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HomeMy WebLinkAboutMiscellaneous - 130 MARIAN DRIVE 4/30/2018 -� 130 MARIAN DRIVE 290/107.C-0053-0000.0 -- --- ` n ` . 1 North Andover Board of Assessors Public Access :, V Page 1 of 1 a t pORTI{ North Andover Board of Assesst]rs rofit�.e,eq.y0 - K i #i •oewo«.E:«... r• wr.o w ..� � j —ACHt roperty Record Card Parcel ID :210/107.C-0053-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Click on Photo to Enlar e i 130 MARIAN DRIVE I Location: 130 MARIAN DRIVE Owner Name: DENITTO,NICHOLAS J BARBARA M DENITTO Owner Address: 130 MARIAN DRIVE I City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6-6 Land Area: 1.30 acres , Use Code: 101-SNGL-FAM-RES Total Finished Area: 2448 sqft Total Value: 393,200 393,200 Building Value: 184,000 184,000 Land Value: 209,200 209,200 Market Land Value: 209,200 Chapter Land Value: Sale Price: 0 Sale Date: 01/01/1969 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 01134 Page: 0101 ;I http://csc-ma.us/PROPAPP/display.do?linkld=1896508&town=NandoverPubAcc 3/19/2012 i SUMMARY OF INVERTS BUILDING TIES r SEWER 0 FDTN. 97.58 BLDG. CORNER AB C D NOTE: THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.35 SEPTIC TANK OUT 1!1- 17.0 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 97.10 PUMP TANK - - - SYSTEM. 1T IS A RECORD OF THE LOCATION DIST. BOX IN 96.23 DIST. BOX - 35.7 60.7 AND ELEVATION OF THE EXISTING SYSTEM DIST, BOX OUT 96.07 COMPONENTS. INV. IN CRAM. 96.02 BOTT. CHAM. 95.72 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, 1F APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE I 477. Loo fi (56.550 S.F.) I pp 1000 CAL 45't i � Sg,a100 O -'D / LEA f f 1 rx 1aFT w OW/40 {q d�C 4 LK ft �nnroR CHAMO s lop �►. Pair 48.60 r. MARIAN - OF Moss�y o VLADIMIR L G z NEMCHIENOK S L � AS BUILT PLAN LOF RECEIVED SUBSURFACE DISPOSAL SYSTEM JUL ,3 2012 LOCATED IN 1 TOWN OF NORTH ANDOVER NORTH ANDOVER, MASS./130 MARIAN DRIVE HEALTH DEPARTMENT AS PREPARED FOR NICHOLAS DENITTO TM: 107C DATE: 7-10-12 TL: 53 SCALE: I"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 f UMMARY OF INVERTS BUILDING TIES ���-c ER CSD FDTN. 97.58 BLDG. CORNER A B C D fes* THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.35 SEPTIC TANK OUT 18.6 17.0 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 97.10 PUMP TANK - - - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.23 DIST. BOX — — 35.7 60.7 AND ELEVATION OF THE EXISTING SYSTEM DIST, BOX OUT 96.07 COMPONENTS. INV. IN CRAM. 96.02 BOTT. CRAM. 95.72 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, 1F APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. SIGNATURE OF DESIGNER DATE an. I LOT 6 (58.550 &F.) 52 �1 leo°GAL. u� N CLIiMC45' TANK * 9' r � ,a�• ,0 g I rt � ter n w%�a a L�. / Il�mu oR CHAMBERS ,w pw 48.67'\ �%A OF�9q MARIAN ��I,4 ssgc VLADoMM L yc Z NEMCHENOK m v L 00 AS BUILT PLAN AL OF RECEIVED SUBSURFACE DISPOSAL ,_,', SvlSTEm` r JUL 1.3 20Q LOCATED IN TOWN OF NORTH ANDOVER NORTH H A1V DO V ERp MASS./130 MAMAN DRIVE HEALTH DEPARTMENT AS PREPARED FOR NICHOLAS DENITTO TM: 107C DATE: 7-10-12 TL: 53 SCALE: 1"=40' 0 20 40 so MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING TIES SEWER ® FDTN. 97.58 �F T BLDG. CORNER A B C D HIS T PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.35 SEPTIC TANK OUT 18.f 17.0 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 97.10 PUMP TANK - - - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.23 DIST. BOX - - 35.7 60.7 AND ELEVATION OF THE EXISTING SYSTEM DIST, BOX OUT 96.07 COMPONENTS. INV. IN CRAM. 96.02 BOTT. CRAM. 95.72 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. 1�Gy/A - IGS 07/ zo/� SIGNATURE OF DESIGNER DATE 4n. LOLL (56.550 8.F.) oulme TAW 45'3 � � 01�0 .A,iso 0 D D f r r ra Jnr n wWouAac 4 LP. ewzrnerae auuiem 1w s �, �. PORT MARIAN o VtADIMM L G z NEMCHEK �► a L AS BUILT PLAN SAL�C��� RECEIVED OF SUBSURFACE DISPOSAL, -, SY STE JUL ' Ut LOCATED IN TOWN OP NORTH ANDOVER NOR'T'H ANDOVER, MASS./130 MARIAN DRIVE HEALTH DEPARTMENT AS PREPARED FOR NICHOLAS DENITTO TM: 107C _ DATE: 7-10-12 TL: 53 SCALE: I"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. 