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HomeMy WebLinkAboutMiscellaneous - 217 GRAY STREET 4/30/2018PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/13/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Replacement of an On -Site Sewage Disposal System By: Todd Bateson At: 217 Gray Street Map 107D Lot 112 North Andover, MA 01845 ate shall not be construed as a guarantee that the system will function satisfactorily. ichele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (t4 repaired; (Print Name) Located at: Z 117 ovo y si-v-e_e �- (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated Rya . I y , 2-01q and last revised on 5e&, 3o, 2a I N , with a design flow of Ngallons per day. The materials used were in confonnance 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: 0 ('u I I And —Print Name �% ll '� l Final Construction Inspection Date: ` I� J And — Print Name Installer: �� (Signature) Engineer: ��l (Signature) Engineer Representative (Signature) Engineer Representative (Signature) Date: S___ /3 1600 Osgood Street, North Andover, MassachL Phone 978.688.9540 Fax 978.688.8476 . http://www.townofnorthandover.com And — Print Name Date: `$131 I 1G. 01845 Web Commonwealth of Massachusetts City/Town of Novi+ PAW( ( Certificate of Compliance ^M Form 3 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On -Site Sewage Disposal System ❑ Construction of a new system IRepair or replacement of an existing system ❑ Repair or replacement of an existing system component Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP): DSCP Number DSCP Date _FOVI Vd lel v' Facility Owner 21q 6(00 OYezi Street Address or Lot # City/Town Designer Information: Name p�� Signature Installer Information: MA bl$Li5 State Zip Code L) >2 Ev o �ku�v�c t I Name of Company hvo 31 20113 Date Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc• 06/03 Certificate of Compliance • Page 1 of 1 1) 2) 3) 4) 5) 6) 8) 9) 10) 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 7As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 7Street Address, Assessor's Map and Lot Number Lot Lines and Location of Dwellings served by the system V Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable) Aes 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: Subsurface, interceptor & foundation drains Catch basins Property lines Dwellings or other structures IL Private water supply or irrigation wells Watercourses or wetlands Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system Location of water, gas, electric lines, cable, control panel (if applicable) Location of Structures within 6 Inches of Finished Grade 11)V Original Stamp & Signature 12) Location and holder of avYesseements which could impact the system7 13) Impervious Areas; Drivetc ly� 14) 7/ North Arrow 15) \/ cation & 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, if applicable, 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 indicating the wall - was, or was not, constructed in accordance with the intended d J ii and any manufacturer's specifications. " Signature of Designer Revised 3/17/15 Date North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 217 Gray St. MAP: 107D LOT: 112 INSTALLER: Todd Bateson DESIGNER: LJR Engineering PLAN DATE: 8/14/14, rev. 9/23/14 BOH APPROVAL DATE ON PLAN: 10/9/14 INSPECTIONS TANK INSPECTION: 8/26/15 DATE OF BED BOTTOM INSPECTION: 8/26/15 DATE OF FINAL CONSTRUCTION INSPECTION: 9/2/15 DATE OF FINAL GRADE INSPECTION: 10/27/15 SITE CONDITIONS ® Contractor reports any changes to design plan ® r xisting septic tank properly abandoned) ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: New septic tank and pump chamber were installed instead of using the existing tanks. SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A 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 finish grade installed over one access port ® Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan 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: 28x42 with overdig SOIL ABSORPTION SYSTEM (Gravel -less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ® Number of chambers per row: 8 ® Number of rows (trenches): 5 Comments: Total Chambers = 40 FINAL GRADE X Loamed X Seeded X Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer X As -Built Plan BM = 88.24 HR = 3.68 HI = 91.92 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT DESIGN INVERT ELEV ELEV Benchmark At cast iron Building Sewer OUT 6.38 85.19 85.42 Septic Tank IN 6.46 85.11 85.27 Septic Tank OUT 6.75 84.82 85.13 Pump Chamber IN 7.12 84.45 84.25 (2")Pump Chamber OUT 6.92 84.83 ----- 2" Distribution Box IN 5.28 86.47 86.42 4" Distribution Box OUT 5.30 86.27 86.25 Lateral 1 TOP 5.38 Lateral 1 INVERT 86.19 86.17 Lateral 2 TOP 5.40 Lateral 2 INVERT 86.17 86.17 Lateral 3 TOP 5.40 Lateral 3 INVERT 86.17 86.17 Lateral 4 TOP 5.40 Lateral 4 INVERT 86.17 86.17 Lateral 5 TOP 5.40 Lateral 5 INVERT 86.17 