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HomeMy WebLinkAboutMiscellaneous - 1278 Osgood Street (2) / 1,R 75 QSaoo f { 1 `1 Lot & Street 1A78 DvC,ccb `jT Map/Parcel 6Zi� CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Z&7 Plan Approval: Date: Approved by: 1 Designer:�� Plan Date: h - 4�0 Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Date Approved Bacteria I Date Approved Bacteria II Date Approved Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: ' r SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? NO Type of Construction: NE REPAIR New Construction: Certified Plot Plan Review S NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: NO DWC Permit Paid? ES NO DWC Permit#_ Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: AZ. By: Construction Inspection: Needed: As Built Pla Satisfactory: YES:__ Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: TMNN OF NORTH ANDOW!, SYSTEM PUMPING RE CORD NOV 2 6 2a t. DATE• sysTL,m wAI ER & ADDRESS- SYSTEM LOCATION (example: lee front of Ouse), dgt�ce �I 6 � , � o d i �t�r, "A +ri4T1r OF PI 11fPiNG.. ! -�� L,ANTI'1`�' I'l'1iI' -��� Gi�LLONS CESSPOOL; NO � XE5 SEPTI:C"I'ANK: NO /Yrs NATURE OF S. RVICE: RO[f'F1NP; v EMERGF-N�CY OBSERVATIONS: GOOD CONIyfTWIN FULL TO COVER HEAVY GREASE R kf'FI.1 S I�lt 'PLACE ROOTS LEACtME-LU RUN-BAC.'K. _ EXCESSA E SOLIDS FLOODED SOLIDS CARRYOVER +l7TUER (EXPLAIN) �LLJ121' INM !( � 0, Ir 7j/, COMMENTS: CONTLNTS TRANSFEIZTtEI) ,Q �. C� /\`� .�. •. V �� v- TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed; ( )repaired; by [2&Kprn cr— ) located at C 66�I2 `-2 ' —� , was installed in conformance with the North Andover Board of Health approved plan, System Design Permit# , dated ' with an approved 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: I r ''O?/ (�.0 Engineer Repre entative Installer: �r, r�, Lic.#:/of,-A Date: a y Design Engmccr: c.,v,.,7 Date: �'� UILDI f S ®TE: 'r4117Pi,^.►.s + et6ll F►GA-rTv" IS 00T � Ww-o �I�fr.l• tWJK A >S G a ►, ,�,`�►�TY 0f't+�r S�+QSu�F.�� o�L or Id _ 04,TKM , TT IS A eL&OW OG P4& La TVW PW T' �oHPoNak rti. I fie. 4 A' Ll IIgf I P l'J ELL dl i 'V AS BUILT PLAN ®F � SYS7E� SIjBSI�FACE. DISPOSAL LOCATED IN NoR-TH Ar' ►Dd\/�� 1 wl. , / 12-7 ��,loon "07 oFn�S ��Py S9c �1 AS PREPARED POR o`' � pANIEL cP L44,FBF adrs IZ-�i 4CORAV S a IA ull DATE: 12•Z�v�. �M �� a7 (,' f SCALE: Iis e '�1, 13 ��cissiNALti,��� MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET a ANDOVER. MASSACHUSETTS 01810 or TEL (617)473-3553. 373-5721 AS-BUILT CHECKLIST LOT NUMBER STREET NOME ASSESSORS MAP& PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS& DIMENSIONS OF SYSTEM, NA TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES& PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM 1� TOP OF FDN ELEVATION LOCATIONS OF WELLS,DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER,GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP&SIGNATURE QA z uo c6��r cry o NORTH ARROW `�^ LOCATION&ELEVATIONS OF BENCHMARK USED FAX: 978-475-1448 Bill Dufresne FORGETTA FARM — 1278 OSGOOD 1. Location, elevation and discharge spot of foundation drain. 2. Specify watertight joints. 3. Show 3" air space above tees/baffles in tank. 4. Connect all lines to vent. Think that's it. CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: Name of Designer: Plan Date: Z�� 6 Z Revision Date: Date of Review: Property Address: Z 7 A Map: Lot: BOH Reviewer: l Type of Plan(new or upgrade):_ Number of Bedrooms in Assessor's Records: gpd)Garbage Disposal Allowed: General Information: N.A. =North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility being served-220(4)(a) Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.02i L-' Name&address of record owner&applicant- NA 8.02k �-� Name&address of designer-NA 8.021 ✓ Holder and location of all easements-220(4)(b) Date plan drawn&any revision date- NA 8.02m 5/ All dwellings and buildings,existing and proposed-220(4)(c) t/ Location of all existing or proposed impervious areas-220(4)(d) ✓� All distances on site plan—NA 8.03a-c ✓ Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) Limits of excavation of leach area on site p an--N—A .02z Locus