on the as -built plan 2) 'v As built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3 Street Address Assessor's Map and Lot Number 4) _ _Lot Lines and Location of Dwellings served by the system 5 Locations Elevations and Dimensions of As -built system components, includi /reserve if applicable) -�— � Y p � �$ ( pp ) 6) V Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure Setback distances are shown on the as -built plan from system components to: Subsurface, interceptor & foundation drains Catch basins RDProperty lines wellings or other structures Private water supply or irrigation wells (� Watercourses or wetlands 8) 14 ' Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system 9) O Location of ater,gas, electric lines, cable, ntr panel (if applicable) 10) ✓ Location of Structures within 6 Inches of Finished Grade 11) f Original Stamp & Signature 12) Location and holder of any easements which could impact the system 13) Impervious Areas; Driveways, etc 14) North Arrow 15) Location & Elevation of Benchmark used 16) j STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material; exposed component covers etc., shown on this as -built substantially agree with the approved plan and have determined that the breakout elevations, if applicable, have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT (NA 4.9) a Letter or statement on the as -built indicating the wall - was, or was not. constructed in accordance with the intended design and any manufacturer's specifications." Signature of Designer Revised 3/17/15 Date North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 101 Spring Hill Rd. MAP: 107.A LOT: 0241 INSTALLER: Rob Daigle DESIGNER: Ben Osgood Jr. PLAN DATE: 6/22/15, rev 7/13/15 BOH APPROVAL DATE ON PLAN: 7/23/15 INSPECTIONS TANK INSPECTION: 10/9/15 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 10/22/15 DATE OF FINAL GRADE INSPECTION: 100 16 SITE CONDITIONS ® Contractor reports any changes to design plan N/A (Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: Filter fabric used instead of peastone above leach field which meets Title 5 requirements. EXISTING SEPTIC TANK N/A Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan N/A Bottom of tank hole has 6" stone base N/A Weep hole plugged N/A 1500 gallon tank has been installed N/A H-10 loading N/A Monolithic tank construction N/A Water tightness of tank has been achieved by visual testing N/A Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 18" inch cover to finish grade installed over outlet access port ® Neoprene boots around inlet & outlet Comments: Tank is being re -used. 3 covers have decayed somewhat. Will be changed out. New pipe, location of pipe will be replaced. DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: FINAL GRADE Loam ed Seeded Cover per plan nts: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer [U/As-Built P-,S�; BM = 226.83 (manhole cover) HR= 2.18 HI = 229.01 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Exist. Septic Tank OUT 4.37 224.29 224.75 Distribution Box IN 6.26 222.40 222.23 Distribution Box OUT 6.45 222.21 222.06 Lateral 1 TOP 6.67/6.85 Lateral 1 INVERT 221.99 / 221.81 221.96 / 221.75 Lateral 2 TOP 6.67/6.85 Lateral 2 INVERT 221.99 / 221.81 221.96 / 221.75 Lateral 3 TOP 6.67/6.85 Lateral 3 INVERT 221.99 / 221.81 221.96 / 221.75 Lateral 4 TOP 6.67/6.85 Lateral 4 INVERT 221.99 / 221.81 221.96 / 221.75 Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Bottom of Bed 220.81 220.75 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 1 Commonwealth of Massachusetts Map -Block -Lot 107.A0241 ----------------------- BOARD OF HEALTH Permit No North Andover BHP -2015-0368 ----------- P.I FEE $250.00 F.I.----------------------- ---WhzA&P-- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Robert Daigle ----------------------- ----------------------------------------------------------------- to (Construct) an Individual Sewage Disposal System. at No 101--SPRING-HILL_ROAD --------------------------------------------------- I ---------------------------------------- ------------------------------------------------------------------------------------------ ----------------- - ----- --------------- ------- as shown on the application for Disposal Works Construction Permit No. BHP -2015 -036 - Dated __August 31,201-5 ----- ---------------------- --------------- P Issued On: Aug -31-2015 HEALTH OF NORTH 4ti y9SSACHUSE� Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. _Q rtmm Application for Septic Disposal System 3 Construction Permit -TOWN OF TODAY'S DAT Full Repair NORTH ANDOVER, MA 01845 250.0 -Component Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* El Repair or replace an existing on-site sewage disposal system* �/Repair or replace an existing system component —What? A. Facility Info or & W ykQ"'LQ'W City/Town 2.