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HomeMy WebLinkAboutMiscellaneous - 108 CHRISTIAN WAY 4/30/2018 108 CHRISTIAN WAY 210/104.D-0137-0000.0 a l d Lot & StreeMap/Parcel CONSTRUCTION APPR VAL Has plan review fee been paid: CYEB_� NO Permit#_&Y_:�_ Plan Approval: Date: 0.39 Approved by:�� Designer: 4J Plan Date: b/_3 Lo Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YE NO Well Construction Approval? .YES NO Septic System Construction Approval? Y NO Certification? ~E NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF E/At-T1 APPROVAL: DATE: 17` APPROVED BY: SEPTIC SYSTEM INSTALLATION CONDITIONS: �D /,1/� U/�/D/G�5 Ui(�G��cS 5 �� _-9&0�,e Is the installer licensed? YES NO Type of Construction: NEW REPAI New Construction: Certified Plot Plan Review YES N Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit# 16q31 Installer: P Begin Inspection: ES NO Excavation Inspection: Needed: a er ^ 010 L� le Passed: ���3/// By: �'/jkklz_, Construction Inspection: Needed: It Plan Satisfactory 9/30/ Approval of Backfill: Date: By: (Z'4� Final Grading Approval: Date: ��/� B D� NN :Y Final Construction Approval: Date: By:� Certificate of Compliance: Approval: _/C1GL Date: r �� I Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System 'constructed ( ) or repaired by ► W-e,I c INSTALLER / at d O h r 15' i o i7 a,6-i6- >� ,Ior d SITE OCAION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. "/ 3 dated azi . g —10-0t. The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. --- BOARD OF HEALT AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP &PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS 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 V ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW LOCATION &ELEVATIONS OF BENCHMARK USED Town of North Andover, Massachusetts Form No.2 • pORTIy BOARD OF HEALTH ^ ?o�.�.. ,•��c .mac l._ /n� '2aC�o 3 ._w. '• °c �l'. X19 �' A DESIGN APPROVAL FOR : C"USEt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant L 16zi-,' Test No. Site Location J Cif • Reference Plans and Specs. I Al - ENGINEER DESIG DATE : Permission is granted for an individual soil absorption sewage Isposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. Zz/_� � ��� �l��IsT//�iU ��� ,� ` �_,•a� -vim '1 + '���'-� ''.. INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials A. Bottom of Bed 7 3 1 1. Excavation to proper depth 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. Comments: B. Retaining Wall 1. Wall height and width as specified _= 2. Waterproofed 3. Wall minim o leaching facility - 4. Wall m specifications of plan Comments: 1000 C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe C- 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8"per foot minimum 6. Pipe properly set on compact firm base - 7. Pipe laid on continuous grade in straight line d 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90°change 10. 10'minimum offset to water line Comments: �y /a y r, r - •� �. + �,�, �t �n r , r •r . D. Septic Tank F, � 1. Level 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade t , 5. Manholes over center and each tee 6. 3-20"manholes 7. Inlgt tee minimum 12"under invert 8. Outlet tee minimum 14"under invert ;�✓' b!�^�� I 9. Outlet line cemented 10. Air space 3"above tees 11. 2"-3"drop from inlet to outlet �. 12. Pipe set ►�" 13. Compact base with 6"of/e"crushed stone under tank 14. Tank is watertight Comments: A Yes NO E. Pump Chamber 1. If separate from tank,compase with 6"of stone underneath 2. Minimum 2"pipe to d- if gravity system 3. 20"access mann 4. Tank level 5. Waterti 6. Tank a agrees with plan specification 7. ole to grade 8. Check valve and bleeder hole present -,= Alarm in building on separate circuit . 