plan-220(4)(t) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) 1/ Existing grade elevation of each deep hole-220(4)(h) Elevation of percolation tests—N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) ✓' Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records ✓ Locatigns of waterlines, drains,and subsurface utilities-220(4)(m) Y Observed and adjusted g.w. elevation in the vicinity of the system-220(4)(n) Complete profile of the system to-seal=220(4)(o),NA 8.02c Cross section of leaching facility-NA 8.02w Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) _/ Original R.S./P.E. stamp, signature&date-220(1)&(2) 2 If P.E.,discipline specified within stamp. MGL C. 112 s. 81M 1/ sfc. supplies(w/in 400'),pub. wells(w/in 250'),pvt.wells(w/in 150')-220(4)( Location of watercourses,wetlands,wells,etc. Win 150'of system-NA 8.02r / Wetland disclaimer-NA 8.02s ! Land surveyor plan reference required(property line setbacks)-220(3) Plan contains designer's certification statement I - Use approvals/standards checked for UA system-DEP docs., Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&(13) --- Perc rate> 60 MPI-must use modifted tight tank or 11A technology-245(4) t✓ Proposed system qualifies as "shared" system-002(definitions) 1/ Flow is'over 2,000 gpd-No R.S. allowed-220(l) Design flow was set in accordance with code-203 ✓' Existing system location and note on proper abandonment-354 Leaching facility at least 1' above Base Flood elevation-NA 9.05 All piping Sch 40 minimum-NA 10.01 Basement floor minimum 1'above groundwater elevation-NA 5.04 _ Foundation drain present with elevation-NA 8.02y ! On-site Soil and Groundwater Review OK Problem N/A Proper deep observation hole logs on plan-220(4)(h) All deep holes and peres shown,including aborted tests-NA 8.02n Soil evaluation forms submitted within 60 days of field work-018(2) Proper percolation test log-220(4)(i) Ample deep observation holes in primary disposal area(minimum 2)- 102(2) Ample deep observation holes in secondary disposal area(minimum 2)- 102(2) ✓ Ample perc testing(one in each disposal area,3 in prim. >2,000 gpd)- 104(4) Deep hole testing conducted within two years-NA 7.05 Hole Identification Numbers: ground elevation el. 9 acceptable soil el. Leach facility invert el. 1 7. ground water el. l y Z,-] l / refusal el. 1 �. bottom of leach facility el. thickness of acceptable soil . before&after soil R&R separation to groundwater �_ .Z separation to refusal soil class �f perc rate 17—rM42 t 2 i 3 loading rate septic tank below g.w.table (yes or no) pump tank below g.w.table (yes or no) Lf in fill S -255(l) Setback Distances(Given in feet) 15.21 1 OK Problem N/A Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 Septic Tank Leach Facility Property line 10 10 V Cellar wall 10 20 Inground pool 10 20 Slab foundation 10 10 Deck,on footings,etc. 5 10 r Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 325 -� Reservoirs 400 400 Tributaries to reservoirs 200 200 j/ Drains(wat. supply/trib.) 50 100 Drains(intercept g.w.) 25 50 ✓" Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope w/o barrier 4 Building Sewer OK Problem N/A Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4"minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 / Watertight joints specified-222(3)&(4) Pipe laid on.compact,fin base-222(5) l/ Pipe laid on continuous grade in straight line-222(7)@ i/ Cleanouts precede all changes in alignment and grade-222(8) k/ Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignment change-222(8) Invert elevation at building: , , 3 1 Invert elevation at septic tank:1 y4T Length of run: Slope: (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK Problem N/A Tank is accessible-228(3) Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) �/. 