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Miscellaneous - 1907 SALEM STREET 4/30/2018 (2)
1907 SALEM STREET 210/106.6-0012-0000.0 7'C I I { I SUMMARY OF INVERTS BUILDING TIES SEWER ® FDTN. 97.39 BLDG. CORNER A 1 B C NO TE THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.02 SEPTIC TANK 1N 11.6 35.9 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 96.85 SEPTIC TANK OUT 19.2 40.6 SYSTEM. IT IS A RECORD OF THE LOCATION DIST. BOX IN 96.73 DIST. BOX 25.3 39.7 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX OUT 96.56 COMPONENTS. INV. IN CHAM. 96.49 BOTT. CHAM. 96.17 Swx TANK m pm LEAW Flan W/ ol! s r, x. ovAmm J i •� 't \ (44.104 SF.) f , i i VIM sypaT AS BUILT PLAN � }' OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./1907 SALEM STREET AS PREPARED FOR JON HEYDENREYCH TM: 106B DATE: 12-1-10 TL: 12 SCALE: 1"=40' 0 20 40 so MERRIMACK ENGINEERING SERVICES 66 PARK STREET TQWN OF NORTH ANDOVER ANDOVER, MASSACHUSETTS 01810 �� HEALTH DEPARTMENT SETTLED jsy6 . COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CSE 9 �rl HCATE OE CO-14PLIANCE As of: lDecem6er 15, 2010 This is to cert that the individua(su6surface dzsposaCsystem received a SATISEACYI0RTIM(PEMONof the: Complete Wspair and Construction of an On Site Selvage CD4" osa[System By ToddBateson At: 1907 SAXGE9W STX EET 210/106.B-0012-0000.0 Map-106.B~Parcel-0012 Xorth,,gndover, JKA, 01845 The Jssua4q of this If not be construedas a guarantee that the system wifffunction satisfactorily. Aswan T Sawyer, JPEW (Pu6Cu Ifeafth(Director is 911ealth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com o` NORiN 9 1 RECEIVE �SSACHUS f� APR I6 ZU11 PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired; By: Ta DD (Print Name) Located at:_ o-7 ET (Installation Address) Was installed in conformance with die North Andover Board ofIIealth approved plan,originally dated — )_and last revised on 10—Z'Z_—— I,® ,with a design flow of 0 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: � ti Engineer Representave(Signature) And—Print Name Final Construction Inspection Date: `��— Oy2 . Engineer Representative(Signature) iffsw � sE���a)C And—Print Name , _ F— Installer: (Signature) Date: 11--177- f e And—Print Name Enginer: 11"Plld IV'LOWW/f/ i�(Signature) Date: Z-�'I—to And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com • North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 1907 Salem Street MAP: 106B LOT: 12 INSTALLER: Todd Bateson DESIGNER: Vladimir Nemchenok PLAN DATE: 10/5/10 BOH APPROVAL DATE ON PLAN: 11/8/10 INSPECTIONS Illzll0 TANK INSPECTION: h DATE OF BED BOTTOM INSPECTION:I ) DATE OF FINAL CONSTRUCTION INSPECTION: 11/24/10 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS NA 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 NA Cleanouts per plan Bottom of tank hole has 6" stone base Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of final grade installed over inlet and 24" cover to grade over outlet access port ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box NA Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTIONi SYSTEM (General) �J 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 NA 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 NA Retaining wall (boulder/concrete /timber/block) ❑ Final cover as per plan. Comments: MaqtyyUA' 5&0_.' ODOn_51tk 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 i BM = 100.00 HR = 4.04 HI = 104.04 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark 4.04 100.00 100.00 Building Sewer OUT 6.29 97.40 97.4 Septic Tank IN 6.66 97.03 97.04 Septic Tank OUT 6.83 96.86 96.79 Distribution Box IN 6.95 96.74 96.72 Distribution Box OUT 7.12 96.57 96.55 Lateral 1 TOP 7.20 Lateral 1 INVERT 96.49 96.50 Lateral 2 TOP 7.19 Lateral 2 INVERT 96.50 96.50 Lateral 3 TOP 7.18 Lateral 3 INVERT 96.51 96.50 Lateral 4 TOP 7.18 Lateral 4 INVERT 96.51 96.50 Lateral 5 TOP 7.18 Lateral 5 INVERT 96.51 96.50 Top of Chamber 7.18 95.86 96.89 Bottom of Bed/Chamber 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 10' ® 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 FINAL GRADE INS E ;ION Date: / / Address: -46 LOAMED? VEEDED? OVERP LA ? Other: rc DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 13, 2011 10:54 AM To: 'jon@faith-andover.org' Cc: Sawyer, Susan; Grant, Michele Subject: Septic System- 1907 Salem Street- Request for COC Importance: High Follow Up Flag: Follow up Flag Status: Flagged Hello Jon, I think that from the beginning of the septic system process for your property at 1907 Salem Street,our department has kept you in the loop via email,and letting you know when applications came in,etc. All involved worked as quickly as possible in order to complete your septic system work. Our office did not receive the Installation Certification or the Septic As-Built from the engineer prior to this week. As you know,at your request,I had notified you via email as the process went along,so if I had received all of the required paperwork,I would have of course notified you at that time. As the septic season was closed for the season right after your project was done,and we had such a long winter with heavy snow,it is generally assumed that septic systems worked on at the end of the septic season would wrap up their paperwork and finish the Final Grade in the spring,so therefore,there was no red flag for us. Also,a final grade where the loaming and seeding is done cannot be done in the winter,and is commonly ompleted in the spring for homeowners who complete their systems at the end of the year. As you came to the office on Monday of this week requesting a Certificate of Compliance,I followed up with your engineer,Bill Dufresne,to let him know we were missing the final paperwork. We were also never notified that the system was ready for a Final Grade inspection. It is the responsibility of the engineer to be sure that all the proper paperwork is submitted to the Health Department,and we cannot move forward until this is received. If there was a reason to rush this through,it most likely would have been hand-delivered to us,of which I have no record. We also did not receive any follow-up calls or requests in the month of December for a Final Grade Inspection or that the homeowner was urgently waiting for a COC. On your behalf,I requested that Bill scan the Installation Certification and Septic As Built to me,which he did,and it is now being reviewed by Susan Sawyer. I also received the original in the mail today. In addition,Michele Grant adjusted her schedule to be sure that the Final Grade inspection was completed for you on Monday,April 11th. I feel that the Health Department acted in due dilligence to complete all of the work necessary to facilitate the repair of your septic system. As we now have the final paperwork from the engineer,we now have the tools to review the information,and issue a Certificate of Compliance for you. I will notify you as soon as it is complete. Best Regards, Pamela DelleChiaie Departmental Assistant I Community Development ( Health Department Town of North Andover 1600 Osgood Street Bldg 20 1 Suite 2-36 North Andover,MA 01845 N Office-978-688-9540 9 Fax-978-688-8476 9 Email-pdellechiaie@townofnorthandover.com ; Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous --Original Message----- 1 From:jon@faith-andover.org[mailto:jon@faith-andover.orgl Sent:Wednesday,April 13,20119:26 AM To:DelleChiaie,Pamela Subject:Can I help Hi Pam: I do not like being a pest,but from my perspective-I should have received this certificate of compliance soon after the work was completed on this septic system-last December. So...The ball was dropped somewhere. I want to make sure this does not happen again. So.... How is the progress and is there anything I can do to assist? My understanding is that the engineer sent you via email what is needed. Sorry to bother you. Jon Heydenreich Sent via B1ackBerry by AT&T 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. 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, April 11, 2011 12:14 PM To: 'Bill Dufresne(brdufresne@comcast.net)' Cc: 'jon@faith-andover.org'; 'marsha@faith-andover.org'; Grant, Michele; Sawyer, Susan Subject: FW: Septic- 1907 Salem Street-ready for Final Construction Inspection Hello Bill, The homeowner,Jon Heydenreich,came to the office to request a Certificate of Compliance on his septic system for 1907 Salem Street. The permit was applied for in November at the end of the septic season,and Todd Bateson did the work at the end of November. We have not yet received the installation certification form that you and the installer need to sign off on with the applicable dates and signatures. Michele will conduct a Final Grade inspection today. Please advise as to when we can expect to receive that paperwork. Thank you. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 0 Email-pdellechiaieotownofnorthandover.com -16 Website hftl2://www.townoftiorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous From: DelleChiaie, Pamela Sent: Wednesday, November 24, 2010 11:08 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: Septic - 1907 Salem Street- ready for Final Construction Inspection Hello, Bill Dufresne called and spoke with Susan and stated that 1907 Salem Street is ready for a Final Construction Inspection. Please call Todd Bateson at: 978.815.2703. Thank you.-- &AtRe , Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 9 Office-978-688-9540 R Fax-978-688-8476 M Email-pdellechiaieotownofnorthandover.com Lh Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."—Anonymous i I i 1 s I 4, Commonwealth of Massachusetts Map-Block-Lot 106.60012 . .� Board of Health ----------------------- y a o i. Permit No North Andover BHP-2o10-o�5s P.I. FEE caui F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 1907 SALEM STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. 13HP-20107075 Dated November 09 2010 ----r--- 'i-- ;,.�,..,, "--------------------- Issued O--Nov-09-2010 ' Board of li alth t Application for Septic Disposal System `AConstruction Permit -TOWN OF TODAfSLIATE •f' ORTH ANDOVER, MA 01$45 $250.00—Full Repair �►,s�,...�� � $125.00-Component Important, Application is herebv made for a permit to: forms o the out L]Construct Construct a new on-site sewage disposal system computer,use only the tab key epair or replace an existing on-site sewage disposal system* to move your ❑Repair or replace an existing system component—What? cursor-do not use the return key. A. Facility Information 90 7 ICI Address or Lot# Cityfrown 2.-*TYPE OF-SEPTIC SYSTEM*: ❑Pump Grav-ity(choose one) "If pump system,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) PKInfiltrator or Biodiffuser(Gravel-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 -J k N Name 9O `7 S�lc S 7`• , Address(d different from above) City/Town State Zip Code Telephone Number 3. Installer Information � Ole ShcJ Name • +FnrrERr�I�zS—ffde----- Name of Company 11 ARGILLA ROAD Z I f lQfq Z I 4- ANDOVER, MA 01810 Address MA Cd}dTown State Zip Code Telephone Number(Cell Phone#if possible please) a. Designer Information /"let r , Aa . Name Name of Company Address /Tn� P2P• citylTown State MA- Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit Page t of 2 O'.",7 Application .for Septic Disposal System 1/- 41-- /o _ - Construction Permit — TOWN OF TODAY'S DATE ORTH ANDOVER, MA 01845 x;25 00-Comp hent SICHUS PAGE 2OF2 A. Facility.Information continued.... 5. Type of Building: BI esidential 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 issuedA this Board of Health. Name Date Applicatio proved By: oard of Health Representative) Nam Date Appli ation Disapproved for the following reasons: For Office Use Only: L Fee Attached. Yes✓ No 2. Project Manager Obligation Form Attached. Yes No 3. Pump S sv tem? Ifso;Attach copy ofE'lectrical Permit Yes "//o No 4. Foundation As-Built. (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes_ No Application for Disposal system..Construction Permit•Page 2 of 2 l • SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: Plans or b /"!.¢fT""'helms �Nq• e" (Address of septic system) FP Y �— _ 1 (Engineer) Relative to the application of e cQg l-tsv,✓ J (Installer's name) And dated (Original ate . Dated —(Io�ay's ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer,I am obligated to obtainall permits and Board of Health approved plans prior to performing any work on a site. I must have the approved_plans and the permit on site when any work is being done. 2. As the installer,.I must call for any and all inspections. If homeowner,contractor,project 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. 