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HomeMy WebLinkAboutMiscellaneous - 111 MARIAN DRIVE 4/30/2018 111 MARIAN DRIVE I 210/107-C-0048-0000-0 n Y+ k � ti ry MAP # LOT # 1 1 PARCEL # STREET ,(1 CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NO I PLAN APPROVAL: DATE 7�/,3 X? APP. BY DESIGNER: PLAN DATE 711-0 h CONDITIONS 1 WATER SUPPL �TOWN WELL WELL PERMI DRILLER WELL TESTS: CHEMICAL DATE APPROVED BACTERIA I DATE APPROVED TERIA II DATE APPROVED PLUMBING SIGNOFF WIRING SIGNOFF COMMENTS: i FORM U APPROVAL: APPROVAL TO ISSUE YES NO _r DATE ISSUED BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: i SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? ES NO TYPE OF CONSTRUCTION: s ,{ NEW REPAI NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO I CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT NO DWC PERMIT PAID? YE NO DWC PERMIT NO. INSTALLER: BEGIN INSPECTION YES N0: EX,-AVATION INSPECTION: NEEDED: PASSED By CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: __ YES- APPROVAL 0 BACKFILL: DATE: By_'./ FINAL GRADING APPROVAL: DATE /��`ll�T By FINAL CONSTRUCTION APPROVAL: DATE: BY O NEW ENGLAND ENGINEERING SERVICES INC . RECEIVED AUG 0 2 ?004 N©,F NpR h, crkqip July 30, 2004 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: RE: 111 Marian Drive,North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely Benjamin C. Osgoodf r. Certified Title 5 inspector 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 e COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_//) /v1 0 2)Y}AJ D P _/,J o ED-( A j Do,)E 2 Owner's Name: GG_ 0/cR CFS . RECEIVED Owner's Address: f L /w r42)661 .D 2 V_ � q Date of Inspection: `72� ay AUG 0 2 2004 Name of Inspector:(please print) Benj amin C. Osgood, Jr. TOWN OF NORTH ANDOVER CompanyName:New England Engineering Services Inc. HEALTH DEPARTMENT MadingAddress:60 Beechwood Drive, North Andover, NLA 01845 Telephone Number. 978-686-1768 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.'I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 9 — Date: Z o The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I Paget of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1,/I m,4 21 A.w c>R t o e VofZ1tf A,,)t> ooe� Owner: I_EL Pi E21E5 Date of Inspection: -Z I w�(o v Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. .System Passes: E 1 have not found any information which indicates that any of the failure criteria described in 310 CMR "15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: /yy One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following.statements.if"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obsf.ructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Pagel of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11t 1Mt9--211jti P glue Owner: LES Pl e/z 43 Date.of Inspection: -7.12, pC_ C. Further Evaluation is Required by the Board of Health: IVO Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary4o a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicatesthat the well is free from pollution from that facility acrd the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: l I ivi Ail (IN b2tuc No2il-t 4NDOL)M Owner: 1- -% 7 I F21k E Date of Inspection: Z� D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No ti Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _L, Discharge orPang din of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — v Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/�day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tn'butary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. — Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but eater than 50 feet from a private water P vY gr supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] ND (Y.es/No)The system fads.