10. Alarm functions 11. Manual operating switch 12. Pump delivers 15#-td-box Comments: F. Distribution Box 1. D-box level 2. Minimum 0.1 T'(2")drop from inlet to outlet 3. Minimum 6"sump C' ' -4. Outlet pipes show equal distribution -- 5. Compact base with 6"of stone beneath box ) } � 6. Box is watertight 7. All lines cemented with hydraulic cement 1-- 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double-washed-3/,"- 1 ''/z" -pea stone Bucket test done? 2. Minimum 2"of pea stone above distribution lines - 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope ' 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5'from edge of property; if not,then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches - 2. Length of trenches agree with.,plan' (Max.length 100') 3. Width of trenches ag'e'e wfth plan-Minimum 2';maximum-4'. 4. Vent prese. 0 feet or specified _ 5. Dista tween trenches minimum 4' and maximum of 6" 6. Minimum distance between trenches 10.' - 7. Pipe slope minimum 0.005 or " 100' 8. Depth of trenches below outlet invert minimum of 6". i ' a Yes NO 9. Pipes set on stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' 3. Separation between pipe 6'maximum 4. Pipes connected at end -� 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base 7. Maximum 4'separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi --- Comments: I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall be- and 48"wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cerftit" M Comments: ' K. Final Grade i. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond i—Winc!2 FMS-Noonan&-McDowell,Inc. Fie Blit 7ool� Data Mai to � Process• Wew.,Repo rrs1, ,V itiow IS ft Project: 1770 _ � ffrofHealtti DepartrnertharfStreet bIa AC[deye :� _ ... BiIllrig.GraupilD `028 _ M[T, 8[Iling Type Tillin IA�rr� $ 1c �ntsnInfo a B[If[�� M�ssage Art , - - .. _ _: p �D•e�arttrrent� �. PtoposalrNumber R • Contract,Number, GontractDate, 8/9/2001 s l 3 . workStart64te 8/9/2001 - +3 Expected FintstttDate, /f.— U46 orernrrrerlt;IrFrot�Sty� xT - � Dascnptlon Survey engineering services required for septic system inspection. Installer. Mike Reilly 508.387.2687 Pager,978.375.5701 Cell j Applicant: Holt 108 Christina Way 2 It L i Start' do Launch �. � ' Project Request Record Town of North Andover Date: Client Id: ToNA Card Id:ToNA Client/Company Name: oard of Health Card Type-Client Contact Name: Ms. Sandra Starr Phone: 978-688-9540 Title:Director Fax: 978-688-9542 Address: 27 Charles Street Email: Notes: Town: North Andover State: MA Zip Code: 01845 Other contacts if applicable: ie Engineeriq Lstalflle:r ) Name: d!/�� /� ` 7� Phone: 5.P P'-- 3Sr 7— $ Title: Fax:-- -� 79 37S- 52c, G L Address: Email: Notes: Town: State: Zip Code: Project: Project Id: 1770 Project Title: Town of North Andover,Board of Health (JOB NO) �y (PROJECT NAME&STREET ADDRESS) Manager:NOW Billing Group: 0�b Billing Code:Fixed Fee / S p Contract Info.Project Description for each billing group BG/ Applicant /f Q Z-- 7— Assessors Map Lot Street /O S- >,- Type of service -*ir 7—v cc t- G- 7-,r G S Y l Office/forms/jbrqutona _may.-� -•��" - 1 �r . t t TOWN OFNORTH toIZTH ANDOVER SE�V:�cYr; DISPO�.�r: S� S`�El�i ' I\STALLA-rioiN CERTIFICATION The uncersi&:;ed ;lerecv certify that the SewaLe Disposal Syste:-1 ibY �•�� f2^atrzL: f. located at /V Qi C . i2I T)!i✓�t/ W�4 _ N�r2�-1 _ �vA J �2. was installed in cpnfunance with the Nlo.th Andover Board of He:ith a-fprovea plan, Svstern Design Pe^rit _ dated with an approved des&,,-)n flow of eallens er day The mate a:s used were in comormar;e �'i:`l those specified on the approved plant; the system xas installed in accorddrec vNith the prcvisions of 3 10 CMR 15.000, Title 5 and local res-z.tlations, and the final Qradir.!