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Home My WebLink AboutMiscellaneous - 146 DEER MEADOW ROAD 4/30/2018 10/DEER MEADOW ROAD 210/104.B-0072-0000.0 P SUMMARY OF INVERTS BUILDING TIES SEWER 0 1=DTN. 97.33 BLDG. CORNER A B C D NOTE•• THIS PLAN & CERTIFICATION IS NOT �! SEPTIC TANK IN 97.20 SEPTIC TANK OUT 25.5 34.3 — — A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 96.97 DIST. BOX 35.5 31.5 — — SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.84 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 96.68 COMPONENTS. INV. IN CHAMBER 96..60 BOTT. CHAMBER 95.95 "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, IF APPLICABLE, HAVE BEEN MET." APPROVED DESIGNS PLANS. V,lAllgal Al;&W44�e_ 4730 491 SIGNATURE OF DESIGNER 6ATE 60.000 LOT (46,428 S.F.) M cp �1 00 4 1500 GAL. D-BOX LEACH FIELD I 4; W/55 INFILTRATOR f VENT CHAMBERS � INSPECiEON PORT j RECEIVED 40.� AUG 0 3 2015 f � TOWN OF NORTH ANDOVER ' HEALTH DEPARTMENT 110.00' DEER1i&"W ROAD ��'V oF,�gssq VLADIMIR L. �yG o NEAACHEIYOK L AS BUILT PLAN IVAI -" 0 OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./146 DEERMEADOW. ROAD AS PREPARED FOR ROBERT HARDING TM: 104B A DATE: 5-30-15 TL: 72 SCALE: 1"=40' 0 20 40 so H MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 w. • F I lE COPY >r PUBLIC HEALTH DEPARTMENT Town of North Andover Conununity Development Division CERTIFICATE OF COMPLIANCE As of: 8/6/2015 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Todd Bateson At: 146 Deer Meadow Road Map 104.B Lot 0072 orth Andover, MA 01845 The s ance of this certifi at ha be construed as a guarantee that the system will function satisfactorily. o ichele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com f � SwgT1:�D 7�2 • 'DECEIVED AUG 0 3 7015 TOH�A�TH DEPARTMENT F NORTH ANDOVER PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System instructed;( )repaired; By: -fOPV r1A�'0�Z�J (Print Name) � �I pp�� n ,� Located at: i p we�(/��G porj (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 'ZI'd 7 and last revised on -'�'�'—1 ,with a design flow of t�Q 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: Engineer Representative(Signature) DIw 9m�� And—Print Name �)Aj Final Construction Inspection Date: LA "I Engineer Representative(Signature) And—Print Name Installer: (Signature) Date: e And—Print Name Engineer: I//k/IMG Nkllckikk (Signature) Date: And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web h"p://www.townofnorthandover.com Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) All changes to the design plan have been reflected and noted on the as-built plan 2) V As-built plan has a suitable scale; 0 inch=40 feet or fewer for plot plans) 3) Street Address,Assessor's Map and Lot Number 7 4 Lot Lines and Location of Dwellings served by the system 4cations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) V Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: w1� Subsurface,interceptor&foundation drains i R Catch basins Property lines N (N Dwellings or other structures AV Private water supply or irrigation wells Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) J Location of water,gas,electric lines,cable,control panel (if applicable) 10) / cation of Structures within 6 Inches of Finished Grade 11) d Original Stamp&Signature 12) �' Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) _ZNorth Arrow 1� ✓ Location&Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "I 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,ifappl4cable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicat4nz the wall- was or was notconstructed 4n accordance with the intended des4Qn and any manufacturer's s�ecif4cations." Signature of Designer Date As of:Tuesday,N/ � S�gTv"En�Ysy� �c Q�R.4TED �' North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 146 Deer Meadow MAP: 104.13 LOT: 0072 INSTALLER: Todd Bateson DESIGNER: Vladimir Nemchenok PLAN DATE: 1/22/15 BOH APPROVAL DATE ON PLAN: 4/23/15 INSPECTIONS TANK INSPECTION: 5/27/15 DATE OF BED BOTTOM INSPECTION: 5/27/15 DATE OF FINAL CONSTRUCTION INSPECTION: 