2-3"drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 3"air space above tees/baffles(minimum)-227(4) " 9"air space above flow line(minimum)-227(4) Tees are not to be replaced by baffles-227(1) s� Tees extend 6"above flow line-227(1) Inlet tee extends 10"below flow line(minimum)-227(6) Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) (� Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compart) / 228(2) V/ 3-20" manholes-228(2) 1 childproof,24"riser/manhole to final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) Soil compaction below tank specified(if soil is non-native)-221(2) ✓ 6" of<=3/4"stone beneath tank specified-221(2)&22 8(1) _. If> 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. -223(t)(b) ✓/ If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(1)(c) Buoyancy calcs.required if tank at or below water table-221(8) ,/' Tank is watertight-221 (1) 9"of cover over tank(minimum)-2280) H- 10 loading(min.)-14-20 if traffic-226(3) L� Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 5 Tight Tank(Check here if not present: OK Problem N/A 500%of deisgn flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified(if soil non-native)—221(2) 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) Tank is watertight—221(1) 9" of cover over tank specified(minimum)—228(1) H-10 loading(min.)—H-20 if traffic—226(3) Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 AN alarm set at 3/5 tank capacity—260(2)(c) Min. 1-24"frame w/cover at finished grade—228(2)(f) i Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: OK Problem N/A Inlet elevation: Outlet elevation:Ll�7. 6- 0.17' - 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6"sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) - Outlet pipes laid level for first 2 ft. -232(3)(c) Pipe Sch 40-NA 10.01 Number of outlets: Number of laterals: Size of outlets: ! . Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6"of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36"below grade-221(7) Buoyancy calculations'required if box is at or below water table-221(8) Pump Chamber(Check here if not present: ) OK Problem N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) Minimum 2" delivery line to d-box if gravity-254(1)(c) Pressure dosed l.f if flow>=2,000 gpd-254(1)(a)&254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 24 hour storage capacity above pump on elevation-231(2) Number of pumps: 2 if system serves>2 dwelling units-231(6) 5 6 l ,+ Capacity of pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4"solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 Check valve, bleeder hole-NA 12.01 1 childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr. specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) Leaching Facility(general-complete for all designs) OK Problem N/A 50%larger if garbage disposal-240(4) Trenches to be used whenever possible-240(6) No vehicle access or imperv. area above 11 unless unavoidable-240(7) Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) .7— Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9"cover over peastone-240(9) ✓ Reserve area provided(new construction)-248(1) Reserve 4' from primary leach area–NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a)&(b) 4'(down to 2'with variance or I/A-upgrades only)of natural soil under 11 _ GW separation is adjusted to highest existing grade if facility cuts into a hillside ✓. Pipe slope minimum of 0.005-251(9) Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36"below grade-221(7) Final grade over l.f. minimum 0.02 ft/ft-240(10) Surface&subsurface drainage away from l.f. -240(1 1)&245(5) Minimum design flow 440 gpd without deed restriction–NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to–3:lslope-255(2) Impermeable barrier/retaining wall poured concrete–NA 9.02 �f. Retaining wall stamped by P.E. -255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(0 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) Perc test(s)done in most restrictive layer- 104(2) t/f- Perc test 4'below leaching elevation–NA 7.06 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC–NA 10.01 �. Leach pipes minimum 4"diameter except for dosed system–NA 14.04 Leach lines capped,vented,or connected together-251(9) Pressure dosing guidance followed if pressure distribution-254(2)(c), 7 Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) A Leaching Trenches(Check here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff. 2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth-251 (1)(d) In fill or reserve between trenches, 10' min. -NA 14.01& 14.03 Available leach area given(Min. 500 s.f.)