_� agrees substantially xNith the approved plan. :5.il work is accurateiv reoreseatedcar. the As-built which has been submitted to the Board e:'_-iealth I/ - Ezd inspection •late: — Engineer R hese :alive Final inspect:cn date _.—_— Engiree: Represe^tat_.e tnstalier: = Date: F Cesiy7 n Eng-inee . _ Date G . o C. YANGARD y X09 '•; 0 e' TC O.-HOPTH, r- Town of North Andover, Massachusetts Form No.3 e Ho oTti 1 BOARD OF HEALTH <t�- oo F F ,► moo'i DISPOSAL WORKS CONSTRUCTION PERMIT 9SSACHUSEt (\ Applicant NAME (ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair (L4/an Individu'all.S�oil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee �� D.W.C. No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: (6 �� �\ CURRENT INSTALLER'S LICENSE# LOCATION: p LICENSED INSTALLER: SIGNATURE: 4��_UTELEPHONE#97)T`���-/a3_) CHECK ONE: / REPAIR: ( NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. ,v or Administrative Use Only $160.00 Fee Attached? Yes V/ No Foundation As-Built? Yes No Floor Plans? Yes No Approval �t'��_ `.� Date: C� INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at relative to the application of � _dated 6-1 Q-0-N---for plans by 0 4E Fund dated with revisions dated 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 first inspection unless there is a retaining wall which should be done first. Installer 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 grading 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 Construction Permit# /,�,� Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH //�� �r 3�ary�z�E° OL 1/ / APPLICATION FOR SITE TESTING/INSPECTION 7�QORATE°E•PR,`��J SSacHUS� Applicant ME ADDRESS TELEPHONE Site Location �� c Engineer &46,4J-- NAME ARESS TELEPHONE Test/Inspection Date and Time / �C� �8a r� GAN• s .O� H• R4#A,-I ,BOARD OF HEALTH Fee Test No. S.S. Permit No.Z/�3 D.W.C. No.1 3 C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH IIBOARD OF HEALTH OST`ED ib�•YO 19- 11,A 9 FO 7r A AR APPLICATION FOR SITE TESTING/INSPECTION AATED 7 PPP\�OJ 9SSACHUS Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. �� N�Zo �p �¢¢P Me � �� NEW ENGLAND ENGNIC EERING SERVICES lk December 18, 2000 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 108 Christian Way,North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of revised design plans, 1 with original signatures. 2. Submittal form for approval. 3. Check to cover the fee. The changes that were made are as follows: 1. The abutters have been added to the plans. 2. The grading on the profile has been revised to indicate 9"of cover over the septic tank. If you have any questions please do not hesitate to contact this office. Sincerely, c Benjamin C. C ? Jr.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 May-27-99 12 : 45P Notrth! Aradov,er- Com. Dev . 508 . 688 9542 P.Ol • i; it i; it SEPTIC PLAID SUBMITTAL FORM LOCATION: /09 CMjZ1 DjgA/ _v_✓moi _ . /Jl,. J -- ` N- -h-W PLANS: YL•-:S $125.00/1113n REVISED PLANS: YES S 60.00/Plan SITE EVALUATION FOPJAS INCLUDED: YES '0 DATE: 1-Z 191, DESIGN ENGINEER: ,,, DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in dace, route to the Health Secretary. i . Town of North Andover E NORTij 1 6ArpOLA Office of the Health Department Community Development and Services Division William J.Scott,Division Director 27 Charles Street �ssACHU � North Andover,Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 January 2, 2001 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, MA 01845 Re: 108 Christian Way Dear Ben: This letter is to notify you that the following variances have been granted for the site at 108 Christian Way. • Separation to groundwater from 4 feet to 3 feet Please note that with this variance (separation to groundwater)that no additional rooms may be added to the dwelling unless it is tied into sewer. The Board of Health requires that a deed restriction be placed on the deed with a copy to