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Miscellaneous - 114 MARIAN DRIVE 4/30/2018
1 114 MARIAN DRIVE _ � � � 210/107.C-0054-000OA ��_ i __ E �5 -.......�- -�- - .�-� .. _ l _ _ - _ - - ��, P-1 = � �--- SEPTIC SYSTEM AS-BUILT AREA 44� 520 S. F. MARK HONEYCUT LOCATION: 114 MARIAN DRIVE NORTH ANDOVER ,MA. 00 N DATE: 8-19-04 1,500 GALLON TANK 1,000 GALLON PUMP TANK SCALE: 1" = 20' F C E A TO D = 33.6' (D= DBOX) BH F TO C = 30.7' (C = SEPTIC TANK) DECK F TO E = 42.8' (E = PUMP TANK) BTOC = 15.0' ,I M = BOTTOM SIDING = 80.00'/ B TO D = 34.6' EXISTING DWELLING' B TO E = 14.2' 11411 PORCH D D—BOX INVERT FOUNDATION = 77.15' INVERT TANK IN = 76.95 _INVERT TANK OUT — 76.70 INVERT PUMP TANK IN = 76.65' A INVERT PUMP TANK OUT = 76.90' INVERT D—BOX IN '= 77.32' INVERT D—BOX OUT =77.15' } INVERT LINE BEGIN =77.01' h ? W N Q) INVERT LINE END = 77.01' ISI � N b 0j 4 � 1 CERTIFY THAT THE SEPTIC SYSTEM COMPLIES HATH C�l TITLE 5, LOCAL CODE AND DESIGN PLAN. � Cla q shy \ l PROFESSI 4 3Q �L DATE: 150.00 _ NGINEERING & SURVEYING RECEDED SERVICES Gia SCMZ L AUG 2 6 200 70 BAILEY COURT ,o w ,0 SOWN OF NORTH AND VER HAVERHILL, MA. 0183 Low HEALTH DEPARTNT ( IN FEETL 978-556-0284 1 aah -20 aMARIAN 1jE S/,., ' I � - � , A _� - .' � I Town of North Andover N°RT Office of the Health Department Community Development and Services Division • 27 Charles Street `s°+ - �'-• ` ' North Andover,Massachusetts 01845 Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-Fax CERTTFICATNEOE C0911(1jPJ(-JJT13'LNM As of: September 9, 2004 ,This is to cert that the individualsu6surface d4osafsystem repaired (X� — Full System by Jon Whyman at 114 914afian lDfive North Andover, JKA 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Yfeafth regulations. The Issuance of this certificate shall not 6e construed as a guarantee that the system wiff function satisfactorify. 4an T�Saayer, RSA Pu6fic Yfealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (constructed; ( )repaired; - by_ . W 6 -tw1 ko C ars S-re_o Cmc oxl located at ja 9A,,,q r 3 Qo g, j 40 h 0y arc was installed in conformance with the North Ando er Bo d of Health approved plan, System Design Permit# , plan dated /0 ��— , with a design flow Of / 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 Iocal regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: D� Engineer Representative hstaller: I ic.#:6 Z Date: v 9 l 0 'G Engineer: Date: S RECEIVED SEP - 9 7004 TOWN OF NORTH ANDOVER HEALTH DEPART' -.'.IT O � Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Monday, August 23, 2004 1:14 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 114 Marian Sue and Pam, Attached please find the inspection report for 114 Marian Drive. Construction was....well...ok. The designer or installer should have lowered the tank and pump chamber a bit to provide for more cover without having a bump in the rear yard as will now be necessary. The Infiltrator chambers were a bit low(approx. 2") but not enough to warrant re-digging them. Installer forgot to hydraulic cement a few pipes which he did while I was there. Installer did correctly identify that the breakout barrier was not needed for the entire-distance-shown-on the plan Lastly, please note thatthe installerused a different pump than was specified on the design plan. I asked the designer to check its suitability and make reference to it on the as-built plan. Whyman is lucky I had my survey rod with me because the one he had was virtually blank from having the paint rubbed off-it was illegible. I would have had to reschedule for another day with him (and been quite ticked off) had I not needed the rod for another job that day and already had it with me. Dan Mill Kiger consulting Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin2.com info@millriv_erconsulting.com 8/23/2004 0 0 ,r TOWN OF NORTH ANDOVER f NORTH 7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET *1 NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss4no. Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX ADDRESS: 114 Marian Rd MAP:107C LOT: 54 INSTALLER: John Whyman DESIGNER: Engineering & Survey Services PLAN DATE: 11/25/2003 Rev. 6/1/2004 BOH APPROVAL DATE ON PLAN: 6/2/2004 DATE OF BED BOTTOM INSPECTION:8/3/2004 DATE OF FINAL CONSTRUCTION INSPECTION: 8/19/2004 DATE OF FINAL GRADE INSPECTION: g136]6� SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = h10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = h10 TYPE OF SAS = infiltrator Trenches DIMENSIONS AND DETAILS OF SAS: 2x9 trenches (26' x 56.25') SITE CONDITIONS ®Existing septic tank properly abandoned ®Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Page 1 of 1 i 0 0 r' TOWN OF NORTH ANDOVER Ot NORTI Office of COMMUNITY DEVELOPMENT AND SERVICES ur b`tiP`tb yoo� HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone I Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Watertightness of tank has been achieved (Visual) ® Inlet tee installed, centered under access port Outlet tee effluent filter & as baffle installed ® g , centered under access port ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: 2-compartment tank, effluent filter installed on 1000 gallon compartment, outlet tee w/ baffle on 500 gallon compartment. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ® Inlet tee installed, centered under access port ❑ Pump model as specified on plan ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Water tightness of tank has been achieved Visual testing Z Hydraulic cement around inlet & outlet Comments: Pump model is Liberty, not Myers. Designer will review and provide information on as- built plan Page 2 of 2 o a TOWN OF NORTH ANDOVER f NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p t 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS Ol 845 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: Plastic d-box used, is on cement pad. SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 2- 9-unit rows, 10' between rows of Infiltrator chambers. Breakout barrier was reduced in size from design plan because breakout elevation was met along side of SAS. Barrier now on entire street side of SAS, +/- 30' along house side of SAS, and +/-5' along property line side of SAS. CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: BASEMENT ❑ Rated for exterior if placed outside Comments: Page 3 of 3 o Q TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 1- p HEALTH DEPARTMENT 27 CHARLES STREET *"� s••'. .r'+" NORTH ANDOVER,MASSACHUSETTS 01845 wCMUs Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX SYSTEM ELEVATIONS Benchmark: 