-NA 9.01(2) Bottom=L x W x# = s.f. Sidewall=L x D x# x2= s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2"2x washed peastone.-247(2) Trench depth of 3/4"to 1 1/2"double washed stone-247(1) I Leaching Pits(Check here if not present: ) OK Problem N/A #ofpits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D k' Depth of pits(max eff. 2'): -253(1)(a) Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall = s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR =____g/day Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X16'—NA 9.01(3) Distribution for galleries/chmbrs. in trench config. -pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2"2x washed peastone.-247(2) 3/4"to 1 1/2"double washed stone-247(1) Each pit has at least one 20"access cover.24"CI to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents, if necessary, extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: OK Problem N/A Number of fields: _ (need dosing chamber if> 1, 231 (1)) Length(100'max.): -252(2)(b) Width: 7 8 t Total area:L x W J00 S.f. Minimum 900 square feet-NA 9.01(1) j Distribution lines connected with solid pipe—NA 15.01 Effective leach area given Loading factor: •`j I / Effective area=total area s.f x LTAR = g/dav f/ Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) '! 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) t/ 10'minimum separation between adjacent leach fields-252(2)(f) Between 6"and 12" of 3/4- 1 1/2" stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2"2x washed peastone.-247(2) 8/28/98 R 1 t?� - 1 . i . y'I , y 4 rt. ' \ S r N� C , .T k d, w s I , OC 7-10r1- 12-7�. 80; 'viv Sj ------------ �===SOL-.i LON i=�i .= •`. itvI E GF :0, .�: • O i .-�:VIL:: i Wil.':.^. TIME E 11 la-A 15 t � ;tvi= i 'A - Location: 1278 Owner's Name: F.,)"f: ri-x Map/Parcel•_ / Address:_ / o546gQp . r Installer. Tel New lsisol ✓ Repair Date: Wetlands>(�77.ane II Soil Svmbol_I&LrSoil lQame oil Class (:fl Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color Soil Mottling % Gravel,Stones,etc; • tl� 7.5' '(4 s/g 6yt4Jf1 v'e Parent Material -Te Ll. Depth to Bedrock_—" Standin;Water in the Hole: weepin,from Pit Face��HG�Y T 2• • 0-13 w lc 13 L r, Imo, 5 1'.O Y i.5/ V*rc ,f Parent Material tr_(_ Depth to BedmcL• '— Standin;Water in the Hole: +. �Yetpin;from Pit Face • FSFIGW: � Date_ Percolation Tests Observation Hole Depth of Perc w fi Start Pre-soak !v 2 I Time at 12" I I Time at 9" Time at 6" I I Time(911-6") I I Rate Min/Inch I Performed Bv• 1'7, IL�rIZfFJ Witnessed By; r..�` BOARD OF HEALTH NORTH ANDOVER, NIA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: /Q 7F— QSo j LICENSED INSTALLER: SIGNATURE:,&.,t� ,!!a ,n owe TELEPHONE# <-4-c/. CHECK ONE: REPAIR: NEW CONSTRUCTION: i IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 160.00 Fee Attached? Yes No Project Manager Ob. Yes No Foundation As-Built? Yes %� No Floor Plans? Yes No Approval 6- � Date: /� � INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at relative to the application of dated for plans by and dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the, system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: 3a Q Disposal Works Construction Permit# /F 7?' Town of North Andover, Massachusetts Form No.s MORTq BOARD OF HEALTH O�t•`•o�0,�0 � ZD�� O A o ,j�b,,,.p,;.•� DESIGN APPROVAL FOR ss"c"u5`t SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Test No. Site Location__ Reference Plans and Specs. e / � �'/° ��E5 llZi 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. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 7 Town of North Andover, Massachusetts Farm No.-3 NORTH BOARD OF HEALTH pL % DISPOSAL WORKS CONSTRUCTION PERMIT Sg^CHUSE Applicant ADDRESS TELEPHONE Site Location zU z Permission is hereby granted to Construct ( Or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. &ZZ L •- CHAIRMAN, BOARD OF HEALTH Fee %� D.W.C. No. /��� SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: $160.00/Plan CSG REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: S NO DATE: 10. 