86.17 Top of Chamber 5.40 86.52 Bottom of Bed/Chamber 85.52 85.5 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback i Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). s 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 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 i Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). s 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 Town of North Andover — Septic System - AS -BUILT CHECKLIST 1) J All changes to the design plan have been reflected and noted on the as -built plan 2) As -built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) Street Address, Assessor's Map and Lot Number 4) y Lot Lines and Location of Dwellings served by the system 5) J Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable) 6)_LTies to all tank openings, d -box, and leach area from dwelling or Permanent Structure 7) Setback distances are shown on the as -built plan from system components to: WO, Subsurface, interceptor & foundation drains N TW Catch basins 7—Property lines —7—Dwellings or other structures 4Private water supply or irrigation wells N 1� Watercourses or wetlands 8) v 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) J Location of Structures within 6 Inches of Finished Grade 11) Original Stamp & Signature 12) N �I� Location and holder of any easements which could impact the system 13) U Impervious Areas; Driveways, etc 14) North Arrow 15) J Location & Elevation of Benchmark used 16) _LSTATEMENT ON PLAN (NA 5.3) NOV 3 0 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT a. "I certify the locations, elevations, ties, cover material; exposed component covets etc., shown on this as-builtsubstantiallyagree with the approved plan acrd have determined that the break out elevations, if applicable, have been met." Signature of Designer Date "If a STUCTURAL WALL IS PRPSLNT W 4.9) a Letter or statement on the as -built indicating the wall - was, or was not, constructed in accoz dance with the intended desmon and any manu,factut er's specifications. " Signature of Designer Date As of: Tuesu,y, March 17, 2015 iq I Commonwealth of Massachusetts Map -Block -Lot 107.D0112 ----------------------- BOARD OF HEALTH Permit No 15- HP B North Andover -200250 BHP --015---------- P.I. FEE F.I. $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd -Bateson to (Upgrade) an Individual Sewage Disposal System. I; at No 2-17 GRAY STREET ---------------------------- as shown on the application for Disposal Works Construction Permit No�2 02 at 0 s=: Application for Septic Disposal System Construcfion Permit - TOWN OF NORTH ANDOVER, MA 01845 Important When filling out forms on the computer, use only the tab key to move your cursor -'do not use the return key. as ,Earn ` r (�'/<_ k W -1. `z - TODAY'S DATE $ 250':00'=fd11Re0air1 Component , ' Application is hereby made for a permit to: ❑ construct a new on-site sewage disposal system* tepair or replace an existing. on-site sewage disposal' system* i ❑ Repair or replace an existing system component — What? f� A. Facility Information nn AU(; 1015 a) ?,7C. t, s 4 " - TOWN OF Address or Lot # City/Town 11,114 2.- *TYPE OF SEPTIC SYSTEM*: ➢ ump ❑ Gravity (choose one) * if pump system, attach copy of electrical permit to application"' ➢ ❑ Conventional System (pipe and stone system) ➢ ❑ Infiltrator 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 No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? What is tbeModef, , 2. Owner Information Mame Ge Address (if different from ��above) City/Town 3. Installer Information 91 '04f,11- State <,11- State 97? 6 9' Telephone Number Zip Code - Sao :3 149 Name Name ofCompaIRATMON ENTERPRISES, INC . 111 ARG ILLA ROAD Address ANDMEti, mA 810 Cityrrown 4. Designer Information Name Address City/Town State Zip Code Telephone Number (Cell Phone # if possible please) Name of Company �'l�• ©IgC'% State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 M kppfloa#i-on..for Septic Disposal :Syst .onstruction -Permit = TOWN OF TODAY'S DATE �WRTH_ANDOVER, MA 01:845 $.250.00 Full Repair $125.00.- Component PAGE 2 OF 2 A. Facility. Information continued.... 5. Type -of Building: 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 Subsun°ace Disposal Regulations for the Town of North Andover, and not to place the system In operation until a Certlflcate of Compliance has been Issuedby this Board of Health. S'—Af — /,5 Name Date ,Applic tion _Pproved By: i ar of He /th Representative) Name Date Application Disapproved. for the following reasons: For Office Use Only: 1 Fee Attachedp Yes No 2. � ProjectMariaget Obligation Form Attached.P Yes No 3,: Pumai vfy ►? Ifso) Attach copy ofElectrical Permit', . Yes No 4. F6undid6nAs Built,?(grew construction-ronl}r); Yes (Same scale as approvedplan) No 5. FloorMws?