97.58 BLDG. CORNER A B C D NOTE** THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.35 SEPTIC TANK OUT 18.6 17.0 - - A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 97.10 PUMP TANK - - - - SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.23 DIST. BOX - - 35.7 60.7 AND ELEVATION OF THE EXISTING SYSTEM DIST, BOX OUT 96.07 COMPONENTS. INV. IN CRAM. 96.02 BOTT. CHAM. 95.72 "I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL; EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS-BUILT SUBSTANTIALLY AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. 07 �o/ SIGNATURE OF DESIGNER DATE n. LOT is (56.550 &F.) 1000 OAL TAW "`� `f s1'OR1•o t r' t� f rs �' '4 y LEA04 FM ` i N�0 QUIpC 4 LP. �iRAldt liAl�lS � `�,r ,o• 48.67' / OF MARIAN Lsq�yG NEMCHENOK �n o � V H A�o,��FgIS� AS BUILT PLAN SS�ONAL �` � OF - SUBSURFACE DISPOSAL SYSTEM _ JUL ' 1 3 M2 LOCATED IN TOWN OF NORTH ANDOVER NORTH ANDOVER, MASS./130 MARIAN DRIVE HEALTH DEPARTMENT AS PREPARED FOR NICHOLAS DENITTO TM: 107C DATE: 7-10-12 TL: 53 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 i � . . . f � r . � r +� \��`+ '. •- fs�q'fI:EDj PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Certificate of Compliance As of My 23, 2012 This is to cert that a SATISE-ACTORT EVS PEC2ION Was completed for the: Cow4to ft& ement air o f an On Site 7Nastezyater osaCSystem By: Todd Bateson at: 130 Warian Drive Parcel ID :210/107.C-0053-0000.0 North,Andover, wA 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the On Site Sewage Disposal System will function satisfactorily. i an 2r Sa er, S u6licYfealth 1ni ector r 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com t ooR7p Qe iS 610 ♦1�O �?b: �is', ♦ L 10- A i"s +If a� ��SSACHUS t PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER y h [ SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION TOWN OF NORTH ANDOVER HEALTH The undersigned hereby certify that the Sewage Disposal System( on cstructed;( )repair_ DEPARTMENT By: TOb17 fI�,"�EGio Lj (Print Name) ,, ll Located at: 117® PIC AA N 129d m (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated '— and last revised on "lr� �� ,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. Bottom of Bed Inspection Date: 7- 111 F2. Engineer Represen alive(Signature) And—Print Name Final Construction Inspection Date: Ie2. (!�2 Engineer Representative(Signature) raft)j?j And-Print Name Installer: (Signature) Date: '7— 1 And—Print Name Enginer: 1/G4bwa� WA1W&rk-- (Signature) Date: And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com DelleChiaie, Pamela From: Randy Burley [rburley@millriverconsulting.com] Sent: Monday, July 09, 2012 4:58 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: Emailing: Construction Inspection Form 7-9-12.doc Attachments: Construction Inspection Form 7-9-12.doc Please find attached the Construction Inspectionrm for 130 Marian. was installed per plan.There is no one living mi the house but there was about 4 inches of water in e aller said it was from a running toilet.This should of course be addressed. Sincerely, Randy Burley The message is ready to be sent with the following file or link attachments: Construction Inspection Form 7-9-12.doc Note:To protect against computer viruses,e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. i R I • SST-LEDy6a� r North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 130 Marian Dr MAP: 107 C LOT: 53 INSTALLER: Todd Bateson DESIGNER: Merrimack Eng PLAN DATE: 4-17-12 BOH APPROVAL DATE ON PLAN: 6-15-12 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION:7-6-12 DATE OF FINAL CONSTRUCTION INSPECTION: 7-9-12 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan N/A ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction JR Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port Of Outlet tee installed centered under access ort ® p effluent filter ❑ inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Tank only had a small amount of water it from running toilet. No one is living there at this time. DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers LP ® Number of chambers per row: 4 ® Number of rows (trenches): 10 Comments: Total Chambers = 40 SYSTEM ELEVATIONS AS-BLT INVERT DESIGN INVERT ELEV ELEV Building Sewer OUT 97.67 97.50 Septic Tank IN 97.43 97.30 Septic Tank OUT 97.18 97.05 Distribution Box IN 