80.00 Rod at Benchmark: 0.94 Height of Instrument: 80.94 INVERT ON DESIGN PLAN INVERT ELEVATION Building Sewer OUT 75.95 Septic Tank IN 75.75 76.96 Septic Tank OUT Pump Chamber IN Pump Chamber OUT 77.00 Distribution Box IN 77.27 77.27 Distribution Box OUT 77.10 77.11 /77.07 Lateral 1 INVERT 77.00 76.82 Chamber Top 77.46 77.04/77.24 Top of Sand 76,46 76.39 Lateral 2 INVERT 77.00 76.83 Comments: Page 4 of 4 I f APPLICATION FOR DISPOSAL WORKS CONSTRUCTION P&M'IT DEC 1 6 2003 DATE: 12 E/U3 CURRENT INSTALLER'S LICENSE# LOCATION: l LICENSEDSTALLER � `'1 s T2u ter► SIGNATURE: -__ TELEPHONE# 7e' CHECK ONE: REPAIR: V/ NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only y $ .00 Fee Attached? Yes No Foundation As r Floor plans on Approval__ Date: I V , J APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMITDEC 2003 • 1 DATE: CURRENT � l INSTALLERS LICENSE# LOCATION: 0 7 Mo-awkl LICENSEDSTALLER: ��+"1 �- s ►`4zv�T SIGNATURE: TELEPHONE# 7e 3 Z- CHECK ONE: REPAIR: V/ _ NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. OAdministrative Use Only $ .00 Fee Attached? Yes No Foundation As-built? Yes No FloorP lans on file? Yes No Approval_ Date: s 'Vy i 4' ? . 0 o �(or 1 6 2003 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL,SYSTEM- M INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( )constructed; ( ) repaired; by � _ �,�N Lf f4,4 d ljJ Cd �S ff d C-1 ►� located at f C_q M OJ ST was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated , with a design flow Of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: Lic.#: Date: Engineer: Date: j Id , �a PROJECT MANAGEMC.)i OBLIGATIONS IN J AAs the North Andover licensed installer for the construction of the septic system for the property at 1�'� �Sr. -r relative to the application ofA- *81-, dated 2t U" for plans by A and dated I ea p� 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, contracto project manger, or any other person not associated with my company schedules an inspectio 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 applicabl inspections as indicated below. I understand that requesting an inspection,. withou completion of the items in accordance with Tile 5 and the Board of Health Regulations ma: 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 don; first. Installff��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 of verbal OK from engineer must be submitted to Board of Health, after which installer. calls fol inspection time. Installer must be present for this inspection. With pump system allelectrical work must be ready.and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all gradiSg 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 required b m company to complete the installation of the system the work- re Y P Y P not perform q Y 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 , s stem and/or revocation or suspension of my license in the Town of North Andover plus system, 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. ro 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 r r components. 5. As the installer I understand that I am solely responsible far the nstallatiozi 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. Un rsigned Li s d Septic Installer Date: r 1/1 1. 13 Disposal Wor Construction Permit# I .. ............. ....... ................................ ....................... ..mF.�„�...,� Commonwealth of Massachusetts Map-Block-Lot 107.C-0054- i Board Of Health Permit No North Andover BHP-2004 491 FEE $250.00 I Disposal Works Construction Permit Permission is hereby granted Ton WhyTrlan __.......... ...... ............... to(Repair)an Individual Sewage Disposal System. i at No 114 MARIAN DRIVE _......----- -------------- .-------- as shown on the application for Disposal Works Construction Permit No. BUM004-049 Dated July 4 I Issued On:Jul-16-2004 Board Of Health ! - -- Jul 13 04 12: 00p NORTH ANDOVER 9786889542 - p. 2 n TOWN OF NORTH ANDOVER "pp'" pt Office of COMMUNITY DEVELOPMENT AND SERVICES F p HEALTH DEPARTMENT 27 CHARLES STREET `'• NORTH ANDOVER,MASSACHUSETTS 01845 �sswc�us6� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone 978.688.9542—FAX Public Health Director healthdoT)t@to,,vnofnortliandover.com WWW.Lownofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: b" Q LOCATION. LICENSED ENSED INSTALLER NAME: PLEASE PRINT SIGNATURE• TELEPHONE# 79 1 3(1` 4 CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR(indicate what parts): *NEW CONSTRUCTION: *I f NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $250.00 Fee Attached? Yes No Project Manager Obligation From Attached? Yes ✓ No Foundation As-Built? Yes No Floor Plans? Yes No � gent CSL Approval of Health A �- Date: � . . g Jul 13 04 ,12: 00p NOR RND�OVER 9786889542 p. 3 . o INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover li ense tnstaller f 4he construction of the septic system for the P at . relative to the application S dated 0 /S for plans b ,5 �' and of P P Y dated j� Z with revisions dated 03/.2,4 o I understand the following obligations for management of this project: I As the installer I am obligated to obtain all permits and Board of Health approved plans prior. 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 manger,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 1 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, tics, etc. ,As-built or verbal OK 1Tom 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 allgrading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required 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 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 Lobe 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.' G. As the installer I understand that 1 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. Un rs aned Licensed S is Installer Date: 7 Diso•al works onstruction Permit# Jul 13 04 12: 01p NORTH RNDOVER 9786888542 p. 4 � - Jou A� TOWN OF,NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Th"ndersigned hereby certify that the Sewage Disposal System( }constructed; (0 repaired; by tj r4.'t'tit.4 w1 �r.+r s�IZ.ckT70►J located at /1 l I//r` O l A 13 P I vC was.installed in conformance with the North dov r Board of Health approved plan, System Design Permit# ,plan dated v , with a design flow of WO 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 3I0 CMR 15.000,Title 5 and local regulations,.and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer: c. : Date: 1 0 I f Engineer: Date: . 