3.4 As the installer,I am required to.have the necessary work completed prior to the applicable inspections as indicated below. _I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50`00 fine being levied against me and/or my company. a. Bottom lof Bed Generally,this is thefirst(15�inspection unless.there is a"retaining wall,which should be done-first. The installer must request the inspection but does not have to be present. b. Final:Construction Inspection—Engineer must first;do their inspection for elevations, ties, etc. As-built of verbal OK(or e-mail to:.healthdeptOtownofnorthandover com)from the engineer must be submitted to the Board of Health,after which installer.calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and.alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work(other than jimple excavation)and I am required to complete the installation of the system identified in.the attached application for installation: '..I further understand:that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my liceT nse to operate in the Town of North Andover._significant fines to all persons involved are also possible 5. As the installer, I understand that must`be on-site during the performance of the following construction steps: a. Determination that.the proper elevation of the excavation has been reached b. Inspection of the sand and stone to he used. c. Final inspection by Board ofHealth staff or consultant. d Installation.of tank,D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer, I understand that I amsolei res 12onsible for the installation of the s stem as er the approved plans. No instructions by the homeowner general contractor, or a!y other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) N arae—PrinC 1, arrle' ` Y . IFILE "'OPY 2 North Andover Health Department Community Development Division November 8,2010 Jon and Marsha Heydenreich 1907 Salem Street North Andover, MA 01845 RE: Septic System Design approval for 1907 Salem Street,map 106.13; Lot 12 North Andover,MA 01845 Dear Property Owner, 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 dated October 5, 2010, last revised October 26,2010 and received Nov. 2, 2010. This septic design plan has been approved. This approval includes the Health Department approval of a local upgrade for allowing the reduction for the offset of to the Estimated Seasonal Water Table from four feet to three feet. Please keep a copy of the attached document for your records. With the approval of the reduction of the offset to the water table, the owner has been advised that the number of rooms currently in the home.shall not be allowed to be increased at a future, time unless town sewer becomes available. In accordance with state subsurface disposal regulations, plans shall expire three years from the date approved unless construction on the lot has begun. 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. This approval is 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, and North Andover Health Department, 1600 Osgood Street Building 20 Suite 2-36 North Andover MA 01845 Phone:978.688.9540 Fax:978.688.8476 Pagel of 2 ` 1907 Salem Street Septic Plan Approval November 8,2010 2. the installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 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 or imply compliance with any of the aforementioned requirement. 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 may have. Sincerely, ��L Swan Y. Sa er, EHS S Public Health Director Cc: Merrimack Engineering Services Attach—Form 9B—Local Upgrade Approval Form North Andover Health Department 1600 Osgood Street Building 20 Suite 2-36,North Andover MA 01845 Phone:978.688.9540 Fax: 978.688.8476 Page 2 of 2 o Commonwealth of Massachusetts City[Town of North Andover a w Local Upgrade Approval Form 913 0 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 Jon Heydenreich key to move your Name cursor-do not 1907 Salem Street use the return key. Street Address North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 550 gpd 5. System Designer: Vladimir Nemchenck 70 Bailey Court Name PE ® RS 66 Park Street Haverhill MA 01832 Address Cityrrown 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 1907 Salem 913 11 8 10•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts W City/Town of North Andover a e Local Upgrade Approval Form 9B GSM B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 18 min./inch Depth to groundwater 3 ft. ❑ 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 List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department Approving Authority Susan Sawyer, Health Director November 8, 2010 Print or Type Name and Title signature v Date 1907 Salem 9B 11 8 10•rev.7/06 Local Upgrade Approval* Page 2 of 2 Commonwealth of Massachusetts City/Town of North Andover w Local Upgrade Approval a Form 9B 41M V B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 