- *TYPE OF SEP IC SYSTEM*: ➢ ❑ Pump YGravity (choose one) ***If pump stem, attach copy of electrical permit to application*** ➢ KConventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A:S. ➢ ❑ Does the system require an effluent filter? Yes No�� if yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? 2. Owner Information %: /1 fri c (t fti t - Name „ t k _ 1 Email address [khat is the Model? Ol Stat'` —,I ^ I / Zip Tphone Numbei(',Y) �Xvj 3. Installer Information 114 V/— Name Name of Compan Address #4144v4�t, # Via- t�3t� City/Town State Zip Code 9�V_ 4GZb Telephone Number (Cell Phone # if possible please) 4. Designer Information /1G' ,� Q a a,. �� ��J" is Name Name of Comp y Address _S lQ 6? © City/Town ate Zip Code RECEIVED AUG 31 2015 A 4 "'s-1 �p TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Application for Septic Disposal System ' �1h Construction Permit -TOWN OF TODA 'S DATE $ 250.00 - Full Repair NORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Boar of Heal h, the "stalled system is not approved. Name Date 4Na ati - n Approv d i3y' (B ard of He Ith Representative) Date Application Disapproved for the following reasons: For Office Use Only: L Fee Attached? Yes/ No 2. Project Manager Ohligation Form Attached? Yes V1 No 3. Pump S sy tem? Ifso, Attach copy ofElectrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approval letter, all paperwork received? Yes No 5. Foundation As -Built? (new construction only): Yes No (Same scale as approved plan) 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit - Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: Oil (Address of septic system) Relative to the application of 3 (Installer's na XZ Dated // s(I o ay s ate) For plans by WP J (Engin) And dated L/,_9 � 1 %'� (urtgmal date) With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans p1lior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that reauesting an insbection. without comt)letion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (ls� inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a 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 grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done 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 to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. 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 or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solel, 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: t (Today's Date) 3 ame —Print)- (N am — tgne OF NORT/� qNMCOPY s�� oCL 5 �9SSACHUS��� North Andover Health Department Community and Economic Development Division July 23, 2015 Ann McDuffie 101 Spring Hill Road North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 101 Spring Hill Road (Map 107A, Lot 241) Dear Ms. McDuffie: The proposed wastewater system design plan for the above site dated June 22, 2015 with a final revision date of July 13, 2015 and received on July 16, 2015 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4 -bedroom (max 9 -room) home utilizing a 20' x 42' leach field. This design plan approval is valid until July 23, 2017. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 —r North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 A + 'A 101 Spring Hill Road July 23, 2015 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office 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. Sincerely, Michele Grant Health Inspector Encl. Installers list cc: Ben Osgood, Jr., P.E. . 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 Benjamin c. Osgood, Jr. P E. 157 Bluff Street Salem, NH 03079 Tel: 978-435-1324 July 13, 2015 Michelle Grant, Health Inspector North Andover Board of Health Building 20 Unit 2035 1600 Osgood Street North Andover, MA 01845 Re: 101 Spring Hill Road, North Andover Dear Michelle: RECVjvVD Ak 16 2015 'SOWN OF NORiH ZMENT R N�p,�,SH p�PAR Enclosed are three (3) copies of revised subsurface sewage disposal which have been revised as follows. 1. The system profile scale has been added 2. The cut off note has been corrected 3. The tank indicates 9" min of fill over the top 4. The system size has been increased to 20' x 42' 5. Construction note #3 has been revised. The intent of the note is to insure that there is a minimum of 6" of Title 5 sand between the bottom of the leach field and naturally occurring soil. It is the opinion of this engineer that the system will last longer if there is a layer of sand between the leach field and the naturally occurring soil. The note is not meant to limit the depth of sand required. 