96.31 96.20 Distribution Box OUT 96.15 96.03 Lateral 1 INVERT 96.05 95.98 Lateral 2 INVERT 96.03 95.98 Lateral 3 INVERT 96.02 95.98 Lateral 4 INVERT 96.03 95.98 a DelleChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Friday, July 06, 2012 10:34 AM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 130 Marian Dr Bed-bottom Todd Bateson had to excavate more than expected because of an unknown stump pit and leaching pit. The dimensions of the bed-bottom matched that of the plan and it scaled properly off the house to being in the correct location.He thought he may be ready Monday for a final inspection,but will let you know; I will try and keep time free if it comes together. Sincerely, Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.miliriverconsultinp-.com rburleygmillriverconsulting_com r>Mill Rivlalr 11`17 < cons u lilt i ng CI'011 En rnitnrin # rntiironrnent+ad Pcrin;ttIng Municipal FOVIronrnrntal HV3111% cor1"1411ing Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 t AS-BUILT'"CHECKLIST � � ,1-1g11 11'y16 All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number,Street Name,Assessors Map and Parcel Number / Lot Lines and Location of Dwellings served by the system JUL 1 12012 ✓ Locations&Dimensions of system,including res (if applicable) TOVVNOF NORTH ANDOVER FIEAITH DEPARTMENT Ties to dwelling or Permanent Structure&Wells a.From Septic Tank b.From Leach Area Ties to Lot Lines from leach area Locations of Deep Holes&Peres / Elevations of Disposal System !/ Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 150 feet of system Location of water,gas,electric lines,cable F Distances from Corners of House to Center of Tank&D-Box Location of Structures within 6 Inches of Finished Grade t / Original Stamp&Signature —b'— Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc North Arrow V Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "I cert the locations, elevations, ties, cover material; exposed component covers etc. shown on this as-built substantially agree with the approved plan and have determined that the break out elevations, if applicable, have been met." Signature of Designer Date or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 5 . w I LEDJ Commonwealth of Massachusetts Map-Block-Lot BOARD OF HEALTH ParmC3 No I North Andover -BHP-2012-0679---------------- ------ P.I. FEE V44W F.I. $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-B-ateson --------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 130 MARIAN DRIVE �� " as shown on the application for Disposal Works Construction Permit No. BHP-2012-067Dated June 29,2012 --- --------------------------- ----- Issued On: Jun-29-2012 BOARD OF HEALTH i Application for Septic Disposal stem /01pp �oR1k nM N N TODAr ConstructionPrmitTOWN OF � 250.00—Full Repair -•�• •f'* ORTH ANDt.� ER, MA. 01845 $925.00-Component c►w9 • RE E`� � . . Important Application is here.b made fora permit to: When Ming out " (]Construct a new on-site sewage disposal system* forms on the ��� ` ��L s lace an existing on-site sewage disposal syst * computer,use [�')Zepair or rep S only the tab key TOWN OF NORTH k,•.:,4'•JV.E to move your ❑Repair or replace an existing system component—What? A cursor-do not use the return A. Facility Information key. 1.3 o ®r-<_ Address or Lot# nom, Citylrown 2.-*TYPE PTIC SYSTEN [a Pum ravity(choose one *'*If p ectrical permit to application*** ❑Conventional System(pipe and stone system) nfiltrator or Biodiffuser(gavel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Box Present)S.A.S-. 2. Owner Information A Name , Address(if different from above) f Lo Mot L'FrA4 5 Ckyrrown state Zip Code ocloq --'`l,3 TO Telephone Number 3. Installer Information B t-!SA-T-eS0stJ BATESON ENTERPRISES,INC. Name Name.of CompanyANDOVER , I1 Ary ��i'l�* ,MAolslo Address J A-4.4 dr 1/1.4 0/y/0 Cityfrown State Zip Code `�'`78' gA�S—a►`yo s Telephone Number(Cell Phone#if possible please) 4. Designer Information Name /� r Name of Company G�& s�1 Address Aid Citylrown State _ Zip Code Telephone Number(Best#to Reach) Appleatiors for Disposal System Construction Permit•Page) of 2 Y rOR7M1 Applicati•on..for Septic Disposal System �- 3TODAY'S DATE p Construction Permit ' TO'NT OF • * 0_ F' ORTH ANDOVER MA 01845 $.250.00 Full Repair ^CHUS :! $125.00-Component PAGE 2 OF 2 A. FacilitOnformation continued.... S. Type-of Building: m4esidential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been lssued_by this Board of Health. Name Date Application roved : (Board of Health Representative) 2 Nameon DiDate pplicatisapprov for the following reasons: For Off[ce Use Only: 1 Fee Attached. Yes c/ _ / No 2. ProjectMariaget Obligation Form Attached. Yesv No 3.: PumUS-8tem? Ifs q)Attach copy ofElectrical Permit`. Yes_ No 4. Foundation As Built?