18 min./inch Depth to groundwater 3 ft. ❑ 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 List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department Approving Authority Susan Sawyer, Health Director November 8, 2010 Print or Type Name and Title ignature v Date 1907 Salem 9B 11 8 10•rev.7/06 Local Upgrade Approval* Page 2 of 2 • • North Andover Health Department Community Development Division October 22,2010 Vladimir Nemchenok C/o:Bill Dufresne,Engineer Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re:Subsurface Sewage Disposal System Plan for 1907 Salem Street,Map 106B,Lot 12 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated October 5,2010 and received on October 8,2010 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. 1. On sheet 2 of 2,the scaled profile is required to have a vertical scale of 1"=2' (NA 3.2). 2. On sheet 1 of 2,please depict proposed spot grades above the leaching facility on the site plan to ensure there is 3 feet or less of cover material proposed(3 10 CMR 15.221(7)). 3. On sheet 1 of 2,it appears the bottom of the septic tank(92.4')is below the estimated seasonal high groundwater table(93.1'). This requires buoyancy calculations to be provided(3 10 CMR 15.221(8)). 4. On sheet 2 of 2,a gas bale or approved tee filter is proposed.If an effluent filter is proposed please indicate the brand,model and required maintenance((3 10 CMR 15.227(7)). 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. Sincerel Susan Y. er,�. Public Health Director cc: Jon Heydenreich File Page 1 of 1 North Andover Health Department, 1600 Osgood Street,Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, November 08, 2010 3:22 PM To: DelleChiaie, Pamela Subject: agenda items ***1907 Salem will not need to come to the BOH Todd is going to get it done.... Agenda items Minutes Old business Local Regulation regarding standards for food storage areas (no attachments needed in packet) Request by Bill Thomson and for an extension of time for the site assignment requirement regarding trash truck monitoring. (when the letter comes in from Bill please attach) New business Health Department planning to provide a service to landlords for sanitary code inspections for Pre-occupancy of Rental housing-discussion of applicable fee for service Susan Sawy u Yub&9(caPth J7bcecton 1600(969"d Sheet .W4 20,unit 2-36 ✓VodA and"",✓M 01845 mice 978 688-9540 fax 978 688-8476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. 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:hftp://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, November 09, 2010 4:10 PM To: 'jon@faith-andover.org'; 'marsha@faith-andover.org' Cc: Sawyer, Susan; Bill Dufresne(brdufresne@comcast.net) Subject: FW: Septic- Plan Approval - 1907 Salem Street Attachments: 20101109112334069 In addition, I did receive the construction application from Todd Bateson yesterday and will issue it today for him. Maat R Banda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 2 Office-978-688-9540 R Fax-978-688-8476 O Email-pdellechiaie@townofnorthandover.com `6 Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."---Anonymous From: DelleChiaie, Pamela Sent: Tuesday, November 09, 2010 4:08 PM To: 'jon@faith-andover.org'; 'marsha@faith-andover.org' Cc: Bill Dufresne (brdufresne(acomcast.net); Sawyer, Susan Subject: Septic - Plan Approval - 1907 Salem Street Attached is a scanned file of your septic plan approval letter,along with the LUA approval for 1907 Salem Street. Please call the office if you have any further questions. Vint Ref anda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 W Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com -16 Website bM://www.townofiiorthandover.com/Pages/"index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Friday, October 08, 2010 4:22 PM To: 'Daniel Ottenheimer; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Subject: Septic- 1907 Salem Street- New Septic Plan Review Application 10.8.2010 Attachments: 20101008160525756.pdf Hello, Attached are the sheets related to a plan review submission for 1907 Salem Street,North Andover, prepared by Bill Dufresne of Merrimack Engineering. Please note--this site also has an LUA request for a reduction from SAS to High Groundwater. This is the property where the septic system is failing, and the homeowners must pump it each week until the system is repaired. I am sending you two plan reviews today in the same package, and due to the circumstances, would you please review this one first? Thank you. Best Regards, Pamela DelleChiaie Departmental Assistant lCommunity Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 N Office- 978-688-9540 9 Fax - 978-688-8476 9 Email -pdellechiaie@townofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."