0 114 MARIAN DRIVE JS-2003-0695 Proiect Detail Repot Printed On:Thu Aug 26,2004 Project Name: GIS#: 7820 Project No: JS-2003-0695 Owner of Record HONEYCUTT,MARK Map: 107.0 Date Submitted: May-13-2003 114 MARIAN DRIVE Block: 0054 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 114 MARIAN DRIVE Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision _ Description Septic System Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2003-0027 8/26/04-Thurs. Al Halfrey stopped by for Jon Whyman to drop off I copy of the As Built. Jon still needs to sign and date the certification form with his signature and correct date. Al had signed previous form,and dated as 7/16/04. NO COC UNTIL FINAL GRADE INSP DONE AND ALL PAPERWORK SUBMITTED. 8/17/04-Greg Saab stated ok for Final Insp. 8/17/04-Dan called to setup inspection. 8/2/04-Andy will call Jon Whyman and arrange for a BB inspection for Tuesday(S.Sawyer requested that Mill River do this inspection.) 7/16/04-Jon sent his assistant Al to fill out DWC forms. Pd.For DWC permit,gave copy of approved plan. I explained process of inspections before he left.--p.d. 7/13/04-Jon Whyman called asking if everything is approved. Thought he filled out forms. x✓ Called back and explained 3 step process:soils,plans,construction,and that application and `+ check submitted at the time of each job. He requested that forms be faxed:DWC;Cert form; obligations form. 6/2/04-H/O:Mark Honeycutt came in to sign the LUA form. 5/18/04-Susan Sawyer called Greg Saab--He did review fax. Will submit plans and ask owner to come down and sign LUA. 5/4/04-Septic Plan Revision 3 submitted. To Sue Sawyer for review. Engineer not charged for Revision 2&3--should they be? It is normally a$75 charge per revision after Rev. 1. Since this did not go to Dan,let me know. Tx--p.d.. 4/29/04-The groundwater offset is okay when pumped. It is still a LUA variance. Given 3 foot,allow the other modification. Greg will show tank. Susan will send out approval letter. GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 3 114 MARIAN D"VE JS-2003-0695 Proiect Detail Repot Printed On: Thu Aug 26,2004 Mr.Markey motions to approve a 3 foot variance as long as it is pumping to the D-box. Dr. Trowbridge seconded the motion. All were in favor.--p.d. 4/27/04-Left message at office for Clay Morin and Greg Saab re:meeting on 4/29/04.--p.d. 3/31/04-Septic Plan Revision 2 submitted. To Sue Sawyer for review. Per Susan,needs to go to the BOH meeting on 4/29/04 re:Groundwater reduction. 2/1.2/04-Received a call from John Whyman:781.334.2323. Requesting variance for Item 12 listed on the Plan Denial letter from Dan Ottenheimer,Septic Consultant,on 12/16/03. Mr. Whyman had sent a letter regarding this on 11/26/03 which is mentioned in Item 1.2. Ms. Sawyer,Health Director will review the file and let Mr.Whyman know whether his request will be granted or not,and what the next step will be with regard to Item 12. Mr.Whyman states that the engineer will be addressing all of the other items on the letter. 12/16/03-Plan Denied 1.2/16/03-Received packet of misc.Completed forms in mail-soil tests,dwc app.,install cert. ;project management obligations;Comm.Of Mass.DWC permit. Plan is currently in for review,not sure why these forms are being submitted. Soil testing was done back in May 2003. No checks were received with these forms. 11/26/03-Received septic plan submission. 7/8/03-Tues.-Soil Testing done on 7/7/03. File back in active files pending Design/DWC apps.--p.d. Tues.6/17/03-Received a call from John Curtin looking for status of application for Soil Testing. John faxed a contact list to me with current/former h/o names and phone numbers. Folder not in file drawer. Put copy of Project Detail Report and contact list sent by Mr.Curtin in Sandy's Soil Test inbox.--p.d. 6/2/03-Mon.-Conservation approval put with file and passed on to Sandy's Soil Test in-bin.-- p.d. 5/29/03:Received a faxed copy of test pit sites. Copy to Conservation for sign off. Original file in holding bin until response from Conservation.--p.d. 5/28/03: Spoke with Greg Saab,certified soil evaluator. He thought Jon Whyman was going to call re:test pit sites(Jon's name not anywhere on application). He will call John and tell him that we need test pit sites indicated. 5/13/03: Left msg.With engineer that we need indication of where the test pits will be. Hold until info.Received before sending to Conservation.--p.d. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0491 Jul-16-2004 SIGNED OFF JS-2003-0695 Plan Review BHP-2004-0367 NEEDS REVIEW JS-2003-0695 Rev.3 Plan Review BHP-2004-0336 DENIED JS-2003-0695 Rev.2 Plan Review BHP-2003-0389 DENIED JS-2003-0695 New Repair Soil Tests BHP-2003-0077 May-13-2003 Signed Off JS-2003-0695 Soil Testing-Repair GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 2 of 3 114 MARIANDRIVE JS-2003-0695 , Proiect Detail Repot Printed On: Thu Aug 26,2004 Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Inspection DWC-System Repair BHP-2004-0491 Aug-19-2004 SIGNED OFF Dan Ottenheimer JS-2003-0695 Bottom of Bed Inspection DWC-System Repair BHP-2004-0491 Aug-03-2004 SIGNED OFF Susan Sawyer JS-2003-0695 GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 3 of 3 0 TOWN OF NORTH ANDOVER sa Office of COMMUNITY DEVELOPMENT AND SERVICES aaa:'��eD �YOOG HEALTH DEPARTMENT p 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer- 978.688.9540—Phone Public Health Director 978.688.9542—FAX June 4,2004 Mark Honeycutt 114 Marian Drive North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 114 Marian Drive Map 107C Lot 54,North Andover, Massachusetts Dear Mr.Honeycutt, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property,submitted on your behalf by Engineering and Surveying Services dated October 25,2003 (Last Rev.June 1,2004). The design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for threeears from om the late of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations.In the event an imminent health problem such as sewage backup into the dwelling is.occurring,the time period for which this plan is valid may be reduced by the North Andover Board of Health. The application for a Local Upgrade was approved as requested,for a reduction in the separation between the soil absorption system and the high groundwater from the required four feet to three feet. With the granting of this reduction,the maximum number of bedrooms of this dwelling has been limited to three bedrooms. This restriction shall remain on the property until such time that the dwelling is connected to a municipal sanitary sewer system and the soil absorption system is properly abandoned. This approval is subject to the following conditions: 1. The'attached DEP Form 9b must be submitted to the appropriate Regional Office of the Department of Environmental Protection at One Winter Street,Boston MA by the property owner. 