(new construction ronly). Yes No (Same scale as approved plan) A Floor Plans?(new construction only): No Appl do Wn for.0100sal Systerii Construction Permft%Page 2 of 2 SEP'T'IC SYSTEM.INST- ALI ER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system.for.the property at For plans by (Address of septic system) (Engineer) Relative to theapplication of f And dated 47 �— (installer's name) r gena ate Dated �-'' �' — With revisions dated o s ate (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am.obligated to obtain.all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved tilans and the permit on site when anv work is beim,g done. 2. As the installer,.I,miistcall.for any and altinspections. If homeowner,contractor,,project manager,or any other person not associated with my company schedules-an inspection and the system is not ready,then item three.shall•be.applicable. 3. As the installer,I'atn required to.have the necessary.work completed prix..to the applicable inspections as indicated below I understand that reIgg6ttng'an inspection,without completion:of the items in.accordance with Title 5 and the Board of Health Regulations tnay result in a$50 OO fine behik-levied aeamst me..and/or iny, eompany: , a,. Bottom of Bed Generally,this is the`first(1'�inspection unless.:there is a`retaining wall,which shotild•be done4rst. The'installer must:rp uest-lie inspection but sloes not have to be present. . b. Final Constructori.Inspeetioti—Engineerrnust firstties, etc. :do their inspection for elevations; As-built of verbal OK(or a-mail to.healtlideptO. ofnorthandover.com).from the engineer must be submitted to.the Board of Health,after which:installer.ca3ls for an inspection time. Installer must be present for this inspection. With a pump system;all electrical*orkmust be ready and able to cause.pump to work and alarm.to function.. c. .FindfQtade Installer must request inspection when,oll,grading is complete., .Installer does not have to be on=site. 4. As-the installer,'I understand that only I riiay perform the work('other than:rim,ple excavation)and I ani required to complete the installation of the system identified in the attached application;for.installation. -I further understand-that workdone byothers utilicensed-toinstall septic systems in North Andover can constitute reasons for denial of the system and/or�revocation or suspension of. lieenseao operate in.the Town.of North Andover significant fines to all 1iersons involved are also possible. 5.. ,As the.installer,I understand that:I musfbe onsite during the perfosrnance.of the following construction, steps: a. Determination that.the proper elevation of the exreawation has been reached b. Inspection ofthe sand and stone to be used. c. Final inspection by Board ofHealth staffor consultant. d. Installation..oftank,D-Box;pipes,stone, vent,pump chamber,retar.nhW waffand other components. 6. As the installer,I understand that I:atn sblely responsible for the installation of the.system as per the jpproved lilans No instructions by the homeowner,general.contractor,-or•my-.other.:persons shall absolve me of this obliZation. Undersigned Licensed Septic.Installer. day's Date) G —J 'r i a- ame,-Print) � � "4a TOWN OF NORTH ANDOVER a NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES ?�'��`�'°'•ao� HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 ��SSACOW t 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: .-2'7—)7.- 11AY Vag NII TOWN OF NORTH ANDMA Site Location: 117,70 UA rk3 W,I vE H Abd': WTME NT Engineer: New Plans? Yes $225/Pl n Check# 10 (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yes V No Local Upgrade Form Included?N-4 Yes No Telephone#: X70 Fax#-67q E-mail: l�iZ" L!