—Anonymous -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Friday, October 08, 2010 4:05 PM To: DelleChiaie, Pamela Subject: Septic - 1907 Salem Street-New Septic Plan Review Application 10.8.2010 This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 10.08.2010 16:05:25 (-0400) Queries to: norepllygtownofnorthandover.com 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/Treidx.htm. Please consider the environment before printing this email. 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 13, 2011 1:12 PM To: 'jon@faith-andover.org'; 'marsha@faith-andover.org' Cc: Sawyer, Susan; Grant, Michele Subject: I.R. -Septic- 1907 Salem Street-Septic As Built Attachments: 20110413125640255 To:Jon Heydenreich 1907 Salem Street Jon, Attached is your Septic As Built Plan for your property at 1907 Salem Street. diet Rigaada, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 Fax-978-688-8476 Email-pdellechiaieotownofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our We if we are too busy focusing on the pebbles under our feet."--Anonymous 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, April 13, 2011 1:11 PM To: 'jon@faith-andover.org'; 'marsha@faith-andover.org' Cc: Sawyer, Susan; Grant, Michele Subject: I.R. -Septic- 1907 Salem Street-Septic COC (Certificate of Compliance)and Installation Certification Form Attachments: 20110413125509796 To:Jon Heydenreich 1907 Salem Street Jon, Attached is your septic system COC (Certificate of Compliance)and Installation Certification Form for your property at 1907 Salem Street. haat a9444, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 'R Office-978-688-9540 R Fax-978-688-8476 0 Email-pdellechiaieCa)townofnorthandover.com '11� Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 a TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES 0 :o``...4 °� HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 �` --=�-• �'' NORTH ANDOVER,MASSACHUSETTS 01845 �'SS;�wU 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdeptatownofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: 0—(P- 10 Site Location: I Q�f A L EJ *�C kf lnE:E Engineer: � X11 ) I, New Plans? Yes / $225/Plan Check#_(includes 1'`submission and one re- review only) 1.14111072-zz R R I Revised Plans?Yes $75/Plan Check# W Site Evaluation Forms Included? Yes No "WN NO Local Upgrade Form Included? Yes No N tot 0 VfON7' Telephone#:� Fax#: 6W) E-mail: f J l-E P.12.�c7►9F C- Cnc 4 ee`e KJ--J- Homeowner Name � �I W j itg OFFICE USE ONLY When the subm ion is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database h ` Commonwealth of Massachusetts CitylTown of North Andover Form 9A - Application for Local Upgrade Approval 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. 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 accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Jon Heydenreich Residence only the tab key Name to move your 1907 Salem Street cursor-do not use the return Street Address key. North Andover MA 01845 CitylTown State Zip Code rah 2. Owner Name and Address(if different from above): SAME ream Name Street Address Cityrrown State Zip P Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 5 BDRM. 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): Field t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts CitylTown of North Andover Form 9A - Application for Local Upgrade Approval ,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. 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 550 gpd Design flow of facility: 550 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: Complete 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. Bio reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1.0 ft. Percolation rate 18 min./inch Depth to groundwater 3.0 ft. t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 1 ` 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. 