6. The plan scale has been corrected 7. The soil log on the plan and on the form 11 has been revised. 8. The leach bed end section view has been revised. 9. The note has been corrected. These plans are being submitted for approval by the Board of Health. If you have any questions you may contact me at 978-435-1324. Sincerely, C� Benjam C. Osg�r.",E Ln LU o r cc WN E5 ix i O CL CD A� V+ 1 O L O f+ CD U) N N Q ate+ c N O O �1+ �Q� E L O O o O (q = Z 1 c O r Q 3C: o 'v N LL o :t-- p U U LL a v CV O J c) O O U') J c� a 00 G 0 Q N 0 U Q N N m v U O O 00 f0 Un U r 3 i- a O ca rn CL z No ° z Q ° z co a� ® c � 0 z O U Z Z U) 0 Ui 0 U 3 � ® 0 Z > O_ ❑ >, ` 1, < U) C L c o O i + co�? U U a c W N No ° z Q ° z ca E ® ® z O Z Z 0 Ui ❑ ® a E c N m Lo } } O ❑ ❑ 0 w. 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N d 4) U) d a.+ O L Q f+ E N � a Z � O @z c o E o E L- 0.— V U LL Go 0 0 E `0 LL 0 North Andover Health Department (ommunity and Economic Development Division July 6, 2015 Benjamin Osgood, P.E. 157 Bluff Street Salem, NH 03079 Re: 101 Spring Hill Road (Map 107A, Lot 241) Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated June 22, 2015 and received on June 23, 2015 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 scale of the "System Profile" was not noted on the design plan. 2. The note in the "System Profile" was cut off. 3. In the "System Profile" a minimum of 9" of cover material is not proposed over the existing septic tank. 4. The size of the proposed leach field (20' x 41' = 820 sf) does not meet the minimum size requirement of 831 sf based on the design flow and loading rate. Please revise as needed on the design plan. 5. Construction note #3, the unsuitable removal of soil appears to extend beyond the "minimum of 6" below the bottom of the leach field" as indicated in the note. 6. The site plan appears to be at a scale of 1" = 30'. The plan indicates a scale of 1" = 40'. 7. The soil log for TP2 on the design plan and Form 11, indicate a total depth of 76". The field book notes (see attached) from the Board of Health representative indicate a total depth of 96". 8. The "Leach Bed End Section" view indicates a leach field width of 15' and 20'. 9. General note #3, indicates the incorrect soil testing date. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 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. incerely, 4t ichele Grant Health Inspector cc: Ann McDuffie 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 Blackburn, Lisa From: Blackburn, Lisa Sent: Tuesday, June 23, 2015 10:55 AM To: Dan Ottenheimer, Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 101 Spring Hill Rd. Septic plans will be mailed out today for 101 Spring Hill Rd. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email IblackburnCcDtownofnorthandover.com Web www.TownofNorthAndover.com Benjamin c. Osgood, Jr. P E. 157 Bluff Street Salem, NH 03079 Tel: 978-435-1324 June 22, 2015 Susan Sawyer, Health Director North Andover Board of Health Building 20 Unit 2035 1600 Osgood Street North Andover, MA 01845 Re: 101 Spring Hill Road, North Andover Dear Susan: Enclosed are the following documents concerning the above referenced property 1. Three (3) copies of septic system design plans 2. Two (2) copies of Form 11 3. Two (2) copies of Form 12 4. Application for plan approval 5. Check # 557 in the amount of $ 225.00 to cover the plan review fee. These plans are being submitted for approval by the Board of Health. If you have any questions you may contact me at 978-435-1324. Sincerely, 9.,-� Benjamin C. Osg d, Jr., PE RECEIVED JUN 2 3 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER f Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director SEPTIC PLAN SUBMITTAL FORM Date of Submission: June 23, 2015 Site Location: 101 Spring Hill Road Engineer: Benjamin C. Osgood, Jr., PE 978.688.9540 — Phone 978.688.8476— FAX E-MAIL: healthdeptatownofnorthandover.com WEBSITE: httn-//www.townofnorthandover.com RECEIVED JUN 2 3 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT New Plans? Yes X $225/Plan Check # (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes X No Local Upgrade Form Included? 