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. i M Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 1;Pd. You must in ' either"yes"or"no"to each of the following: (The following triter' ly to large systems in addition to the criteria a yes no — — the system is within 400 feet surfs inking water supply — _ the system is within 200 of a tribu to a surface drinking water supply the em is located a nitrogen )or a ma en sensitive area terim Wellhead Protection Area–IWPA � — ltd iig PPS ne II of a public water supply well If you have answered"yes"to any question in Section E the system is co 'dered a significant threat,or answered "yes"in Section D above the large system has failed.The owner oroPer ator o large system considered a Y significant threat under Section E or failed under Section D shall upgrade the syst in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Dep ent. I Page.5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:- /it M P+RLkAvj po u C lU 0 a:N AN 0 o C2. Owner; t Er- n c�2 K es Date of Inspection: -1`2 1 a�{ Check if the following have been done.You must indicate`yes"or`5no"as to each of the following: Yes/— Pumping information was provided by the owner,occupant,or Board of Health "Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? L-"fiave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(if they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on. Yes Existing information.For example,a plan at the Board of Health. t/Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: III mo-(2.i A},.1. ,r>(2- Po DSLNo a-- A-^J;pOjek Owner: L EL% P U 21t. ES Date of Inspection: 1 Z&'1 o H FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):q Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): c� Number of current residents:__�{___ Does residence have a garbage gander(yes or no): ,v-0 Is laundry on a separate sewage system(yes or no):/J-0 [if yes separate inspection required] Laundry system inspected(yes or no):— .Seasonal Seasonal use:(yes or no):A,/o Water meter readings,if available(last 2 years usage(gpd)): Sump Pump Cyes or no):_4Lc Last date of COMMERCIALMiDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of designflow seats/ sons/ etc. : ( lam' elft, ) Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):T Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meta readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: w I TM(ti L-65:—) t`}� Was system pumped as part of the inspection(yes or no):LVQ If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative(Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):&D Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / c 4,,z i r-ry 0 2 JJo ouc/L Owner• cL D i C2K C5 Date of Inspection: -��z c- BUILDING SEWER(locate on site pian) Depth below grade: 3 Matenals of construction: ✓cast iron 40 PVC other(explain): Distance from private water supply well or suction lime: Comments(on condition of joints,venting,evidence of leakage,etc.): P L U N 7 G R- S Li4B 1�J S f}5E°/Y/CST SEPTIC TANK:—(locate on site plan) Depth below grade: Material of construction: concrete_metal fiberglass_polyethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: J Sludge depth: L 2 � eP Distance from top of sludge to bottom of outlet tee or baffle: 3 Scum thickness: 2- Distance Distance from top of scum to top of outlet tee or baffle: Z Distance from bottom of scum to bottom of outlet tee or baffle:1 How were dimensions determined: r l} s E s'I CA Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7Ti9-\1)k 100 C�0 D Cy N 9 t'�ten. S c K 4 o PO C 72 e 1 � Cep D C>N D t i1 �7 &424r)E n V t/L t+ GREASE TRAP:J&ocate on site plan) Depth below grade:_ Material of construction:_concrete metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert evidence of leakage,etc.): II Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_,u r M,q g_j(+ti r> Owner: O-e orr2tkES Date of Inspection: 7'12 to TIGHT or HOLDING TANK:,1i(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DLSTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 130X IN nlCk- cz , P 'TZ "s [E esr LC1'�/<AG� l nr o X 0'j 0 2 Sam+ D 3 c A-YULI oy/1- 1 13 i►1 0'_' 67(Z LJ A-C.. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):�)C5 Alarms in working order(yes or no): LA eS Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page-9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: n l M i4ai ON D 2, - 10_ ygjDOJEZ 'tied Owner: L.C2- l C--R K cs Date of Inspection: -7 2(,/sy jSOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: �I Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: '--leaching trenches,number,length: Lf L-00 & v?'