2. 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)). 3. 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. 4. As this system uses an infiltrator system,the installer must submit proof of certification to the BOH prior to the issuance of a disposal works permit. �J Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. ISiffincmerelyer,REHS/RS Public Health Director cc: A4m mark FnvinParin� .�� file Commonwealth oassachusetts City/Town of Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer,use -7 , ��G se4 h only the tab key Name to move your M Z� cursor-do not Street Address use the return M key. A 2A"- c`/o r✓e / `� ! .S Cq/T'wn State Zip Code ISI 2. Owner Name and Address(if different from above): a,[.L ��o-�•��c cmc�� ' 0 Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: gpd 5. System Designer: Name ❑ PE ❑ RS Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction t5form9b•rev.5/02 Local Upgrade pg Approval* Page 1 of 2 Commonwealth o�lssachusetts City/Town of Local Upgrade Approval Form 9B B. Approval (continued) Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate min .finch li Depth to groundwater ❑ Relocation of water supply well (explain): List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: Approving Authority Print or Type Name and Title _ S'Wu Date i t5formgb•rev.5/02 local Upgrade Approval,Page 2 of 2 . 4 - l4assachusetts Department of Environmental Protection �-----:"-- i P Tc� �r©F tT6RTI�I,az Bureau of Resource Protection—Wastewater Management Program BOARD OF P�1:—, Form 9A - Application for Local U rade Approval ---- Required by 310 CMR 15.403(1) pg p vp 9 1 7- Required 9A is to be submitted to the Local Board of Health for the upgrade of a failed o'-noncohfdtming septic system with a design flow of less than 10,000 gpd,where full compliance, as defined in 310 CIVIR _j 5.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.417. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. . Facility Name and Address forms on the s computer,use ___ a CcJ 2 l r ►� — --- -- — -- ------only the tab key Name to move your M P-1 A,&3 Q J cursor-do not Street Address use the return nn key. �e�r�� A-rjA00 r MA, DIg�(S City State Zip Code 2. Owner Name and Address: 'SA ME Name Street Address ---- — City--- State -- -- ----- Zip Telephone Number 3. Type of Facility(check all that apply): residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Conventional ❑ Other describe below): 6. Type of soil absorption system (trenches,chambers, leach field, pits, etc): � •2ac� `F��1� t5form9a•rev.5/02 Application for Local upgrade Approval*Page 1 of 4 . i C) L71Massachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Management Program j Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: L4 4d Design flow of existing system: gpd Design flow of proposed upgraded system gpd LI40 Design flow of facility L4 N 0 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ❑ Voluntary ❑ Required by order, letter,etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: t o ov E� SpC3 L4-6 AJ S FPTtc TA-1,3 K W C))1, Lcsiy6- .s Ajr L-rQArve— TRt/vcHE-S . 3. Local Upgrade Approval is requested for: ❑ Reduction in setback(s)—describe reductions: Percolation rate for 30 to 60 min./inch: min.Anch ❑ Reduction in SAS area of up to 25%' SAS size,sq:ft. %reduction eduction in separation between the SAS and high groundwater: Separation reduction ft_ Percolation rate min.ln Depth to groundwater ❑ Relocation of water supply well (explain): t5fonn9a.rev.5/02 Application for Local Upgrade Approval*Page 2 of 4 r 17LMassachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A — Application for Local Upgrade Approval Required by 310 CMR 15.403(1) ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation,an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Gr eel" -7/7/6 3 Evaluator's Name(type or print) SignatureV Date of evaluation C. Explanation Explain why full compliance,as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance pwith 310 CMR 15.000 is not feasible: n� aa 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: C sk e S 3. A shared system is not feasible: A 4. Connection to a public sewer is not feasible: "A t5fonn9a•rev.5/02 Application for Local Upgrade Approval*Page 3 of 4 i Massachusetts Department of Environmental Protection, P � d j LLIBureau of Resource Protection —Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) 5. The Application for Local Upgrade Approval must be accompanied by all of the following(check the appropriate boxes): M Application for Disposal System Construction Permit a/complete plans and specifications ite evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR.15.405(2). ❑ Other(List): D. Certification "I,the facility owner,certify under penalty of law that this document and all attachments,to the best of my knowledge and belief,are true,accurate,and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberat violations." acili ers9—gnat�re Date , sof Print Name - 12 - p y Name of Preparer Date Preparers address City/Town H o 'i-76-ss6, -a,?-gy State/ZIP Telephone NOTE: 310 CMR 15.403(4)requires the system owner to provide a copy of the local upgrade approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction. t5form9a•rev.5/02 Application for Local Upgrade Approval*Page 4 of 4 d Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, June 02, 2004 2:38 PM To: Sawyer, Susan Subject: 114 MARIAN DRIVE-ACTION REQUIRED Vlhope Importance: High Susan,You need to do a septic approval letter and stamp the plans before anyone can get a DWC pern Whyman did not go ahead and start doing anything without a permit....I will leave the file in your inbox. P 6/2/04 -H/O: Mark Honeycutt came in to sign the LUA form. 5/18/04-Susan Sawyer called Greg Saab— He did review fax. Will submit plans and ask owner to come down and sign LUA. 5/4/04-Septic Plan Revision 3 submitted. To Sue Sawyer for review. Engineer not charged for Revision 2&3— should they be? It is normally a$75 charge per revision after Rev. 1. Since this did not go to Dan, let me know. Tx—p.d.. 4/29/04-The groundwater offset is okay when pumped. It is still a LUA variance. Given 3 foot, allow the other modification. Greg will show tank. Susan will send out approval letter. Mr. Markey motions to approve a 3 foot variance as long as it is pumping to the D-box. Dr. Trowbridge seconded the motion. All were in favor. —p.d. 4/27/04-Left message at office for Clay Morin and Greg Saab re: meeting on 4/29/04.