�I' �f�+r�i d E+• N � Homeowner - Name: 00 LA-5 Q&p 6• Q OFFICE USE ONLY When the submi sion is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ tl Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ' A. Facility Information Owner Name I OW A rwkO 0 V ut 0-� eV Street Address Map/Lot# Mown4 kA V 119 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction /Upgrade ❑ Repair Bort P► ct I ;15s 2. Published Soil Survey Available? Yes ❑ No If yes: Year Pub fished Publication Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes �lo If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? M/Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No =o Within the 500-year flood boundary? E] Yes ❑ No Within a velocity zone? ❑ Yes E] No >Z q 0 M 5. Wetland Area: National Wetland Inventory Map Map Unit Name ©Z � Wetlands Conservancy Program Map D i ' Map Unit Name K Z 6. Current Water Resource Conditions (USGS): Month/0 Range: El Above Normal El Normal Below Normal M 7. Other references reviewed: Test Pit Form t5form1 l.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts Cityrrown of r� Form 11 Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: ' Z 1 ,00Awl 7LLO 4%0405 45"o Date Time Weather 1, Location Ground Elevation at Surface of Hole: Location (identify on plan): �fc RAO 2. Land Use F,0I PIC01A L (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform ! Position on Landscape(attach sheet) , 3. Distances from: Open Water Body fee't� Drainage Way >feed Possible Wet Area feet e Property Line fee feet Drinking Water Well Other feet 4. Parent Material: t ! �'� Unsuitable Materials Present: Yes ❑ No If Yes: ❑ Disturbed Soil Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Ob:;erved: _ E es ❑ No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 77 „ 'l'e inches elevation Test Pit Form t5form11.doc•rev. 1A 0 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) - Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Structure Consistence Other Depth Color Percent Gravel Cobbles& (Moist) Stones r) LL Additional Notes: Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ` C. On-Site Review (continued) Deep Observation Hole Number: VD AH 45U�Q, 6L0JP'> Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): Xc t 2. Land Use 011A L, (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) VegetationLandform Position on Landscape(attach sheet) 6 � p 3. Distances from: Open Water Bodyfee�� Drainage Way a Possible Wet Area feed Property Line feet Is Drinking Water Well feet Other feet 4. Parent Material: +t't o Unsuitable Materials Present: ❑ Yes R_<0 If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes SIO If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: ` �'z inches elevation Test Pit Form t5forml 1.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: '_ Z, Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Munsell Moist Layer Consistence Other y ( ) (USDA) Structure Cobbles& (Moist) Depth Color Percent ravel Stones o-ate" A 66Yw3A> sL 14k_ Additional Notes: Test Pit Form t5form1l.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of 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 ❑ D th weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A. -7 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 aPeast four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil 7Yes tion system? ❑ No b. If yes, at what depth was it observed? Upper boundary: 1 � ,5 Lower boundary: 10 ( !inches inches Test Pit Form t5forml 1.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ,rte F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator Date yH _ Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam ,2l& I� a.L HIL -�iva�n &III Ao~ems Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. Test Pit Form t5forml 1.