5/29/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan X Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK X Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port w ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 55x25 SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Low Profile Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 11 ® Number of rows (trenches): 5 Comments: Total Chambers = 55 u FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Ej// Certification of Installation Form submitted B engineer and signed and dated by ngineer and installer As-Built Plan BM = 100.00 HR = 4.75 HI = 104.75 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 7.06 97.34 97.5 Septic Tank IN 7.20 97.20 97.20 Septic Tank OUT 7.42 96.98 96.95 Distribution Box IN 7.54 96.86 96.83 Distribution Box OUT 7.71 96.69 96.66 Lateral 1 TOP 7.78 Lateral 1 INVERT 96.62 96.58 Lateral 2 TOP 7.78 Lateral 2 INVERT - 96.62 96.58 Lateral 3 TOP 7.79 Lateral 3 INVERT 96.61 96.58 Lateral 4 TOP 7.80 Lateral 4 INVERT 96.59 96.58 Lateral 5 TOP 7.78 Lateral 5 INVERT 96.62 96.58 Top of Chamber Bottom of Bed/Chamber 8.45 96.30 96.30 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Commonwealth of Massachusetts Map-Block-Lot 104.BO072 ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2015-0159 ----------------------- R.r�h'AdvFEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted BatesonEnt to(Construct)an Individual Sewage Disposal System. at No --14-6-DEERMEADOWROAD as shown on the application for Disposal Works Construction Permit No. BHP-2015-015 Dated May 05 2015 ---------------- Issued On:May-05-2015 ------------- 1 - ----- BOARD 0HEALTH ' 1 Application for Se0tic Disposal System ¢ TODAY'S DATE Construction Permit TOWN OF NORTH ANDOVER $250.00'–Full Repair, MA 01845 $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site'sewage disposal system* RECEIVED forms on the computer,use RAepair or replace an existing on-site sewage disposal'system* MAY 5 tory the tab key 0 Repair or replace an existing system component–What? 2015 to move your cursor-do not TOWN OF NORTH ANDOVER use the return A. Facility Information h HEALTH DEPARTMENT key. Address or Lot# an Cayirown 2:*TYPE OF SEPTIC SYSTEM*: ➢ ❑Pumpg[ cavity(choose one) * if pump system,attach copy of electrical permit to application— ➢ ❑Conventional System (pipe and stone system) ➢ �ehfiltratcr or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑Does the system require an effluent filter? Yes 1/ No If yes, does plan specify make and model of filter? YES (no further info.needed) NO=(installer must specify brand of blter before DWC r uance) WAatis the Mabe? that is the Modal 2. Owner Information *tame Address(if different from above) Cityrrown State Zip Code 7lr y90 Telephone Number 3. Installer Information `� �j --7e—,4,e a7fe so�/ =- 1 rt S aAl Name Name of Company /// ASG.11/14 Address V /tea Hca z.v`2sa- Cityrrown State Zip Code el 7 els=2-W,3 Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address �d City/Town State Zip Code g z�j—G 074 G -- Telephone Number(Best#to Reach) 0 Application for Disposal System Construction Permit•Page 1 of 2 MdRTM Ap-plicati-on,.for Septic Disposal :System TODAYS DATE A Construction -Permit ' TONT -OF -ORTH AN 'DOVER. MA 01845 $.250.06-Full Repair ' $125.00..Component �cNus . PAGE 2 OF 2 A. Facility.information continued.... 5. Type'of Buiidinq: Qffesidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provlslons of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system In operation until a CUOMO of Compliance has been Issued y this Board of Health. Name Date / A Ii a�fio, A prove B . (Bo% of H a h Represen Name Date J Application Disapproved.for the following reasons:" For Office Use Only 1 "FeeAttached.? Yes V/ No 2.- PtojectMartaget Obligation Form Attached. YiSV No� 3.: EM24vstem? h fEl 'c 1 P rmit V 4. Form 2bonAs Built,?(new c t No (Same scale as apptovedplan) 5. FloorPlans?(hew CoRsGtiollonlY)t Application for•p(spp5al.Syatbe.n onaroction Permn Page 2 of 2 MM MQ.NT As fhc-Nqrtx Andover.lic=,etl t t for die•td=tmcdQn ftp th6septic gstm'£at.theapre?pc ty at: (Adm of sepdc spec M) ph.by Rdad"to ths.appl of A"Alwo REM) Altd dated Dated With tevinom dated OUTS a ' • i'�`itRlSe�� .