—p.d. 3/31/04-Septic Plan Revision 2 submitted. To Sue Sawyer for review. Per Susan, needs to go to the BOH meeting on 4/29/04 re: Groundwater reduction. 2/12/04-Received a call from John Whyman: 781.334.2323. Requesting variance for Item 12 listed on the Plan Denial letter from Dan Ottenheimer, Septic Consultant, on 12/16/03. Mr.Whyman had sent a letter regarding this on 11/26/03 which is mentioned in Item 12. Ms. Sawyer, Health Director will review the file and let Mr. Whyman know whether his request will be granted or not, and what the next step will be with regard to Item 12. Mr. Whyman states that the engineer will be addressing all of the other items on the letter. 12/16/03-Plan Denied 12/16/03-Received packet of misc. Completed forms in mail-soil tests, dwc app., install cert. ; project management obligations; Comm. Of Mass. DWC permit. Plan is currently in for review, not sure why these forms are being submitted. Soil testing was done back in May 2003. No checks were received with these forms. 11/26/03-Received septic plan submission. 7/8/03-Tues. -Soil Testing done on 7/7/03. File back in active files pending Design/DWC apps.—p.d. Tues. 6/17/03- Received a call from John Curtin looking for status of application for Soil Testing. John faxed a contact list to me with current/former h/o names and phone numbers. Folder not in file drawer. Put copy of Project Detail Report and contact list sent by Mr. Curtin in Sandy's Soil Test inbox.—p.d. 6/2/03-Mon. -Conservation approval put with file and passed on to Sandy's Soil Test in-bin.—p.d. 5/29/03: Received a faxed copy of test pit sites. Copy to Conservation for sign off. Original file in holding bin until response from Conservation.—p.d. 5/28/03: Spoke with Greg Saab, certified soil evaluator. He thought Jon Whyman was going to call re: test pit sites(Jon's name not anywhere on application). He will call John and tell him that we need test pit sites indicated. 5/13/03: Left msg. With engineer that we need indication of where the test pits will be. Hold until info. Received before sending to Conservation.—p.d. 6/2/2004 • North Andover Health Department • 27 Charles Street • North Andover,MA 01845 facsimile t wanitul To: Greg Saab Fax: 978 689-OR" ZVI From: Susan Sawyer Date: 5/11/2 Re: 114 Marian Drive Pages: 1 C CC: [Click here and type name] ' ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle rfor the property listed above has been reviewed and unfortunately, a tems need addressing before it can be approved. If you disagree with se comments please feel free to contact me. ing the pump—please indicate on the plan that the pump and alarm n separate circuits 2)There need to be buoyancy calculations for each of the tanks 3)Although you did submit the form 9A for the LUA, it is not signed by the owner of the property. Please let the owner know that they must sign the form prior to issuance of an installation permit is issued I 4) Please note on the plan that the installer must be certified by the manufacturer of the infiltrator system and show proof of the certification to the BOH. 5)The comment#17 in the Notes should be removecLdue to the revisions 6) Please identify who is responsible for making s thatall<o#h r applicable' permits such as; plumbing and electrical are obtained. Thanks, Susan . . . . . . . . . . . . . . . . . . . . . . . . . . . . i I Page 1 of 1 s DelleChiaie, Pamela From: Dan Ottenheimer[info@ millriverconsulting.com] 4' Sent: Tuesday, December 16,2003 11:25 AM To: Heidi Griffin; Brian LaGrasse; Pamela Dellechiaie Subject: 114 Marian Drive Heidi, Brian and Pam, Attached please find the plan review letter for the property at 114 Marian Drive. For a whole host of reasons we could not approve this plan (maybe starting with the correct street name on the plan would have been a good start for them - it is not "Sullivan Street" as they indicated on part of the plan). Stay warm, Dan Daniel Ottenhelmer, President Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultina.com info@millriverconsulting.com 12/16/2003 • .1 Yr ,. TOWN OF NORTH ANDOVER ®�KORrH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT rt 27 CHARLES STREET "' - •� NORTH ANDOVER_ MASSACHUSETTS 01845 3�SS tCHUS Key Heidi Griffin 978.688.9540—Phone Acting Health Director 978.688.95 Q December 16, 2003 Clayton Morin, P.E. Engineering& Surveying Services, Inc. 70 Bailey Court Haverhill, MA 01832 Re: 114 Marian Drive, Map 107C, Lot 54 Dear Mr. Morin: The proposed septic system design plans for the above site dated October 25, 2003 and received on November 26, 2003 have been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval: e1-? Please indicate the correct street name on the design plan. Please indicate the location and elevation of the foundation drain, if present. (NA 8.02) r Please provide a completed Massachusetts Department of Environmental Protection (DEP)Form 11 and 12 for the site evaluation performed by Greg Saab. 4. Please request a variance from North Andover Board of Health Regulations for the ti placement of the septic tank within 5' of the porch. �✓ o ( 5. Please specify the building sewer pipe diameter and that it is to be laid in a continuous grade. (3 10 CMR 15.222) 6. Please indicate the inlet and outlet tees of the septic tank are to be placed on the center line of the tank. (3 10 CMR 15.227 `Z: Please provide buoyancy calculations for the septic tank to determine if it will remain stable in the ground. (310 CMR 15.221) Please provide a minimum of 9" of cover over the septic tank. (3 10 CMR 15.228) Please specify the outlet pipes from the distribution box are to be laid level for the first 2'. (3 10 CMR 15.232) 1�0. Since the distribution box is proposed to be placed in fill material, please specify compaction of the soil beneath. (3 10 CMR 15.221) 11%Please specify that the distribution box is to be watertight. (3 10 CMR 15.221) 12. The design includes a Local Upgrade Approval request to reduce the separation from the bottom of the soil absorption system to the estimated seasonal high ground water from the required 4' to 3'. Several sections of Title 5 do not allow this request to be r granted including 310 CMR 15.401 and 404(1)which indicates that whenever feasible a design should maintain full compliance with the standards in the regulations. While the concern stated in the cover letter from J. Whyman Construction regarding pumping to the soil absorption system has legitimacy, it cannot displace the regulatory requirement to maintain full compliance with the code whenever feasible. Additionally, please note the requirement to include DEP form 9A with all requests for Local Upgrade Approval. 