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: Test Pit Form t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 r Commonwealth of Massachusetts ------ City/Town City/Town of r Percolation Test tit Form 12 TOWN 00 NI60H ANDOAM Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out forms on the computer,use C1� �j p�tJPFf t�J only the tab key Owner Name move your ��o c WAI_ , A ) 1?94V cursor-do not Street Address or Lot#f V use the return key. l6;if1' � City/Town State Zip Code Contact Person(if different from Owner) T e hone Numbe 0 B. Test Results 4-9-IZ Date Time Date Time Observation Hole# p Depth of Perc ��u Start Pre-Soak D I End Pre-Soak Time at 12" Time at 9" Time at 6" Time(9"-6") Rate(Min./Inch) 5 Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: W N , Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 TOWN OF NORTH ANDOVER of NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ' NORTH „�QASSACHUSETTS 01845 Ss,t„usE RECEIVED Susan Y.Sawyer,RENS,RS 978.688.9540-Phone Public Health Director ,f n 978.688.8476-FAX f 092 healthdept@townofnorthandover.com www.townofnorthandover.com TOWN p�'NORTH ANDOVER HEALTH DEPARTMENT APPLICATION FOR SO DATE: 'j/ MAP&PARCEL: LOCATION OF SOIL TESTS: r*1762 HA K-1 AK) 12 a-1y? OWNER: w6 Contact#: M70 Z-o4 —7 APPLICANT: �7�,i`-I�s Contact#: ADDRESS: I �© ENGINEER: ontact#: (1 70) `Z c+-7 77fle CERTIFIED SOIL EVALUATOR: j2w F"5M Intended Use of Land: Reside .1 Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH TRIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x Il"Plot plan&Location of Testing(please indicate test pit sites on the nlan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians Ad Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1”-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date. a Signature of Conservation Agent. Date back to Health Department: (stamp in): Y 1 a Q e �it r flo S'G W# to UBDIVISION CONTROL .,0 , ."KING BOAFD OF MAR IN IA UO �A L . F a. ._ 5 x + ! i I I E i -75.J v s/ � f s 1 , - , 4 ' 1 4 { 7 _ � I 9is� 9 _ I ) -T- - r � - - - -- _-- - ?, 1 - - - --- - -a� -z n� . 1 C 71),. �A:R1,4 North Andover Health Department (ommunity Development Division May 21, 2012 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 130 Marian Drive Man 107C Lot 53 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated April 17, 2012 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. A Local Upgrade Approval for only having one.test pit in the soil absorption system area must be requested or move the proposed SAS to incorporate both test pits, or dig a new test pit so two test pits are within the proposed SAS. (3 10 CMR 15.405(1)(k)). 2. An interpolated water-table will not be necessary when both test pits are shown within the SAS. 3. It appears that the bottom of the septic tank may be below the ESHWT. Please determine the ESHWT elevation in the proposed tank location and provide buoyancy calculations if required (3 10 CMR 15.221(8)). 4. Grading over the septic tank is unclear. The profile shows adding fill over the tank, but only scales to have 6"of cover;please clarify. 5. The note in the site plan calls for the Infiltrators to be"LP"but the detail call for standard;please clarify 6. Sheet 1 is said to be"l of 1", but there are two sheets,please change to "1 of 2". 7. A catch basin was noted on the soil notes from the witness. Please put the catch basin on the site plan and dimension to the proposed SAS Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 1 jti Tr 130 Marian Drive May 21, 2012 8. Please sign the soil evaluator note on sheet 2. 9. Note 15 states there are wetlands within 70' of the proposed system, but none are shown on the site plan; please remove or clarify. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincer y.� san Y. Sa er, REHS/ Public H th Director cc: File Nicholas Denitto, Homeowner Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 MERRIMACK ENGINEERING SERVICES, INC. ` PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET• ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL info@merrimackengineering.com May 30, 2012 Susan Sawyer Public Health Director 1600 Osgood Streets L Building 20, Suite 2-36 North Andover, MA 01845 T w�N 'R, i AN )OVrER RE: 130 Marian Drive HEALTH Cr-ir 1RTMENT Dear Ms. Sawyer, We are in receipt of your review letter for the above referenced site dated 5-21-12. We have revised the plans in response to items 1,2,4,5,6,7,8,& 9 of your letter. With regard to item 3,no testing has been completed in the area of the proposed tank to give the reviewer any reasonable assumption as to the water table is in that area. It was evidenced in the field that that area of the site was likely