1 1 -V 7, DESIGN ENGINEER:-6 KV44 L1AC-6 !h]aIt-IIIX DATE TO CONSULTANT: AD- When the submission is all in place, route to the Health Secretary. WN NORT};ANDJ'v 4' / BOARD OF HEALTH OCT 16 2002 Town of North A'ndo'ver, Massachusetts Form No. 1 pORTH BOARD OF HEALTH 4LI25 3�Oy Ai�ED b'91.OL 7 APPLICATION FOR SITE TESTING/INSPECTION pDRATED PPP��y SSACHUSE Applicant 'i NAME ADDRESS TELEPHONE M Site Location 12 zSlofY� 7i Engineer NAME /ADDRESS TELEPHONE Test/I nspection Date and Time M �� Al� o CHAIRMAN',BOARD OF HEALTH Fee o/e) 2) Test No. 16446 } i S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH .�1aBOARD OF HEALTH I O�"IED ib4°6"YO OL JJ R .w° APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUs���h Applicant —'—' NAME ADDRESS TELEPHONE Site Location /"I Engineer--Z/ZZ NAME ADDRESS TELEPHONE Test/Inspection Date and Timefob d CHAIRMAN,BOARD OF HEALTH Fee `f'�� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 , Tt...-.E OF r��e 978-688-9540 BOARD OF f { APPLICATION FOR SOIL TESTS M DATE: fj' -5 a?i MAP &PARCEL: LOCATION OF SOIL TESTS: OWNER: A 12TOU Vf S--UAEL. NO.: ADDRESS: �� _��� 1 ENGINEER: �(�l?,1L1(�-� ,I� TEL. NO.: 4e2C_ CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision gl amity Ho Commercial Is This: Repair Testing: Undeveloped lot testing: 1 cTj I- In the Lake Cochichewick Watershed? Yes No V THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$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$200.00 per lot for repairs or gpgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"A 00') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: ��7/�o Check Amount: 41ZcQ Check Date: g JUN-17-2002 01 : 11 PM MARCHIONDA&ASSOCIATES 781 4SS 9654 P. 02 ►a-1 g ©690od s+- /, � EXIST. USE EASEMENT �-jvd 20' 4y � W PARCEL 82 C� 66,347 S.F. x 1,38 Ac. a ww 34.8' E (All 8 ,9' 37.5' w � F 47 2' -Y .y1 DANIEL & JOANNE a Qp. X06.2$'40 r FORGETTA � I CNJ o �y� PARCEL 83 N/FH iy 25000 S.F. A. FORGETTA ` $ ;� 0.57 Ac. 1N b Ma FAMILY TRUST a i eah��' Shy n � z STEPHEN M. 00 a MELESCIUC N EXIST. USE & ` No 39049 GRADING EASEMENT =01'29'24" 1 f�sr R-1960.00' STREt z 74.03' a (PUBLIC — VARIABLE WIDTH) N07'03 ODE (ROUTE 125) r N WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THE DWELLING IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY, IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E_M,A,/H.U,D, FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL NO.250098 0005 C SHOULD NOT BE USED FOR PROPERTY DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR,FLOOD HAZARD ZONE, CERTIFIED PLOT PLAN PARCEL B2 - "MARCHIONDA + ASSOC.,L.P. NORTH ANDOVER, MASSACHUSETTS ENGINEERING AND PLANNING CONSULTANTS DRAWN FOR 62 MONTVALE AVE. SUITE I FORGETTA DEVELOPMENT, LLC STONEHAM, MA. 02180 1049 TURNPIKE (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS 01845 DATE: 6/17/02 SCALE! 1"=90' FORM - U - LOT RELEASE FORM . INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards.and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .............................■............■..■.............................■ APPLICANT �� u d' o ✓ =' ! PHONE ASSESSORS MAP NUMBER y LOT NUMBER_ SUBDIVISION0 2.1 � /�� LOT NUMBER 13 -z- STREET STREET S ' STREET NUMBER OFFICIAL USE ONLY ........................................................................... RECOMMENDATIONS OF TOWN AGENTS (( DATE APPROVED 2 c6NsERVA-noN.ADMffftFkAT0R DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER - - DATE REJECTED COMMi:T]'I5 DATE APPROVED FOOD INSPECTO�R-BFA�LTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS Do SEPTic R PUBLIC WORKS-SEWER/WATER CONNECTIONS ms's r ZFD YP 4 Z, DATE APPROVED_ DATE REJECTED COIyiIviENTS RECEIVED BY BUILDING INSPECTOR DATE Commonwealth Of Massachusetts - City/Town Of NO" � System Pumping Record AUG 10 TOWN!? eM W AN Facility Information: System Location: Address 14 City/Town State Zi=v Code System Owner: f A�y C. I Adress (if different from location of pump) City/Town State Zip Code q7 &&,) - q 0 C/ Telephone Number Pumping Record Date of Pumping ?7 LL,,� / 0 Quantity Pumped_ �y gallons Type of System Septic Tank Grease Trap Other _{;what) System Pumped by: C h _�w Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843 Location where contents were disposed: L Signature of Hauler Date / � 7 �U