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: Isaac Rowe 9-30-10 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: Full compliance would result in having to raise the system further causingradio issues, requiring a 9 9 q 9 pump, and unreasonable financial hardship 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval wM 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 roof that affected abutters have been notified pursuant to 310 CMR 15.405(2). P P ❑ 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." 10-6-10 a ility Owner Signature Date Jon Heydenreich Print Name Bill Dufresne/Merrimack Engineering 10-6-10 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ,vf A. Facility Information Owner Name Iny77 t 0 7.., Street Address Map/Lot# W-0-A lA 01 0)&P5 City State Zip Code B. Site Information 1. (Check one) ❑ New Constructio Vupgrade F-1Repair 2. Published Soil Survey Available? Yes ❑ NoIf yes: 118� ' 6 L5 V) Year Published Publication Scale Soil Map Unit Soil NameSoil Limitations 3. Surficial Geological Report Available? ❑ Yes No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? VYes ❑ No Within the 100- ear flood boundary? ❑ YesY rYY Within the 500-year flood boundary? ❑ Yes Z/No Within a velocity zone? ❑ Yes 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): th� Range: ❑ Above Normal ❑ Normal 2(Below Normal 7. Other references reviewed: t5form11.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 L\ 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: -770 V44-( � Date Time Weather 1. Location Ground Elevation at Surface of Hole: ' Location (identify on plan): 2. Land Use I QzWA (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) L&;-w Q CIPW i o tA� �P' —IVIG 4Ldox' Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >et�o Drainage Way ?tez> Possible Wet Area feet>! Property Line ` ll;� Drinking Water Well 1> Other • feet feet feet 4. Parent Material: TeLL� Unsuitable Materials Present: ❑ Yes pyo If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes [�J/NO If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater, 00 12. Zinches elevation t5form11.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts - City/Town of d• Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: T'r! Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(In.) Structure Consistence Other Layer Moist Munsell (Munsell) (USDA)Depth Color Percent ) Gravel Cobbles 8, (Moist) Stones u — _. f✓ (�_Zrf 1 ©-�0►�1/� ESL. HA-9fe%_i 25-1 Z", G _Z, 5Y '+/1. 7y�o Additional Notes: 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 ,r C. On-Site Review (continued) Deep Observation Hole Number: �� 0 .VA-M aspY � Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): 2. Land Use �� 3 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) L+4:A�Q 64012 HawAt ug Vegetation Landform Position on Landscape(attach sheet) i t e 3. Distances from: Open Water Body feet Drainage Way e a Possible Wet Area fee Property Line fee $ Drinking Water Well feet feet Other feet 4. Parent Material: �L,- Unsuitable Materials Present: ❑ Yes N-4o If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock 0 Bedrock 5. Groundwater Observed: ❑ Yes RINo If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 4� el 3, inches elevation t5form11.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 �L\ 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: T. Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Cobbles& Structure Consistence Other Depth Color Percent ravel (Moist) Stones 10$"/ F-S.L 0"y0) T2�7 �0�IP �li i'•$,L �+d�t�E 2`''0'1 Ce 2,,SPY CJS t7.1 5yo I Sle v6 �t Ii Additional Notes: t5form1 l.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts ' City/Town of d 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 VDepth epth weeping from side of observation hole A. B. incnes incnes to soil redoximorphic features (mottles) A. j B. 644-14 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 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 P least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil abs ption system? __r_( T•'Z/ Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches s t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of d Form 11 - So il Suitability Assessment for On-Site Sewage Disposal 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 EvaluatorOate 1441 U, 1 rYt�S� Typed or Printed Name of Soil Evaluat r/License# Date of Soil Evaluator Exam 54AAC,, i?'