_1j k D r` I D c e e> 7_nc.L c K c-s . leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type(name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): W�J- ",3i0 ^021.14- Ivo PO N l>r Av (,- PAAP 0 2 0 nJ c)So/4--L CESSPOOLS:A(cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scam layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY;4 L(locate on site plan) Materials of construction: Dimensions: Depth of solids: j Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i I Page.10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: I/r .,,o O t Ivo a-04 kAj PO,)eiL Owner• LL-7L__.7 r L%7L KCS Date of Inspection: 7 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply ental the building. ,S—IfIAlcc-5 i3"I V�1� I cl Di3bx 16` 7�Q U r " p-9 j I E n1 2\ � 9 2�v"c ' I Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: !// A4rhz+&,V p F- 0- 1+i J D o -OU Owner: 1-E7-7- �•C-'(1 i��S Date of Inspection: -7-12 6/311 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: -Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: c a ` A P��✓� C dun„ CJ wYi�1��2 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH October 21 19-97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X ) by Mike Reilly INSTALLER 111 Marian Drive at SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 957 dated qej t-PmhPr1 719 g7 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: AI CURRENT INSTALLER'S LICENSE# LOCATION: \ Cd—" LICENSED INSTALLER: 7.P yJ SIGNATURE: TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-built? Yes No Floor plans on file? Yes No Approval � Gl�/L, Date: v.r Form No.3 Town of North Andover, Massachusetts -! BOARD OF HEALTH s: AORTH OJ/�t 4t�au �e 1�O0 /f' 19 Z. F 9 ., 49 -- - = DISPOSAL WORKS CONSTRUCTION PERMIT ... �,SSACHUSE� ., • • Applicant NAME I DDRESS p TELEPHONE Site Location . 7.. ; Permission is hereby ranted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. , CHAIRMAN,BOARD OF HEALTH • Fee D.W.C. No. a q. Town of North Andover, Massachusetts Form No.2 f MOR71y BOARD OF HEALTH O'i �.o ` 19 S DESIGN APPROVAL FOR ss"`14 SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant-- Test No. Site Location ( � Reference Plans and Specs. A.,"_(��t ENGINEER DESIGN DATE Permission is granted for an individual :soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. x CHAIRMAN,BOARD OFTiEALTH Fee Site System Permit No. i SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES r$60.00/Plan"� REVISED PLANS: YES $2 . an DATE: DESIGN ENGINEER: ::n\-LAA- AL(�t �r When the submission is all in place, route to the Health Secretary MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 • TEL.(508)475-3555, 373-5721 FAX(508)475-1448 _ � 1 June 23, 1997 JUL 11997 Town of North Andover _ Board of Health Town Hall School Street NorthAndover, MA 01845 RE: 111 Marion Drive Dear Mr. Chairman and Members of the Board: We have completed a repair system design for the above referenced site. Based on the design, we are requesting a variance from Section 15.02 which requires a 100 foot setback to wetlands where 55 feet is proposed. Additionally, we are requesting a 3 foot vertical separation from water table and an impervious structurally sound retaining wall design other than reinforced concrete. Both variances are allowed with local approval under the current Title 5 Regulations. We greatly appreciate your consideration of the matters. Very truly yours, MERRIMACK ENGINEERING SERVICES William Dufresne Project Manager cd 1 n PLAN REVIEW CHECKLIST 1DDRESS J// zM�' IA/ A-) _D/2- ENGINEER 3ENERAL 3 COPIES STAMP LOCUS NORTH ARROW SCALE 0 f5 .ONTOURSc/ PROFILE 1 . ( Sc) SECTION L BENCHMARK ,,-' SOIL & v- _j✓ ?ERCS Cl"- ELEVATIONS 9 -0i51"lG//WETS . DISCLAIMER s; WELLS & WETS JATERSHED?,fO DRIVEWAYWATER LINE �- FDN DRAIN M&P 3CH40 ✓ TESTS CURRENT? V SOIL EVALGV itJ- SEPTIC TANK Ab '�IIN 150OG -- . 17 INVERT DROP GARB . GRINDER /W ( 2 comps +200 ) 10 ' TO FDN MANHOLEy ELEV GW ## COMPS . GB — D-BOX ✓� SIZE ## LINES FIRST 2 ' LEVEL STATEMENTy INLET - OUTLET /Za = ( 2" OR . 17 FT) TEE REQ' D? LEACHING ����, �7 MIN 440 GPD? RESERVE AREA-- 4 ' FROM PRIMARY? 