41. Please indicate the requirement for the final grade over the soil absorption system to be a minimum of 2% slope. (3 10 CMR 15.240) 14CSoil data indicates the most restrictive soil type found.was_a.—Sand Loam while the pe cr olation test was performed in the less restricts vc Loamy San Please contact the r` office to re-schedule the percolation test in the most restrictive soil horizon, or request a variance from the regulations. X15. Please indicate that removal of the A soil horizon shall extend at least 6" into the suitable soil of the B horizon. (NA 9.02) 16. Please depict the curb stop on the design plan to more accurately depict the likely water line location. This will help minimize construction or permitting problems which might arise during the construction phase. �c 17. Please consider placing the leach trenches parallel to the contour fine rather than perpendicular. (3 10 CMR 15.251) 18, Please explain why a pump chamber is specified on some parts of the design plan but not on other portions. 19. Please provide a swale to divert surface runoff where the toe of slope around the leach area is less than 5' from the property line. (3 10 CMR 25 5(2)) 20-�Please provide the construction detail for the system vent you are proposing which coincides with the operation of the Infiltrator-brand gravelless chambers. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely Z'' lni'a LaGrasse Health Inspector cc: Homeowner CD&S Dir. �e - .. ♦Wii y u. A' pt d �•+ a 7 V"4 t[ -41 Nil OL J was ZZ 9 � _ K� RGF � tt r - e tis► '-4"`-' Al ,� •„fir r ,,� - �.+,�,; � rr�: .. . ...,,w-R.a w�a- '�»+ ,� •,-....�•..,e._�• � 'i, �., f.�- ,'`' r �S "sir "`�:r,� ��+ t�; 0 .r� ♦ s �: "`, •�����Edi _�y�jc.1� sv 4y«{ �r �'` .. r ;y..,k . tg y� Y Nk 4X�f f P71 VAL- NIX so s t i s i ,�•r. �I s k I OF NORTH SEPTIC PLAN SUBMITTAL FOR ```&' ' u NoV 2 6 200; LOCATION: NEW PLANS: YES $225.00/Plan Check#: (Includes 1 sr Re-Review Only) REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES COY LOCAL UPGRADE FORM INCLUDED: YES X14) II DATE: t:! 12-6,103 , DATE TO CONSULTANT: DESIGN ENGINEER:&, Telephone#: v OFFICE USE ONLY When the submission is complete (including check): i 1. Date stamp plans 2. Complete the EER DESIGN APPROVAL FOR SOIL ABSORPTION I SEWAGE DISPOSAL SYSTEM form 3. Attach file and route to the Health Director for review i i ?ION N J.WNYMAN CONSTRUCTION 451.BROADWAY. LYNNFIELD MASS.01940 USA Phone 781-334-2323 Fax 781-334-4330 November 26,2003 MR.DAN OTTEN14EIMER ..:.�F WO N.ANDOVER B.O.H Tt�Z,r Q � t'e3 !I x.4'1 °!: I . 1. Fli, �a N.ANDOVER,MA. . NOV 2 6 2003 � Dear DAN, Please find copies of the above referenced septic design,dated oct.25 2003,along with a septic permit& -1 fee paid with all required extra forms for N.Andover B.O.H. . Per the home owners requMl wo ask fore variance from 4'to 3' from E.S.H.G.W..This is requested as there is public water lines to all area houses,no wetlands in the area,no nitrogen sensitive restrictions in the area,no water sheds in the area..This would also save the owner approx. 5500.00 for the cost of a pump chamber installation and another F of sand needed to meet m does create a mound' of the front and at 3' of setback but would be almost 4 of separation . The system g Y. P Y . unbearably.obscene at 4' separation .We trust you understand this redundant information and will take it into consideration upon your plan review. Should you have any questions,do not hesitate to call. Sincerely, Jon&. anyman i 0 0 • Town of North Andover HEALTH DEPARTMENT �.. �.--�—e -- cr ^���of NORTH Ar�����:�i� 27 Charles Street 1 BOARD OHEALTH North Andover, MA 01845 978.688.9540AR12C�r healthdeptCa),townofnorthandover.com w SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: 3 SITE LOCATION:_ Mt o!Ji ENGINEER: y NEW PLANS: YES $225.00/Plan Check#: (Includes]*NE"L"and one Re-Review Only) J /� REVISED PLANS: YES $ 75.00/Plan Check#: ,/ /s/ SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone#: ��� � �f` 4ax#: Ly��/ E-mail: HOMEOWNER NAME: OFFICE USE ONLY When the submission is complete(including check): 1. Date stamp plans and letter 2 Complete and attach Receipt 3. Copy File; Forward to Consultant 4. Enter on Log Sheet and Database Massachusetts Department of Environmental Protection I 1 y ��m�� Bureau of Resource Protection Wastewater Permitting Program Site Address or Map/Lot Number r w r1 Form 11 - So il Suitability Assessment for On-Site SewageDisposal A. Facility Information s , flc_`^�1RF HE L ,4 ~' 1. Facility Information 3oiNl Pain �u r fit s Owner Name 1� kMAR 3 t ?rq4 y � ��l A � Map/Lot Street Address �/ Q t��r+ ""'"'"" City State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade Repair ❑ 2. Published Soil Survey available? Yes ❑ If yes: I y .p Year Published Publication Scale Soil Map Unit t cc X +0 h Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map:. Above the 500 year flood boundary? Yes �dl No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No [[]� Within a Velocity Zone? Yes ❑ No ['r O 5. Wetland Area: National Wetland Inventory Map A11,4 Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS) �Ia D03 Range: Above Normal ❑ Normal ❑ Below Normal Month/Year 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 1 of 7 Massachusetts Department of Environmental Protection /%L/ AMR 1AA1 ' Bureau of Resource Protection —Wastewater Permitting Program Site addressor Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole A: -7/116-3 o6 ��� 5-1? Date Time Weather 1. Deep Observation Hole Logs Deep Hole Number 1- Ground Elevation at Surface of Hole Location (Identify on Plan) 5 14 2. Land Use: w rs /l/C (e.g.woodland,agricultural field,vacant lot,etc.) pp Surface Stones / Slope(%) � ��S S �l'u.