the Board of Health before a Certificate of Compliance can be issued. With these variances the plans for the septic repair dated 12/18/00 are approved. If you have any questions, please feel free to contact this office. Sincerely, Sandra Starr, R.S.,C.H.O. Health Director cc: Holt BOARD OF APPEALS 688-9541 BUILDNG 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Address 10Y Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes T action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department Town of North Andoverf AORT#I O see° i`1N Office of the Health Department h p Community Development and Services Division William J.ScottDivision Director " °.°- � " 27 Charles Street �4Ss4CHU North Andover,Massachusetts 01845 Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 December 14, 2000 Ben Osgood, Jr. New England Engineering 60 Beechwood Drive No. Andover, MA 01845 Re: 108 Christian Way Dear Ben: This is to inform you that the proposed plans for the site referenced above have been disapproved and have technical deficiencies as followed: • Names of abutters from recent tax map are not provided as required by NA 8.02j. • Minimum of 9" of cover over septic tank not specified as required by 310 CMR 15.228 (l). If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Holt file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Dec-13-00 05: 29P Paul D. Tui-bide, PE/PLS 978-465-0313 P.02 December 11,2000 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for SDS upgrade at 108 Christian Way Dear Sandra, Enclosed find our review of the"Checklist for North Andover Septic System Plans" for the septic system upgrade at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. o Names of abutters from recent tax map are not provided as required by NA 8.02 j. o Minimum of 9"of cover over septic tank not specified as required by 310 CMR 15.228(l). If you have any questions or comments please feet free to contact me. Ca Paul D. Turbide, PE/PLS JZ1 ZA. 81 113 $ PORTit I ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburyport,HA. 01950 (978)465-6594 \\Server P\NARMP28MCHRISTIAN WAY 108.DOC Dec-13-00 05: 28P Paul D. Turbide, PE/PLS 978-465-0313 P.01 Facsimile Cover Sheat To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9540 Fax: 978-688-9542 From: Paul D. Turbide, P.EJP.L.S., President Company: Port Engineering Associates, Inc. Phone: (978) 466-8594 Fax: (978) 465-0313 Date December 11, 2000 Pages Including This Cover Page: 2 Comments: Sandy, I have attached our review of the SDS upgrade at 108 Christian Way. Thanks, Paul D.Turbide,P.E./P.L.S. PDW 0111 ENGINEERING Civil Engineers& .Land Surveyors One Harris Street Newburyport,MA 01950 (978)465.8594 INN INN IN IN IN I IN IN Wril 01IMMME 1 2 log IMM1 ilia 31 11 m IN MI 1111 0 gill IN I ME 11 j r C. q LOC � 710 fel: 0L TJ C N 50I CONI D`.7,. C, _,.c ����: 7`` �- `Y_ ^1 f Ti M A i _ / C5 C y` i I N'I E i 5 �F . C-VE=;NII_ T I N i E 1 iNl= . I I ! iIv E i �.. NEW ENGLAND ENGINEERING SERVICES INC December 4, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 108 Christian Way,North Andover, Septic system design Dear Sandra: Enclosed are the following documents concerning the above referenced property. I. 5 sets of design plans, 1 with original signatures. 2. Submittal form for approval. 3. Check to cover the fee. 4. Soil evaluator sheets. I have enclosed extra copies of all documents for forwarding to Port Engineering. If you have any questions please do not hesitate to contact this office. Sincerely, Benjamin C. Osgoo r.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 t May-27-99 12 : 4SP Noirth, Andov,er- Com_ Dev . 508 688 9642 P. 01 SEPTIC PLAN SUBMITTAL FORM LOCATION:_J00 CriRtq—jir, .v wR_V A)i\ j N—ENV PLANS: LS II25.00/1'lan_ r� REVISED PLANS: YES S 60.