�... I nndentand the followlag obligations fat to gcmcnt ofibs project: i. As.the ins I-am ob%atad to obftm agpemuft andBoatd ofHesd&wed ph. to �etbarmieg any:WA as a site: I==ban agliffle and theadmioukden fimtwk Is hbw d= . ' Y. Aaflieiabt .L=riust Ib sad # p d a: IEhomeawne oaatract psajectmana arany o4herpacmo32 not mwwisated with my lftpm:�m snd the spstrta is not ready,then a�egt ct to bav�e ce atp wotk pita the.gppvcitbk wpearms as io tki Wow is S(=I lsinragtel, hielr d b Gat a t cdom dotbave to be pwtiii •- b. WOW Apm I 10 111 _ ttiafitep for eTevstti ,etc, Ilt o£�tdt OIC"(ore-mil fo; fmM the ewer taost be atib it ad its c-�otmd ofHew # €ar d iaspatipa pine.'Ipsmtkc must belxreseat<f) tl> .invecd* a P' F �'� ready able to pwzgp•t64ork m4dvlam i6 fi4ftm. . C. —$i t tier ments�eque�t tnp aahe i ll tt is ea spltte: iptIci docs Uot have to trete. 4. Astie inatslle;'I mad that perasm thetoflc' t6air �M)ind l anig*ed io clof4p*=lie tt Iatifta of tke •h ist#kti� edi i�atpdtatioa • t ' te�4f�s �.. g cyf tlxa• � ) r.: cads-�.mea� y ,��.,#e� r �•. th`e mat�Ilet: tlodezatattd t i edUft thO-p CC-Of th£&HM�q coasti[+�ehaA a: Derma t dfat.de PW-OJWe&Wdda ofsfir MCftRdO*hss'bCM reached l Zvpo&daa ofth4wd nerd's Cw he wed . a •Fiasl�asp�oabyAo�To!�ieslt�rartttconsul�rttt • . - _ .- - d la�tallatfon<of ty A ug pYp a,�taae, p P cl�nmbrr,n�w�D►aad other . axe a en- Underaprd Umud Sapt lc.IiW4= v IIS i i Infiltrator Chamber 1UA technology Certification I hereby certify that I have been given a copy of the Title 5 I/A technology approval letter, and the Owner's Manual for the above technology and I agree to comply with all terms and conditions. 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Mr,__,.. -w_ �0.4i..` q_G .:.ri._a.:�►.,, .�Yr_s, • �r «+r ,. rsr t � TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(c)townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: K Site Location: 14& pex$ Le�Om ki Engineer: t f-I r✓ 60611 o m"L4 New Plans? Yes $225/Plan Check-4 1/5�017 (includes Ist submission and one re- review only) Revised Plans?Yes $75/Plan Check# Fte 02015 �, Site Evaluation Forms Included? Yes No TOV,, / H' Local Upgrade Form Included? hA Yes No V Telephone#: 70 :a` ?�� Fax#C�2P�) E-mail: lkYt-� dt�F-1 L�iJ Homeowner Name: OFFICE USE ONLY When the submi ion is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ V Copy File; Forward to Consultant ➢ /Enter on Log Sheet and Database c Commonwealth of Massachusetts CityrFown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal r A. Facility Information Pveaa- Owner Name Street Address Map/Lot# ;ri City State— ZipC de c� c%;4 ' B. Site Information y1. (Check one) ❑ New Construction [Upgrade E:1Repair o= 2. Published Soil Survey Available? [�Yes El No If yes: �e P n n�'01 Publication Sscale soil Map Unit CALMO Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes [ No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 59,O;.year flood boundary? /Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): Month/Year Range: ElAbove Normal E<Normal E] Below Normal 7. Other references reviewed: Soil Evaluation Forms.doc•rev. 1/10 Form 11 –Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts -- City/Town of 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: Date ` T�e Weather2� 1. Location q�••••�� Ground Elevation at Surface of Hole: i �'� Location (identify on plan): 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) L&oi! & -TO-I! � Vegetation Landform Position on Landscape(attach sheet) �N 3. Distances from: Open Water Body fee Drainage Way feet Possible Wet Area feet Property Line DrinkingWater Well > {D:0 Other feet feet feet 4. Parent Material: t.V Unsuitable Materials Present: [eyes ❑ No If Yes: ❑ Disturbed Soilill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock LI Bedrock 5. Groundwater Observed: El Yes O NO If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: inches elevation Suil Evaluation Forms.doc•rev. 1/10 