+1 l°�''`o\ 5 �'•eP`cam Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body a23C7 Drainage Way Zit Possible Wet Area 260fi feet feet feet Property Line Li v Drinking Water Well Zov-F- Other feet feet 4. Parent Material: Sa Unsuitable Materials Present: Yes ❑ No E If Yes: Disturbed Soil❑ Fill Materia[E] Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ O 5. Groundwater Observed: Yes LJ No ❑ If Yes: Depth Weeping from Pit �a Depth Standing Water in Hole Estimated Depth to High Groundwater: inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Permitting Program site address or Map/Lot Number r1 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F Deep Observation Hole A: Deep Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles O &Stones l6'` P 16YI 3f�t 1-S I- K � D,SY7/4 VFsL_ rad'` 2,s`( 6/ err• ►� Additional Notes 2 Cef'' ,P e'r-L DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 3 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number t1 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole B: •7 d3 to"oo 7�0 Date Time Weather 1. Deep Observation Hole Logs Deep Hole Number P_ Ground Elevation at Surface of Hole Location(Identify on Plan) S-e 2 P ka' 2. Land Use: `-.5 \` "`S 7Vo c> •-j�� (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(°k) �ra SS Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body '-7a0t Drainage Way 260 t Possible Wet Area Zrz�r feet feet feet Property Line Sv Drinking Water Well ZoOy` Other feet feet 4. Parent Material: Unsuitable Materials Present: Yes [E No❑ If Yes: Disturbed Soil❑ Fill Material[21""Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock[:] 5. Groundwater Observed: Yes Z/No ❑ If Yes: Depth Weeping from Pit �r� r Depth Standing Water in Hole /D6 Estimated Depth to High Groundwater: `�o r '7 3 ,8'6 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 4 of 7 Massachusetts Department of Environmental Protection ! I C-( /�-J R2 1 A N u Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number �1 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole B: Deep Hole Number: Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other (In) Layer (Munsell) (USDA) _ (Moist) Depth Color Percent Gravel Cobbles &Stones 5- r`4l t o05� ins C .sf 5/l� 40 -7,t;-f-e_s/8 G�s� Additional Notes L n o I e 1 u •T� LpaSF_ 5<:>j/ DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 5 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Permitting Program Site address or Map/Lot Number rl 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 Ly- Depth to soil redoximorphic features (mottles) A. a 4-J B. inches inches ❑ Groundwater adjustment(USGS methodology) A. B. 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 curring 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: ZLI +o y0 Lower boundary: a0 inches inches F. Certification I certify that 1 have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the aboveLJ analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. -7/ 1©/6 3 Signature of So' valuator Date ::V71 6 3 Typed or Printed Name of Soil Evaluator *Date of Soil 5jaluator Exam s 14 ti N05yE71 Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for Ori-Site Sewage Disposal* Page 6 of 7 • r w Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot number �1 Form 11 '- Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet for field diagrams: . �4TF2 � ss 7V I � , r +' DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 7 of 7 NUY-11-00 01 :08 PM ESS 508890839 P.02 F4R",t is - PERCOLATION location Adcrass or lot Nc, �`'1 A- i? r COW/1011A/4'.:.ALTHI of IVIASSACHIU 45 lij Massacfiuse~<5 BOP I,.i Or IEP,d-4 ,. MAR 9 1 i Percolazion Fest' Date: -a 3 i me .. . .� 0 3S • Qbserraticr. Y Ocie,.," I CerL`� of ;e:c I Start Fre-soak I i0; 35 _ I End Pre-soak I Sd E Time at 12" 10 ,1 SD Time at 9' �M Time at 6' • .� ,_ 1 1 b®� . Time R= Min-ltnc - srtanum aLtpercdlaticn reesery Last mue,be performed in beth the primary arca ANO e area -' - i Site Passed �ite Filed ❑ Perfcr„led Ey: Sn� Wltne=ed Ey: S A AJ 2 A- Comments: .._..wc,-, �rk -- a",..FTAov=row,•::o��l �f `1 ` Town of North Andover, Massachusetts Form No. 1 ;oRr� BOARD OF HEALTH Y:l E D /6�'Y /47 0 it '` °R °=2•� APPLICATION FOR SITE TESTING/INSPECTION ADp4TED PPa`�y �9SSACHUSE� Applicant �/"'witL`5 �L'r� NAME ADDRESS TELEPHONE Site Location Engineer NAME `� ADDRESS TELEPHONE Test Inspection Date and Time / _ `�l/�,lL • � 1 ,E�H`AIRMAN, BOARD OF HEALTH„ L Fee ? 't' Test No. 'Ile S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. May p 03 Y12:.27p HOttTCpMDOVER 97868U42 p. e BOARD OF-HEALTA' NORTH ANDD ?'ER -MASS. 01845 -� �. APPLICATION F6kSOIL TESTS DATE: MAP&PARCEL I� 1 I®1 C 210 03! Y LO:CATION`OF SOIL TESTS I l OVNIVER: o�r. C tv s 'M NO.: ADDRESS; ENGINETrR. c 0r�v TEL:NO , 0 :!U 35, CERTIFIED SOIL EVALUATOR. , A,k Intended use of land: Residential Sti division S le hanuly Home _Commercial Is This l t testin v 0 Und e- elo g 12epair testing � � / In the Lake Cochichewick Watersfi'eih Yes No, TA,E FOLLOWING 11�UST]B INCLUD WITIi<'THIS>tURM 1; Proofof land owaetsluli(Tax bill,deed,or letEer.from owner perauwng thsts)' 2. _Plot plan ✓" °3,' 3: Fee of; 4 S. 'per Wt..for ft&,cbnstruC C.on This covers the minimum two deep hales•and two percolation tests✓ required for a°ach disposal area-:Fee of.$2IXJ.t50 per Pupr�aics or uneratles: ' GENERAL INFORMATION z_ 1 .,'Only Ceitified Soil Evaluatass may pet oim deep hole inspections ✓ 2•. Only Mass Registered Sanitarians and Professional Engineers can design septic plans v least>two�deep holes,and two'percolation tests are required fo`r each septic system disposal area ✓ 4.. 'Repanrs regmre at least,two deep holes and at least one Percolation test,at the di cretion:,of the.BOH"representat ve o. 5.. Full paj!ment wilt b'e iequued for alt sild►ttonal tests antlpn two v+eeks of testing. - 6,. Within 45 da ''of tes�n'g,,a,scaled plan"(nb smaller than I" 100)shall be submitted to the Board of Health showing tthe ys,. locaticin bf all tests(including aborted tests) �. :Witliin 60.daysaf testing soil evaIuatiori forms shall be.submitted Pletise.D'o NoE Writ Be Thisdine N.A.Conservation Cahmission Approval 1 6 Date Received Check Amount ® Cheek bate _ _ MAY 3 0T0 U9/UU/U3 ''i'UtS 13:18 FAX 9788858$ PCFAX INUU3 226 R Y - �"tiar.... �NttldYrl Ql�t!6�t•a14f3 �i t •_ Wo;lwy W. t►o1�my 1 A.Ftp, and tgltat ' 61 WidpmW Now tarwwaft OW h,(d of atghvX-w tohwmmd aftd mad 00!100 s it N, r 6atead Bad Halo.so feast r; Vit• �ItfAtlO. f0�1A� ffi� one ,Loth of 114 A +�Oft lladoa�r CAGY ai15.tog 1'bo'1l ti+6 autldlt�ttuste0a.1*mad a►1 ot".Now Anawr, } � as>Eallsrr6i , � • hi4de..bo►a�dad aad.dramdba0 � _ 1 ,"!t; 511 t!►6 6ai ttne.of d[ett6h Dsswe ani hwedrod Ift f1 f6et, Y �t / ; S �+•, iipiti#01LYL by lot 4.as 0 Ctl t!pLrtt outow.00 and 0 /100(296A nm f >sto t: by xetw naot and MOM a.now of ? :: atm►[ttia?fleas: :4`, gsc: M►tAs 6, on d a► 'aid 0/I00 t (x60. [ -s= aa6ord�ttT to 6atd plan.440510*F 40 +goer or 16864 Tim ostd yds eaa ohoaA a$ got on a Non aseud Oviltelt} Aom,• + .filed Awe as, Isss, �Rom " MaOo.,draw by b*S"�Aoaado8a6«" 0 r®oa�64:. Cx Dome plea ti4. S91C�. �xnt:tta0totgl I aro amnm* naa6ib the"M of Kalb M"or On aaaurnon.a>rA aU ofts"leanttt► feta p vff"6a are eoawrad 0iblaot Qa ar►aaeodoant da the t Mir.'get. A Tal.tW dated cot.44, 3166.'roao MtL d m so*'1071•hip,1g; snbl6ai �p an i t oonc to as X116. cm. -17. t$�6,raG�Qidod in . 