-wr .ti & w �� t5uLxAtjT �►�. l ay - ,�kIJ�. � 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. I t5form11.doc•rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Y r p w r Commonwealth of Massachusetts City/Town of Percolation Test Form 12 G M 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 tet",� f► lKY,/oto� computer,use L/N �"I�� VG M[f�1/ only the tab key Owner Name to move your ll g.? �XLA ,g cursor-do not Street Address or Lot# use the return ,tA 'Now key. 210W> City/Town State Zip Code — Contact Person(if different from Owner) 1e hon Number B. Test Results -1-3640 Date ^� Time Date Time Observation Hole# fV Depth of Perc Start Pre-Soak End Pre-Soak Time at 12" Time at 9" 1-7 Time at 6" Time(9"-6") Rate(Min./Inch) Nest Passed: Test Passed: F-11��/�'yG►Test Failed: ❑ Test Failed: ❑ Test Performed est Witnessed By: Comments: t5form12.doc•06/03 Pere Test•Page 1 of 1 TOWN OF NORTH ANDOVER NORTF, .1 Office of COMMUNITY DEVELOPMENT AND SERVICES or •`' `'' °� HEALTH DEPARTMENT " 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 3 ••�4T16 � NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y.Sawyer,REHS,RS 978.688.9540-Phone Public Health Director 978.688.8476-FAX healthdept@townoffiorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TESTS DATE: �� 23 -/'O MAP&PARCEL: 117— LOCATION 1ZLOCATION OF SOIL TESTS: l/ 7 �A 1- EA-( OWNER: Q+'! H E ry7i�ltil�LL�IC�I Contact#: APPLICANT: Contact#: ADDRESS: ENGINEER: Contact#: &T�) CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision mgleamily a Commercial Undeveloped Lot Testing Upgrade for Addition: Is This: Repair Testing: In the Lake Cochichewick Watershed? YesNo THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x H"Plot plan&Location of Testing(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 Approval Date: ! 7 0 Signature of Conservation Agent. .� Date back to Health Department. (stamp in): " MDRTBA6E INSPECTION PLAN City/Tovn:,&%%-j3 Q rte___State: lj�_ --- - ------.-- Date: _/-ZL� t _ 9 Scale: �� _ _z •`•� Dvner:-- u tjM-------------- Buyer: E Deed Ret._]�� Plan No. E;2 Dravn,per City/Town of ���� ------ Tax Assessors Map. N/F Gam\i�P�ELI_ LOT Z 9 _N.�•F_ CAMPz,ELI.. �' N�� C.�\rst F='r�:'�_LL X07 O1 r 5-q- -2- r T �� fir-I , i4 � . LL-I IC 1 i � � � �� j/�l�/VGA �✓���O' Z3_�_/o : LL f C� 11..1p - - DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Monday, September 27, 2010 2:30 PM To: DelleChiaie, Pamela Cc: Gaffney, Heidi; Hughes, Jennifer Subject: Soil Eval for 1907 Salem Street scheduled for Thurs/Sept 30 @ 9:30 Just talked to Bill Dufresne; had left him a voicemail. He hasn't digsafed the site yet, so this is scheduled for Thursday/Sept 30th @ 9:30 with Isaac. From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Friday, September 24, 2010 3:53 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Gaffney, Heidi; Hughes, Jennifer Subject: Soil Test Application - 1907 Salem Street Hello all, just received this hand delivered soil test application from the homeowner,John Heydenreich at 1907 Salem Street. The system is failed, and needs to be replaced. The homeowner asked about speeding up the process, as they have to pump every week until the system is fixed. I explained our applications and review processes and the steps to complete each portion of it. However, I said that I would alert all involved to the urgency of the situation, as it is causing a financial hardship and he and his wife have their 85 year old mother living with them. As a result, I am submitting this soil testing application concurrently to Conservation and Mill River, so if there is a delay scheduling the soil testing, Heidi can get me her comments in between that time sometime next week. Heidi, I will leave a hard copy for you today. Therefore, I told the homeowner that our staff and our consultant will do all that we can to schedule testing and inspections, etc. as soon as we possibly can, but protocol and benchmarks have to be met, and it also depends on when his engineer is available and submits the plans, etc. Thank you all for anything you can do to make the process for this homeowner go as quickly as possible. fiat�iganda, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 Fax-978-688-8476 (] Email-pdellechiaiePtownofnorthandover.com '2]L Website hM://www.townofnorthandover.com/Pag_es/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonynious r' 1