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: I 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 y (Munsell) Depth Color Percent ) Gravel Cobbles& (Moist) Stones 10 G 1 ®q 9-4/6 — — L 2- tit FKAAft4 Additional Notes: Sail Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts Cityrrown of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole: —: Location (identify on plan): 2. Land Use (e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) Vegetation Landform Position Lno Position a(attach sheet) 3. Distances from: Open Water Body feet Drainage Way feet Possible Wet Area feet> — Property Line feet Drinking Water Well Othfeeter. feet 1 4. Parent Material: t Unsuitable Materials Present: ❑ Yes ❑-No If Yes: ❑ Disturbed Soil 2reFill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock Bedrock ," 5. Groundwater Observed: ❑ Yes ENo If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: ' si orches elevation Soil Evaluation Forms.doc a rev. 1/10 Form 11 –Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of r 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.) Layer Moist Munsell (USDA) Structure Consistence Other y (Munsell) Depth Color Percent ) ravel Cobbles& (Moist) Stones �- h�� Additional Notes: Soil Evaluation Forms.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 Yt D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inchesinches �epth to soil redoximorphic features (mottles) A. I,p'e B. inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at le st four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil ;�Yes;6 nsystem? ❑ No "r ! �i'-z- - b. If yes, at what depth was it observed? Upper boundary: Lower boundary: inches inches Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 -C--\ Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal y` 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 Ig1w.44H VU 5--q Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam '(rL' 940 �j i A, 121 Loots ►x� fume 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. Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 GSM 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 to the 1'7,,,�,_r_T— ��' ` 6 computer, use �L.�,� I� only the tab key Owner Name to move your 141/ cursor-do not Street Address or Lot# use the return � �„�,., key. � City/Town fState Zip Code Contact Person(if different from Owner) Telephone Number ,ean B. Test Results Date � Time Date Time Observation Hole# T I Depth of Perc Start Pre-Soak ` 17 End Pre-Soak i 5;17 Time at 12" E Time at 9" 2 G Time at 6" Time(9"-6") Rate (Min./inch) Test Passed: [� Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Test Performed By: Witnesse y: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 w ( 3 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND URVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ArOVER,MASSACHUSETTS 018 5 !! —rt I N ANUdVEP I Susan Y.Sawyer,RENS,RS ;��(� 978.688.95Afl-.PhoneH pFp�,%ffJE` Public Health Director 97,8.688.84 _fix Egealthdeptna,townofnorthandover.com IUwNUrwww.townofnorthandover.com HSl APPLICATION FOR SOIL TESTS DATE: I Z-Z.?Z-14 MAP&PARCEL: I 0�f LOCATION OF SOIL TESTS:1 4(l I/�r�a- r"6 CA 120 W V- f0_ OWNER: Contact APPLICANT: G/<( }- Contact#: ADDRESS: ENGINEER: Contact#: CERTIFIED SOIL EVALUATOR: LV ��U F G�—aL� G rt L, 26-) '507,-67Z--00 Intended Use of Land: Residential Subdivision mg�me Family Home Commercial Is This: Repair Testing: ✓ Undeveloped Lot Tes Upgrade for A dition: In the Lake Cochichewick Watershed. Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testin-a(please indicate test pit sites on the plan) ➢ 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 and 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 Approv l .Date. S Signature of Conservation Agent: t Date back to Health Department: (stamp in). � J I 1` 1 111 ; 1 Y I i 1 A u� t � 1 1 , !jj E 7, i `C I I v ;�. E r _ v ! r R • - North Andover Health Department Community Development Division April 23, 2015 Robert Harding 146 Deermeadow Road North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 146 Deermeadow Road (Map 104B,Lot 72) Dear Mr. Harding: The proposed wastewater system design plan for the above site dated January 22, 2015 with a final revision date of March 4, 2014 received on April 17, 2015 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 5-bedroom(max 11-room)home utilizing an Infiltrator Chamber system. 