3076.pb0e 14. 400�mtaea aonvag+ad sa us Y►1►d"d of Pm'd t►.MONOM A"Ma s,. i�i,al�t6au6 also luwo as"moa 8. �dated t"274 490-w in th6 Boom#.Na Dtairw,Roomw of Daod�►W&1911. �311..: M A .w. a stood ap d em1� rr,. .,_ .......�...�.r.-.. � SfAn or ►T� I ;etraA16 __" t 8a$�►f�a' 10, 1879 . aett� law W. pakow quad NOW A. Ao%=V t.• bow 1616 0& ud k � tfq .+y l°.}j• ;7• ._ ». , Sir' �LS'�'r.'� u �':t :'�Altr• :iy4` ... t4' � tl�iirl�ICeilltlllt>RSEr ��`-E'�� ����'C4 ' .;;. :ti41;�1•� '��' -` �„3,y�..'a+et�t,l0ex�ta-- t11�1ati3ti3ktRtltt � S,F�{fg��� ,. ��, `` aQa�3r3ad' t at 1,2e86M X10115 H Oap .��I974 �•. . . . j�• tip` 3 26 1�AX 9786858 x" PCRAX WArru1 05/48/03 ,UR 1 t ,•i ♦ ,.dAtiNt`�r�s ! :;•ty,b i ',u..:Y.+<,.�xu ,.`yy`'(.•: 0' 1"!uN Mfw rtD:ye :. L.rt�a;:,. s; ;4• ;i .. .•' ti`�t.. KS. ,R Y' �_y ajf'.�a.�a�.`_ ��t"t 't:•i��,i,f°-u.rr:.f Lt.+fr d �t� . w .Jai': •. ' `4 cm Ann ..t 2. J.. RV- AY or G ' NM: This fes-not a ommoyr Is t4 ba.nod't�ir }" w. 0Y• `,.. a A+ y 84th forIt am .' W i\V YOV iii .. sx^. for`the. Or4ction of fen�ee•, s r • - • �,�.:...;.. _ . .` I hereby cod. - .t . on �'Tq �O�' NO.. jlntlOVOr• - .•�. ,�' .t to -- at_{ ,�,.,.. ,t: f I 9ARCEL_ID:21011074-004- 008:0 MAP 107,0 BLOCK 0054 LOT 0000.0 PARCEL ADDRESS: 413 MARIAN DRIVE as a► �s oa PARCEL INFORMATION Use-Code: 101 Sale Pdce: 0 Hoots: 01393 Road Type: T i.#W,Date: 911211994 Tax Class: T Sale Dale: 11111979 Page- 0225 Rd Condition' P Maas 0410: Tot Fin Area: 22W Sale Type: CervD": Trawc: M FfItranae: tomer. CURTIN,JOHN PAUL Tot land Area: 1.02 Sale Vaud: N Water. Coliectid: MMC GrsntOr: -Sewer: inspect Reas: 4ddress: 114 MARCAN DRIVE Exismpt4/L°h 0 Resid 13tI.°!. i Comm 81L% I Indust-811.1/a l Open 3P4VL*A I NORTH ANNDOV£R MA 01846 RESIDENCE#1 II'+IFORMATICIN LAND INFORMATION Style: Cl.' Tat Rooms: 7. Main Fn Area: 616 Attic: NNOND CyOpeDE: ode Method 8 s0 CLASS:t Acres6inilu-Y1tV ONE, Class 310ry Height: 2 Bedroorns: 4 tip Fn Area: 1440 Simi Area: 1440 Seg Zoot a Full baths: 2 Add Fn Area. Fn Barret Area: 1 P . 101 $ 43560 Y 148.181 Ext Wall: WS Half"tw. Unlln Area.' 89nit Grade: 2 R 101 A 0.02 Y 50 dascnry Trim: Ext oath Fix: Tot fain Are®' Kvundatlon CN Bath Qual: T. RCNLO: 143191. 10tch Qual: T Elf Yr Built 1972 Mkt Ad)): 1.4 ieaL Type: hw Ext lcllch: Year Wit: 1957 Sound Value: fuel Type: Q Grade: A Cost Bldg: 157500 :palace: 1 %no Gar Gap: Ccnd"+tlon: A Alt Str VaIV DETACHED STRU=RE INFORMATION :erttral AC: N Bsrnt Gar$F: Prat Cornplete: Ati Ste V912: SW Unk Msr-I Msr-2 E-YR•8tt G ade Cond ° C-Wod PlFfr-iR Cast . Class Aft Gar SF: .624 %Good P/FIE/R: 1100/10(kf82 FQrek Anna ' Pie G d9 F04Wr E I80 WE'TCH VALUATION INFORMATION Current Tout W4(100 Bldg: 1576CO Land: . 146500 mlct itr 146500 Prior Tot: 278000 Sidg: 144500 Land: 134300 . Mkti nd: 134300 PHOTO is do 40 F111G FUfflriA 2 lsttlr tltlB 12 son 720 Ggl,Ft. E11 241go s F 14 M - • - .�� - '.xt' �: .s ..mss J� �� �r�� � �r3• i 12_ 1- 30 ' _ 6f'= '.'�'3:`i"� ;yS" �sn �'Zy,',�+•"fi+' ,'y+!.��'�a°� ^�eys5��� r�-.��_ . a ,Sp c O _ .fax f'kY"^y 'l0 2tiyp.��, May 29 03 05: 46a jon r),dman 7813330 P. 1 V5;'-n'/03r WO 10:15 FAX 9786851 PCFAX I A- It ANSW _4 1b OP ;OF 9m, C7 "MVP ;1K yz 3. NMZ-. This is not a survey and Is to be,Uged POOP" mortgage purposes only. N.B.- Do not we offsets for eft"115131mg-lot-IJ01W. for the erection of fences, we-lie, ho-A&S" etc. I hereby COrtlAF Vmt the - on this Property is located as&bW& an sm"MAT'd vViance, Was Pmud.-bw the Vw Town.-of No.- Andover. .4 aio ".4 MAY 2 9 201J BOARD OF HEALTH NORTH ANDOVER, MASS. 0184.5 978-688-9540 APPLICATION FOR SOIL TESTS DEC 16 2003 ` DATE: / 163 MAP&PARCEL: LOCATION OF SOIL TESTS: LlS // ea&/ SST OWNER: '4 T Cu 2—71 P q � TEL.NO.: ADDRESS:_ 114 M E.NGINEER: IAV a i2 tii TEL.NO.: -78-3S� CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Single Family Home Commercial Is This: Repair testing vzl�' Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No _ THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION .r 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. r 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). I. 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: V ` i Icti � ,— —I—_ _I f � i � —— --r__ �._.. -- _ _._ �. _ _ _ __ � ._ _ � 1 �_ 1 i — — - -�— — - .. ... � � I � .moo..�'"„� � � �....w. ..-.. �..__- ,1,4 1 ^� � •V �� s � � � � � � �� '��� L � , , J ---1 ,� r.._�' [_ � � i 1 `�/ 1 ' �- e a � � � � � � i �� - � � � ! . j '' , 1 t � � � �. .`4� ,,,� �; , —.— ---—. �—------ �`' x z-. -7 - 03 SOL i 1.0N i i .= r --- O- _r. - 11 =1, I I �Itii J'-._" I 1� - - Cr , , _ \ I i(vl OVE=•Ni Ni= i ' OFFICES OF: o °�, Town of 120 Main Street APPEALS NORTH ANDOVER North Andover, ° Massachusetts 01845 BUILDING ° er:•�•°r CONSERVATION s"°" DIVISION OF (61 7)685-4775 HFEAI-7H PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIREC"I-OR August 5 1987 . Building Ins,pecter re= 114 Marion Drive Proposed addition This property was inspected, on August 51987. The Septic System appeared to be functioning adequately and there is room for repairs. So this office has no objection to the addition as proposed over the garage. Sincerely ---- -----------_---- ---------- Sanitarian BoaXof Health C _ Hillside Acres 1 `� -� - Lot # 5 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot $ 5 Hillside Acres . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gal. in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 lineal MfNW ) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE // a - l Sig 2!�/ of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE //— a Signature of Health Agent I have inspected the uncovered system indicated above .and find everything done as described. DATE - f-InspectingsPecting Oy4icerSi�atur Percolation Test 8 min. Soil: Clay Garbage Grinder 0 BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. o A3 3 f Z i 0 (s GAL T�AIJ v sa .l- / 1. NAME DATE ��,1 2. ADDRESS LOT NO. S� TEL. 3. NO. OF BEDROOMS 7 DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL g. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE Nov. 26, 1966 NAME OF APPLICANT J • J• Segadelli, Inc. LOCATION Lot #5, Hillside Acres Address of lot no. BUILDING: Dwelling x Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay X GravelSand PERCOLATION TEST 8 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. � r illiam J. D i coll , Engin er Board of HealVh