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: 12 l W/o g DESIGN ENGINEER: DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. t I i i • 0 FORM 11 - SOU. EVALUATOR FORM Page 1 of 3 Date: No. Commonwealty of Massachusetts Massachusetts i 't • i nt o - .. !`�! � Date: /��/�©....._. PerformedBy: ......................_.................�......... ...... .... Witnessed By: ........... ., 'cr-5'�y.....� ....... ........................................................................................ _..................... .............. /Lomt1w AM= �� G��l�Z� /!/'/ Owou't Hum, ew construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes C Publication Scale A 1-�,.— Soil Map Unit _ Year Published .�� ........................................�._ _ ._....... Drainage Class .. Soil Limitations ' Surficial Geologic Report Available: No 0) Yes ❑ Year PublishedPublication Scale GeologicMaterial (Map Unit) .......................................................................................................--...... ........._..............._ Landform ............ .............................................................................................................................................................. ......... ...... ....._.... a Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within loo year flood boundary No ❑Yes Q Wetland Area: National Wetland Inventory Map (map unit) ............••.......... _ Wetlands Conservancy Program Map(map unit) .................................................._..._.............. ..._...._............ Current Water Resource Conditions(USGS): Month Range :Above Normal [ Normal ®Belcww Normal Other References Reviewed: DZ8 AMOVFD k'ot1.M.11107195 ' FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot NO. ��� ��i57T- L(/���A/D, .��C✓��. ' QA-site Bedew Deep Hole Number ..1, Date:.// Time:. IZ `T Weather Location (identifyon site plan) ... �P� �.......,.,�.�.,.� . . ..„. �..M..::. .: Lend Use Slope m . .."" .. Surface Stones .. . -� Vegetation . ���Z „�.S. . .... .. .. :..�..�� .�..,... . .. . .: Position on landscape.(sketch on the back) .:. .. G��-'G.,.....�. .... ..,,:. Distances from: Open Water Body . feet Drainage way/ feet Possible Wet Area 24P5? feet Property Line . 40,. feet Drinking Water feet Other . ..,,' . .._...,, ... DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil other Surface inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) MINIMUM OF 2 Parent Material(geologic) Oepd toBedrock: pepth to groundwater: Standing Water in the Hole: Weeping from Pit Face: _ Estimated Seasonal High Ground. Water: J5 v ' I DEP APPROVED FORM-12/77/95 FORM 11 - SOIL P.VALUATOR FORM Page 2 of 3 Location Address or Lot No.Zf� � may' yo. 14< p cr—K 9n- & ,_eYiew Deep Hole Number Z.. ,.. Date:. Time:./-`/` � Weather� y..✓'�d Location (identify on site pian) - ,,.,�„ . .,...._ .. ......� ,,....� w. Land Use % ��. �'(!7f¢� Slope (96) . .....-- .. Surface Stones .. . . Vegetation , ��. .. . _.. ,.,,.., . .M.. .,.. �,�.. . .. . ., . . Landform ... .M... �! �!/. !/ P /�/. w.w..._.� ..�. ; .._. ._. . . . .. Position on landscape (sketch on the back) .... .T. .... Gmi1--�..,r. ...,.,. .... ..,.. Distances from: Open Water Body :Odr74"'O' feet Drainage way feet Possible Wet Area feet Property Line ..1p.0.. feet Drinking Water Well feet Other . ...w.�.�,�. �.,.-.... DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil other Surface finches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Gravel) ly Parent Material(geologic) i��(��!