20 SLOPE�''�/ i // 9 100 ' TOS WETLANDS-2v ` 100 ' TO WELLS 4 ' TO S .H .GW v ( 5 ' >2M/IN ) 20 ' TO FND & INTRCPTR DRAINS 400 ' TO SURFACE H20_•SUPP ``;'t, 4 ' PERM . SOIL BELOW FACILITY L--*�MIN 12" COVER (-� FILL? �('15 ' ) BREAKOUT TRENCHES , / /� MIN 440 gpd `, SLOPE (min . 005 or 6"/100 ' ) L" SIDEWALL DIST . 3X EFF . W OR D (MIN 6 ' ) y� RESERVE BETWEEN TRENDS? IN FILL? MUST BE 10 ' MIN .yAf°ft°4" PEA STONE? (/ VENT? ( >3 ' COVER; LINES >50 ' ) BOT + SIDE X LDNG TOT ( L x W x # ) (DxLx2x# ) (G/ft2 ) :Qpyr i9hL 0 1996 by S.L. Starr PITS' IN: 440 LEACHING MIN 1:' (13 'x16 ' ) PIT MANHOLE PIT GW MIN 4 '. BELOW ,BOTTOM EXC 2x` EFF W OR D 12"-48." STONE BOT + SIDE. x LOAD _.,TOTAL; (`L x W #) •.(2x(L+W)xD x #) 4 ft2) '4 ;CHAMBERS MIN 4;40EACHING GW MIN 4" BELOW COVER >3 FT VENT MANHOLES STONE ;SPLASH PADS '.SLOPE :`005 q 4 BED)TRENCH (Bed max: MIN 13' X '16 'x PIT BOT _ c + SIDEs X LOAD' = TOTAL j L x #)< {� x '.(L+W jxD x° #) (G/ft2)= x W h. ' iz f #IBLDS "MIN 440 GPD : ' 90"0 ft2 BED - d GW M-IN 4 ' BELOW BOTTOMr OF AFIELD?. " x P-IPE ENDS JOIIED�'- �,4" PEA STONE? D3ST LINE.,SLOPE 0057 COVER-VENT SCk 40 ,`MIN.j2" COVER ' x : RATE s `k ( X }) X TOTAL f L W LDG ,,.}.. DOSING tANK8 PUMPS,4 DIMENSIONS X.7 VX - PUMP .CAPACITY gpm ' 4. L� W D Vol r Y. DISCHARGE`: SIZE' DISCHARGE RATE " DISCHARGE TIME 4 gPm Y r 'MANHOLES TO GRADE z ;ALARM :SEP _.CIRC. GWMiri. 1 '. below +: s inlet). HW =Z k LWL CHECK VALVE BLEEDER HOLE �� MANUAL ` '• ti, OP SWITCH tT ENUF STORAGES µ GoOyright '©-1996,by S..,L: St. NORTH ANDOVER BOARD OF HEAL DESIGN REVIEW REPORT D �C. s DATE V _ FEE. PERMIT ## DATE RECEIV: APPLICANT MAP ADDRESS LOT ## STREET ##J/l ENG. M4�-IVZI J/ ,e /�U,�2�5iU�" STREET �24VWJ —DR-1U,5 ENGINEER' S ADD. 37—. PLAN DATE REV. DATE 7116197 CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: To 5cPe&- D - k--3C9M ISS Iry G /d / TO G Zovo G 11v S 1zc Town of North Andover, Massachusetts Form No. 1 NORTH A' BOARD OF HEALTH 3�O T�eo L R 0O0X1CXPWOF�� APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS�� 5 Applicant NAME ADDRESS TELEPHONE' Site Location Engineer Y \-& NAME ADDRESS TELEPHONE { Test/Inspection Date and Time X2W/ Gam. -sc) r�� 4ti CHAIRMAN,HUAKU OF HEALTH Feel Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I I j I y `kms I �---- SNI--�-�-�-- i -�- - , - -- ----------- --------- c' - s l• N AA 24i'SEe2�, ' im k f t MW u •3 Y 1���..[�.�Te.�, s � �.;r �.,�t�,� � �� r.o � 3i:,�v a•�.; +n:,..c.�s .r � 't F a c t•HY �-3.z`T t '. � + iy` xt�7,,'B` �''-r--k:i. '�; .,.f ,�rr�' rw''3t;1.�•.a y xt Y a5 j� it+zit .t..�1]s�. 'e,< r 4 ' a,7tu *"qty. . r `�• 9 �t' �° «4 tri *r.`_ s►* 111111111111111111� �� � � -� �� J.►�.11ll illllnllllllllll� � -��,1 II�Im11111m111111r1111111111�i 11� . ►.Il�llinnllllnilllll Illlnllnnllll�.�' . ,JI�'�'1^�11 . Ilrnllr, gyp, r - . 1 11111111 1 , Illn 1 Ifni _ . ���f II - - Iln Iminn � := ra�ti 11[• ., - rrlrrlrmmlrrnrin �: Ir111111111��.1 { St . ►lall ' h Ir n t f x Imrrllln � s { r✓un; FORM U - IDT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary aPPrOvals/Permits from Hoards and Departmamts having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �.�F Phone `5 LOCATION: Assessor's Map Number LC) - Parcel Subdivision Streeti ,;,1i`:r.aii. St. Number I 11- ************************Official Use Only********************** * RECOMMMMATIONS OF TOWN AGEMS: Date Approved Conservation Administrator Data Rejected ' Comments Date Approved Town Planner Data Rejected Comments A �� Date. Approved Health Agenm Data Rejected Comments f9/)i) '7 L) Public Works - sewer water connections - driveway permit- De=ar-t=en-- Received ermstDe=artwe.^.tReceived by Building Inspector Data I UILI�L To' umt-iA Y o 11 r$bL� a A �. P ..EX151 E G 1 sr. ' q' 91- 11 JfL LI 0 I ( Z, 7 u it I li Y *44 7- .o N E wl I.�AGI•( Ta 6►•►u•l e s Dt SEW IOool.. Od M ploy TANK o c 'PA ill:. i L 1 U _ I VW6L4 I11 r. �L �►.pJ J �9•�t,33oSF flAeIA�J ¢.Iv AS BUILT PLAN OF SU6SURFACE DISPOSAL SYSTEM LOCATED IN _ Nod?� �I��ovE�.� F�e�hh � 111 Ma►21��i ��I�tE AS PREPARED FOR rf�l.ovEl.tro DATE: SCALE: I 4o' MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 or TEL (617) 475.3555. 373-5721