HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (73) �r
CHECKLIST FOR NORTH ANDOVER
SEPTIC SYSTEM PLANS
N&M Job 1770/ 59
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant: 10'74?eZ P /G t- Name of Designer:
Plan Date: /A n a .Z-Revision Date: Z- Date of Review: ® _
Property Address: i¢Z? 7` Map: /06 Lot:
BOH Reviewer: �/` /140 Type of Plan(new orpgra .
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)
i/ Names of abutters from recent tax map- NA 8.02j
Number of bedrooms,design.calcs.,-NA 8.02i
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
All dwellings and buildings,existing and proposed--220(4)(c)
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 plan-NA 8.02z
Locus plan-220(4)(t) (Not to scale)
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)
L____ Date(s)of soil testing-220(4)(h)&(i)
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
Locations of waterlines,drains,and subsurface utilities-220(4)(m)
SCC Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n)
Complete profile of the system to scale-220(4)(o),NA 8.02c
Cross section of leaching facility-NA 8.02w (Not to scale)
Location of benchmark(s)within 50-75 feet of facility-220(4)(q)
CN 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)
If P.E.,discipline specified within stamp. MGL C. 112 s. 81M
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
d Wetland disclaimer-NA 8.02s
RLS plan reference&certification required(prop line setbacks)-220(3)
Use approvals/standards checked for I/A system-DEP docs.,
2
Perc rate>30 MPI-not allowed for.new,LUA for u ade-
245(1)&('3)
P
e r c rate>60 MPI-must use modified tight tank or UA technology-245(4)
Proposed system qualifies as"shared" system-002(definitions)
Flow is over 2,000 gpd-No R.S.allowed-220(1)
.�' 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
f/ All piping Sch 40 minimum-NA 10.01
Basement floor minimum F 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.
acceptable soil el.
Leach facilitv invert el. J
ground water el. `s
refusal el.
bottom of leach facility el.
thickness of acceptable soil
before&after soil R&R
separation to groundwater a/
separation to refusal
soil classy
perc rate �%-
loading rate
septic tank below g.w.table (yes or no)
pump tank below g.w.table (yes or no)
I.f in fill 4/ -255(l)
Setback Distances(Given in feet) 15.21 1
YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02
OK Problem N/A
Septic Tank Leach Facility
,t"✓. Property line 10 10
v Cellar wall 10 20
2
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