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SCD kQ- o �J± \ƒ/ w 22m cCD $/ «@w < 0 #qJ g\CD R k¢o -ntj- 0 A ""0 O O�§ 2 0 2 � o $ 0 � O. � 0 �D �CL4 � CD c � � m � � 3 m Ml � O 1 0 � cn CD cn � � (D 0 �. � O U) A) C) c U) CD 3 N N CD (D O OL v v 00 0 OD VI O CA N (D N N �D O 1 O (D cn (D (Q (D _v N� O N 00 O 3 °g o 0 A Z O 3 O D h CL A m C) N (D Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of NORTH ANDOVER Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. ReCEIVEO A. Site Information Dan and Ann McDuffie 3UN 23 2015 Owner Name 101 Spring Hill Road TOWN OF NORTH ANDOVER r-r•ARTp0NT Street Address or Lot # H North Andover MA 01845 City/Town Contact Person (if different from Owner) B. Test Results State Telephone Number Benjamin C. Osgood, Jr. Test Performed By: Isaac Rowe Witnessed By: Comments: Zip Code Date Time Test Passed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test • Page 1 of 1 5-21-15 10:00 Date Time Observation Hole # PT 1 Depth of Perc 48/18 Start Pre -Soak 10:05 End Pre -Soak 10:20 Time at 12" 10:20 Time at 9" 10:52 Time at 6" 11:42 Time (9"-6") 50 Mln Rate (Min./Inch) 20 MPI Test Passed: Test Failed: ❑ Benjamin C. Osgood, Jr. Test Performed By: Isaac Rowe Witnessed By: Comments: Zip Code Date Time Test Passed: ❑ Test Failed: ❑ t5form12.doc• 06/03 Perc Test • Page 1 of 1 i h I i L \ - - - -- - - i a Al; Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Wednesday, May 13, 2015 11:14 AM To: Blackburn, Lisa Cc: Grant, Michele; 'Isaac Rowe'; 'Dan Ottenheimer' Subject: FW: 101 Spring Hill Rd. Hi Lisa, Ben Osgood just called and asked if we could reschedule the soil testing that we had on the calendar for tomorrow for the above property. It is now scheduled for Thursday, 5/21 in the morning. Please let us know if you have any questions or concerns. Pam -----Original Message ----- From: Pam Lally [mailto:plally@millriverconsultinp,.com] Sent: Tuesday, May 12, 2015 9:32 AM To: 'Blackburn, Lisa'; 'Dan Ottenheimer'; 'Isaac Rowe' Cc: 'Grant, Michele' Subject: RE: 101 Spring Hill Rd. Hi Lisa, We've scheduled this soil testing for Thursday 5/14 in the morning. Ben was on vacation last week which is why it took longer for him to get back to us. Let us know if you have any questions. Pam -----Original Message ----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Wednesday, April 29, 2015 3:24 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 101 Spring Hill Rd. Attached is an application for soil testing at 101 Spring Hill Rd. -----Original Message ----- From: noreply@townofnorthandover.com [ma iIto: noreply@townofnorthandover.com] Sent: Wednesday, April 29, 2015 3:36 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 04.29.2015 15:35:44 (-0400) Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Friday, May 08, 2015 9:40 AM To: Blackburn, Lisa; 'Dan Ottenheimer'; 'Isaac Rowe' Cc: Grant, Michele Subject: RE: 101 Spring Hill Rd. Hi Lisa, Today I left a second voice mail with Ben Osgood about this soil testing since I didn't hear back from him after my voice mail on Monday. I will let you know as soon as I hear from him. I gave him a couple of dates that Isaac is available (5/12 in the afternoon or anytime 5/14). 1 have his cell as 978-435-1324. Do you have any additional phone numbers for him? Thanks, Pam -----Original Message ----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Wednesday, April 29, 2015 3:24 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 101 Spring Hill Rd. Attached is an application for soil testing at 101 Spring Hill Rd. -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Wednesday, April 29, 2015 3:36 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 04.29.2015 15:35:44 (-0400) Queries to: noreply@townofnorthandover.com All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.townofnorthandover.com Social Networks twitter.com/north_andover www.facebook.com/northandoverma M en. .- TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX healthdept@townofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: 4/27/15 MAP & PARCEL: 107A 241 LOCATION OF SOIL TESTS: 101 Spring Hill Road OWNER: Daniel McDuffieContact#: 978-975-0644 APPLICANT: Same Contact #: ADDRESS: 101 Spring Hill Road, N. Andover, MA 01845 ENGINEER: Ben Osgood Contact #:978-435-1324 CERTIFIED SOIL EVALUATOR: Ben Osgood Intended Use of Land: R�eesidential Subdivision Single Family Home Commercial Is This: Repair Testing:^ Undeveloped Lot Testing: Upgrade for Addition: RECEIVED In the Lake Cochichewick Watershed? Yes Nora APR 2 9 2015 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x Il " 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. 9 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 be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: o 5 Signature of Conservation Agent. aA Date back to Health Department: (stamp in): //.�////.)).1�!_� I