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. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 146 Deadmeadow Road April 23, 2015 2. 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. 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. Sincerely, �, i Michele Grant Health Inspector Encl. Installers list cc: Vladimir Nemchenok File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, 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 April 10, 2015 Michelle Grant Health Inspector r '"i� 1 20 1 5 1600 Osgood Street T g 4V. Suite 2035 h; _ North Andover, MA 01845 RE: 146 Deer Meadow Road Dear Michelle, We are in receipt of your review letter dated 2-20-15 for the above referenced site. We have revised the plans with regard to items 2-7 of your letter. With regard to item 1 of your letter, assessors information is often inaccurate and may be used as a guide,but it is not the-required design criteria, it is ultimately the responsibility of the owner and designer to honestly and accurately disclose the existing number of rooms or bedrooms in a house. In this case,the owner disclosed that 2 rooms had been finished in the basement, and as a matter of normal course of action, I inspected the sewer pipe and basement and evidenced the rooms in the basement, as such,the design plan was prepared for a 10 room/ 5 bdrm. house which is consistent with past number of room interpretations by your office. With regard to the Assessors Office, it is not the responsibility of a septic system designer to petition the assessors office of any town to upgrade assessors information, it is our responsibility to honestly&accurately represent the number of rooms in a dwelling by whatever means possible,that has been done. This is not an attempt to expand a septic system unlawfully. Enclosed herewith please find 3 copies of the revised plans. We feel we have adequately addressed your concerns and comments and respectfully request the plans be approved for construction as the owner is needing to pump the septic tank on a regular basis and is anxious to proceed with construction as soon as possible. Yours truly, William Dufresne, Project Manager MERRIMACK ENGINEERING SERVICES E:1 North Andover Health Department (ommunity Development Division February 20, 2015 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Subsurface Sewage Disposal System Plan for 146 Deer Meadow Road Map 104B, Lot 72 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated January 22, 2015 and received on February 6, 2015 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. The Assessor's property record card indicates 8 total rooms with 4 bedrooms. The design plan is proposed for an existing dwelling with 5 bedrooms. If the Assessor's information is not accurate then please contact this Assessor's office to have the information updated to reflect the correct number of total rooms and bedrooms. Please submit documentation of any changes that are made by the Assessor's office. 2. On sheet 1 of 2, although the finish grade is equal to the existing grade, spot elevations should be shown above the leach field on the northern and southern sides to confirm a 0.02 ft/ft slope above the system(3 10 CMR 15.240(10)). 3. On sheet 1 of 2,the existing spot grade on the walkway at the southeast corner of the / leach field appears to be incorrect at 97.9. J4. On sheet 2 of 2,the manufacturer and model number are not indicated for the distribution box (NA 3.2). 5. On sheet 2 of 2,the existing grade elevation of T-1 (97.7) appears to be incorrect since the 98 contour is down gradient of the test pit. Page 1 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 r 6. On sheet 2 oft, a detail of a compost filter sock is provided but not indicated on the site plan on sheet 1 of 2. 7. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the"Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Plprovide the ppease following as required by the approval conditions Section 11Q7 : e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; Section II 1 c) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 5 IIA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 4. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, mods or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Page 2 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 ter . Please feel free to contact the office or Mill River Consulting at 978-282-0014 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. Sincerely, 1 Michele Grant Health Inspector cc: Robert Harding File Page 3 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Monday,January 26, 2015 3:34 PM To: Blackburn, Lisa; Grant, Michele Cc: Isaac Rowe Subject: RE: 146 Deer Meadow Rd. Attachments: 146 Deer Meadow Road - Soil testing results 1-15-15.PDF Lisa/Michele, Please replace the attached field book notes with the previous notes sent over for 146 Deermeadow Road.The times for the percolation test were incorrect.The correct times are now shown on the attached field book notes. Our brains must have been a little frozen that day! Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone:978-282-0014 ext.804 Fax: 978-282-1318 irowe@millriverconsulting.com www.milIriverconsulting.com -----Original Message----- From: Isaac Rowe [mailto:irowe@millriverconsuIting.com] Sent:Thursday,January 15, 2015 4:23 PM To: 'Blackburn, Lisa'; 'Pam Lally; 'Grant, Michele' Cc: Isaac Rowe Subject: RE: 146 Deer Meadow Rd. Lisa/Michele, Attached are the soil testing results for the above referenced property. Please let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone:978-282-0014 ext.804 i Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Friday, February 20, 2015 9:48 AM To: Blackburn, Lisa; 'Pam Lally' Cc: Grant, Michele;Isaac Rowe Subject: RE: 146 Deermeadow Attachments: 146 Deer Meadow Road - Disapproval Letter 2-20-15.docx Lisa/Michele, Attached is the disapproval letter for the above referenced property. Mostly minor edits except the number of bedrooms on the design plan did not match the Assessor's information (item#1). Please read through my comment and make sure you agree with my requirement. Also I added a note in the closing paragraph for the designer to contact MRC directly. Let me know if your office is comfortable with that option.We never talked about a procedure to handle the questions from designers after we disapprove the plan.As we know some designers have a number of questions so we would be more than happy to work directly with the designers on behalf of the Health Department. Let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: 978-282-0014 ext.804 Fax:978-282-1318 irowe cD-millriverconsulting.com www.millriverconsulting.com From: Blackburn, Lisa [mailto:LBlackburnCabtownofnorthandover.com] Sent: Friday, February 06, 2015 10:59 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 146 Deermeadow Good Morning, 1-I am mailing out plans and paperwork for 146 Deermeadow today. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 1 44 / r s 15 � n � � - t10Rr1/ Town of North Andover oEs,,•o ;•1tio Community Development and Services Division F A Office of the Health Department x 400 OSGOOD STREET +4,^AT•o North Andover,Massachusetts 01845 ,Ss,c„us�� Susan Y.Sawyer,REHS/RS (978)688-9540-Phone Public Health Director (978)688-8476-Fax Date: May 25,2005 Address: 146 Deer Meadow Road,North Andover,MA 01845 Re: Application for: John Wiese Dear: Mr.&Mrs.Harding Your application for refinishing the basement at 146 Deer Meadow Road has been reviewed by the Health Department. The application was denied on,May 25`h,2005 for the following reasons: 1. X Missing information 2. X Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: If#3 is checked: a. Relocate the project If#4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, A Mlih&E.Grant Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535