���T' DepthWB*&ock: Qeoth to Groundwater: Standing Water in the Hole: _ Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED Fort-12107195 FORM 11 - SOIL' EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Reterjnination for. Seasonal High Water Table . Method Ted: ❑ Depth observed standing in observation' hole................... inches ❑ Depth weeping from side of observation hole.................. inches MV In I Depth to soil mottles .._��,J inches Ground water adjustment ..._........... feet 7 / Index Well Number .................. Reading Date .................. Index well level .................. Adjustment factor ................. Adjusted ground water level ....................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious materialist in areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? -- Certificjtion I certify that oni ✓�(date) I have Passed the soil evaluator examination approved by the epartment of Environmental Protection and that the above analysis t was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 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N NI'11�i1111�1 111111 1111 '�, F__ s 111`i x7 C5 r. ci U� u, tNU ��I I I " I— Itl _ III V -. � Q III 7 I��. r1 �j �•I i„ il, �L it': u1 �\I I LI << 7 O) Q < V lJ _i_ II_ I_ U_1 U.1 UJ UJ Q IU1IT) UJ �"; tl.l I11 lIJ ( J 7 11 U Z Z � _ I— ! r ( \ CX FND. o c. 1Y� �. !� LFACH RFLD ¢� OP /wFriD C . D-f OX INLCT I - ' D-BOX OUTLET 173.72 2 ' END.FIEU). 173«?ti i! r- Q ,'p LA r3 DFR L i _ 4 •, X20°2�.� �'�'! � .. ' • - ` •, I t t �l^`,��� J� 1 121,1!r(��,\i V,AY •r I CF.RTLFY THAT TIME SEPTIC SYSTEL! MS IP 7- LLED AS SHO�t�;� -7E36` �r�\I DAT� 6 11 -:�- i t i , iS N7 IhTEND AS A WARRANTY OF TI-4F'5V5!£N; i I .. ME PAREDS c.� ♦d C .�f n • __... _�_. .,. ._ ...... .. � � .. Po 0.`.'�!�•fir f �6 - I BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 ;APPLICATION FOR SOIL TESTS DATE: 6 MAP &PARCEL: LOCATION OF SOIL TESTS: OWNER: Do u, o TEL.NO.: j 7V-- �Z?. ADDRESS: / 016 CI P C?lei LO v ENGINEER: A)U J!FA/&-1-i 1-id i.Vc, TEL.NO.: q7,9- 696 -176 ,0-4 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewiek 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$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified oil Evaluators may perform deep hole inspections. 2: Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the di§cretion 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 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This L' i N.A. Conservation Commission Approva Date Received: U v Check Amount: Check Date: GX�� co AD C� Y.. ELF�,�`� ;�I+ TOP Ffti7) I � � ! � J I- � � i.'t{, U-�i yC E� �-7 r � � i �% �' � . . , , i�r i�;,_ ;, �, BOARD OF HEALTH " ` NORTH ANDOVER, MA 01845 `�� l ` 978-688-9540 ;APPLICATION FOR SOIL TESTS ; DATE: MAP &PARCEL: LOCATION OF SOIL TESTS: /D , C ti 2 isf i a n Wr-.4 OWNER: DGd D I+ TEL.NO.: !7 7-6- !Z7 s-oz oy ADDRESS: /0 96 Clk2tsTctrx LU tq ENGINEER: C L-V 41FAIC-`A-/0 i�� TEL.NO.: 9. 7 E 606 -176 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: � 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$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrade ades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2: Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 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 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH OF,,`-`° b,bq�'o 04 19 FO � A n m APPLICATION FOR SITE TESTING/INSPECTION 7,9 ADAATED PPP,�(�J SSACHUS� Applicant NAME ADDRESS TELEPHONE GHIRKTlkw c.q Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. 7 S.S. Permit No D.W.C. No(--z-C.C. Date Plbg. Permit No. N&a�Jpj LOT y �HI�KTuIAJL.IJ Ndl�TH 4AJPNEI�IMA. PP�� �QtiI 4TER S ►'r'L7 -4F bwrJ ❑ oiEu- AP o�CD1y4TC 5 S SEPTI c Sy S i E.-1 T)Es1 c-,Aj - 31,x) AI'RW'.v6 /urhOR,ry -------------------- coAvPiTiotis_ �Q,4jC �i�PPJz�vED aN/G r /3 L-'- r�vtS'c• -a-� SYSTEM 1 J STA U_,QTIOA J L 74V4Tto� S [] F4 �w,�� �tiSPF�i long �4��IT(OJJAL 1�15�z.j)oN5 �1F-,a►-�Y) D►SfiPY7RU\jF R�So NS•, , FML A PPROva L , . 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