filled or raised to some extent when the house was originally constructed. Additionally,the existing tank is in the same location and has no history of floating and the new tank is being installed at a higher elevation so it is reasonable to assume that the proposed tank will not float. With regard to items 1 & 2,we are requesting an LUA for only one test hole. If the system was designed over both test pits, its would be oriented perpendicular to the slope rather than parallel to the slope(as recommended by Title 5)which would result in a far less practical and feasible design resulting in greater fill, a larger area of grading& construction and significant increased cost to the owner. Enclosed herewith is a completed copy of a Form 9A, Application for Local Upgrade Approval. We feel the plans as revised, meet the requirements of Title 5 and the North Andover Board of Health Regulations and respectfully request that they be approved as re- submitted. Yours truly, " William Dufresne MERRIMACK ENGINEERING SERVICES � L I � I • North Andover Health Department (ommunity Development Division June 15, 2012 Nicholas Denitto 130 Marian Drive North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 130 Marian Drive,North Andover, Massachusetts Map 107C Lot 53 Dear Mr. Denitto, 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 Merrimack Engineering Services, Inc. dated April 17, 2012, last revised on May 29, 2012 and received June 5, 2012. The design has been approved for use in the construction of a replacement onsite septic system for a 5- bedroom design. This plan is generally good for 3-years from the date of approval however as this is for a repair system this is reduced to 2- years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. The following local upgrades have been approved. 1. To allow the use of a single deep hole in the leaching area rather than the two required. This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records 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 Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 w 130 Marian Drive June 15, 2012 Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(l)). 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. 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. Sincerely, Susan Y. awyer, S/RS Public Health Director cc: Vladimir Nemchenok file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Commonwealth of Massachusetts City/Town of 4: o Local Upgrade Approval Form 913 i N SVO 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. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Nicholas Denitto key to move your Name cursor-do not 130 Marian Drive use the return key. Street Address North Andover MA 01845 „b Cityrrown State Zip Code � 2. Owner Name and Address (if different from above): �I Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): x Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir NemchenokName x PE ❑RS 66 Park St Andover MA 01810 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 130 Marian Drive Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts w City/Town of a o Local Upgrade Approval Form 9B 41y Sey`e B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater x Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer June 15, 2012 Print or Type Name and Title ignature Date 130 Marian Drive Local Upgrade Approval* Page 2 of 2 Commonwealth of Massachusetts City/Town of North Andover a p Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(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 15.415. 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 an on-site system constructed in accordan e wl ;ei e e78�C e or 310 CMR 15.000. .�. r Ems► A. Facility Information vt! W �� Important: When filling out 1. Facility Name and Address: 'rQ4VN OF NORTH ANDOVER forms on the tib g1,Tk1 DEPARTMENT computer,use Nicholas Denitto Residence only the tab key Name to move your 130 Marian Drive cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): SAME Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Unknown LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 �. Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Pro upgrade Proposed pg ade i s(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: Total Replacement(see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval Page 2 of 4 �. Commonwealth of Massachusetts City/Town of North Andover v a Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ 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)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature 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 with 310 CMR 15.000 is not feasible: NA 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover a a Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete plans and specifications ® Site 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 deliberate violations." 5-29-12 4Fi Owner's Signatu Date Nicholas Denitto Print Name Bill Dufresne/Merrimack Engineering 5-29-12 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 x-20 State/ZIP Code Telephone LUA FORM t5form9a.doc°rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(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 15.415. 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 an on-site system constructed in accordan 7Wei �1� 8ie or 310 CMR 15.000. A. Facility Information 1UN 6 ?U12 Important: When filling out 1. Facility Name and Address: TOWN OF NORTH ANDOVER forms on the l EALTH DEPARTMENT computer,use Nicholas Denitto Residence only the tab key Name to move your 130 Marian Drive cursor-do not use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): SAME 'QA1 Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ElCommercial F1School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): I Unknown LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 A � Commonwealth of Massachusetts Cityf town of North Andover J: a Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 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: Total Replacement(see plan) 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 J Commonwealth of Massachusetts City/Town of North Andover e Form 9A - Application for Local Upgrade Approval G M , DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ 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)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature 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 with 310 CMR 15.000 is not feasible: NA 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval wM s •r DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA I 4. Connection to a public sewer is not feasible: None Available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete plans and specifications ® Site 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 deliberate violations." IS9--r 5-29-12 FIG ity Owner's SignatDate Nicholas Denitto U17 Print Name Bill Dufresne/Merrimack Engineering 5-29-12 Name of Preparer Date 66 Park Street Andover Preparer's address Citylrown MA/01810 (978)475-3555 x-20 State/ZIP Code Telephone I I LUA FORM t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 3�' Hillside Acres J /1 J -Lot # 6 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hc'~reby make application for a permit for a sewage disposal installation at flet # 6 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 ga.l. 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 o: trenches, the bottom of which will pro- vide a minimum of 200 lineal (.AqQM*) 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 IIl s --o"Vo of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE P - 9- 2 -G 4 ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as descri DATE Signature Inspecting Of 'cer Percolation Test b � - Garbage Grinder 14) BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. y77 ` ,c 8 7 !►3. — RL.'-Ne— p ,10 z. 3 F7. ,-b 1. NAME '-u • DATE 2. ADDRESS �+'G�� AISS . LOT NO. G TEL. 3. NO. OF BEDROOMS 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 9. 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 ATov. 2d. g � NAME OF APPLICANT_ LOCATION_`LQt 6. -i lie t ores Address of lot no. BUILDING: Dwelling x Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND Nigh SUBSOIL: Clay_ GravelSand PERCOLATION TEST 8 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 -gallon capacity. LEACH FIELD 200 _—lineal feet of drain pipe. e William J. D i toll , Engin r Board of Heal