(rear construction only). Yes_ No Application fior•pjspOsal Systerti:Gonstroctlori Permit Rage 2 of 2 WMCAXRNTVJ�LIGATI4M As fa,6;Bcpficsyvt= jot &c,=Pettyat (Ad4iisg a(sqft wg=) -Actpias by EZ Rostive to dw4ppbzdm �4-sr>Aj• (rAUKIWo Oamiy- Abd daftd 41 4/ Ga* VA towom dated 94M reWsed daft) I mdentand the foDowlng obligations farm agement of project: lo, i. As the JnftRa4 I a�as.obligated to obtain aIIpen and bard ofHealth qqmuvw phmpft to any.wcwk da IL aitr-..Lmm themmud 2. As fii;hmft'j m0ftwRimany and inqucros: poojca=xwSw, or any O*Upataon Act ft4ochftd whh my ewnpmy mch m kspecdm and dw spateia is notnudy, thin 3." hme Jbic o—eoqmy.Vo&. .to the iiuVPHC" 9MMAU d W-1- p Ing"" as A pealft tW 4CRwdet bane to b4 pm= qsml dftvfcRkAW*kATR't be reWy ad able to a#iq -tiler mt�et regtaagectioa �aheplt ent�splete; Irista�tsxs i�at 4. As -*e kadler -1 �d that only doo leapletee of the ay+.idmt?sa wippub'L 6. U,udw MO.And&m Woficant finm &2 In fWftAt*d& Ab 6r.*mdilte�r 16bdmmd 16t.I maaeb }he caastrm -,D tv4 wed C" bf B=4ejmwm sjw" =NUAWM, d. Grant, Michele To: Iroy@Ijrengineering.com Subject: RE: Septic system replacement - 217 Gray St., N. Andover Very Well, Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com From: Luke Roy[mailto:lroy@Ijrengineering_com] Sent: Wednesday, August 26, 2015 1:58 PM To: Grant, Michele Subject: Septic system replacement - 217 Gray St., N. Andover Hi Michelle, I spoke with the installation contractor yesterday on 217 Gray Street regarding a field change to layout of the replacement system. From our discussion he intends to install the pump chamber in somewhat different location than shown on the approved plan ... on the opposite side of the front walkway from where we proposed it. I told him that as long as he maintained 1% slope in the pipe from the tank to the pump chamber and that the pump chamber is a minimum of 10ft. from the foundation then I don't have any problem with the change and that we will locate and reflect the difference on our as -built of the system. Luke J. Roy, P.E. UR Engineering, Inc. 234 Park Street North Reading, MA 01864 978-664-8141 978-664-8142 fax Grant, Michele From: Sawyer, Susan Sent: Monday, June 08, 2015 4:17 PM To: Grant, Michele Subject: FW: 217 Gray From: Luke Roy [mailto:lroyC-aljrengineering.com] Sent: Monday, November 10, 2014 2:32 PM To: Sawyer, Susan Subject: RE: 217 Gray Hi Susan, Thanks for the reminder. I will try to pass on to the owner. I haven't had much direct contact with the owner as I was brought in by the installer they were working with at the time to do the design. I will also pass on and remind about the certification of notice. Thanks Luke Luke J. Roy, P.E. UR Engineering, Inc. 234 Park Street North Reading, MA 01864 978-664-8141 978-664-8142 fax From: Sawyer, Susan [mailto:ssawver@townofnorthandover.coml Sent: Monday, November 10, 2014 12:00 PM To: 'Iroy@ljrengineering.com' Subject: RE: 217 Gray Good afternoon Luke, I don't know if your client is planning on installing this year, but this is just a reminder in case you know that they are planning on it. Our last permit goes out 11/15 and it must be in the ground by Nov. 30. 1 don't believe I have their email, so if you are aware, please let them know. I hate to see people miss deadlines, they did not know were there. Thank you, Susan PS did we get the certification of notice? I don't recall off hand. From: Luke Roy [mailto:lroy(abljrengineering.coml Sent: Thursday, October 09, 2014 1:48 PM To: Sawyer, Susan Subject: RE: 217 Gray Grant, Michele From: Sent: To: Subject: Hi Michele, Thanks for forwarding. Luke Roy <lroy@Ijrengineering.com> Wednesday, June 10, 2015 3:48 PM Grant, Michele RE: 217 Gray -Would you prefer a revised design plan showing the conventional replacement area? -1 have a copy of my old infiltrator training card and cert. which I can scan and email -1 sent the owner the certification form again to try to have it signed. Luke J. Roy, P. E. UR Engineering, Inc. 234 Park Street North Reading, MA 01864 978-664-8141 978-664-8142 fax From: Grant, Michele [mailto:MGrant@townofnorthandover.com] Sent: Tuesday, June 09, 2015 9:25 AM To: 'Iroy@ljrengineering.com' Subject: FW: 217 Gray Good Morning Luke, Please see the requirements listed below. When you submit the necessary paperwork, I can then issue a permit to the installer. Best Regards, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com 1 Grant, Michele To: James H.Currier Subject: RE: 217 Gray street North Andover Hi Karen, No, we do not. There were some questions about the design that Jay had. Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mprant@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: James H.Currier [mailto:ihcurrier@comcast.net] Sent: Monday, March 23, 2015 12:10 PM To: Grant, Michele Subject: RE: 217 Gray street North Andover Hi Michele, Jay would like to know if you have a list of "vacuum test companies" we can contact. Thanks, Karen J's Septic & Drain 131 Forest Street MIDDLETON, MA 01949 978-774-6685 -----Original Message ----- From: Grant, Michele[mailto:mgrant@townofnorthandover.coml Sent: Monday, March 23, 2015 11:34 AM To: 'ihcurrier@comcast.net' Subject: 217 Gray street North Andover Good Morning, 1 Attached please find the Approval Letter for 217 Gray st. Also, please put all design questions in writing to our office Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: norepiv@townofnorthandover.com[ma iIto: noreply@townofnorthandover.coml Sent: Monday, March 23, 2015 11:43 AM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 03.23.2015 11:43:01 (-0400) Queries to: norepiv@townofnorthandover.com 2 October 9, 2014 Paul Miller 217 Gray Street North Andover, MA 01845 OF NORT/I qN o CO ��SSA C North Andover Health Department (ommunity Development Division Re: Subsurface Sewage Disposal System Plan for 217 Gray Street; Mau107D Lot 112 Dear Mr. Miller: The proposed wastewater system design plan for the above. site dated August 14, 2014 with a final revision date September 23, 2014 and received on October 2, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom (max 9 -room) home. 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. The plan received the following local upgrade approval. 1) To allow the use of a sieve analysis in lieu of a perc test 2) The allow the use of a single deep hole test rather than two as required by code. . 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. Of special note, this system approval allows the use of existing septic sand, which has been sieve tested by a MA State certified laboratory. With this approval will require an additional inspection by /7 ? This approval is also subject to the following conditions: 1. Please keep the attached DEP Form 9b for your records (attached) 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� _� 4 J-1 7.-Qray Street October 9, 2014 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 4. BEFORE a Disposal Works Construction permit is given the below must be complied with. A letter of acknowledgement must be submitted with the owners signature. Since the (Infiltrator Chambers, Cultec Chambers, Eljen) 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. Please provide the following as required by the approval conditions Section II(7): 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 II0 8): a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; C) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: moi. has been provided a copy of the Title 5 I/A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; 'ii. 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); iii. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and iiv. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the 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 • 217 Gray Street October 9, 2014 '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. 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. Since , S an Y. Sa er, S/RS Public Health Director Encl. Form 9B Local Installers List cc: Luke Roy, LJR Engineering Inc. 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 Commonwealth of Massachusetts Town of North Andover Local Upgrade Approval Form 913 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 Paul Miller key to move your Name cursor - do not 217 Gray Street use the return key. Street Address North Andover City/Town 2. Owner Name and Address (if different from above) �I Name City/Town Zip Code 3. Type of Facility (check all that apply): x Residential ❑ Institutional 4. Design flow per 310 CMR 15.203: 5. System Designer: 234 Park Street Address B. Approval MA State Street Address State Telephone Number ❑ Commercial ❑ School 440 01845 Zip Code gpd Luke Roy XPE ❑RS Name North Reading MA 01864 City/Town State, ZIP 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 217 Gray Street Local Upgrade Approval* Page 1 of 2 Y Commonwealth of Massachusetts _— Town of North Andover Local Upgrade Approval M Form 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ® Use of only one deep hole in proposed disposal area ® Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept Approving Authority Susan Sawyer October 7, 2014 Print or Type Name and Title i nature j Date 217 Gray Street Local Upgrade Approval* Page 2 of 2 Susan, In cases of "new construction" with use of the iniltrator chambers we have had to show a feasible replacement area for a conventional system ... but never done on a replacement design such as this. Not a problem if we have to add. We haven't been involved in obtaining certification from the Owner as required by the conditions you reference. Do you know is there a standard form for this certification/acknowledgement? Luke J. Roy, P.E. UR Engineering, Inc. 234 Park Street North Reading, MA 01864 978-664-8141 X 1a 978-664-8142 a978-664-8142 fax From: Sawyer, Susan[mailto:ssawyer@townofnorthandover.com] Sent: Thursday, October 09, 2014 1:30 PM To: Irov@Iirengineerine.com Subject: 217 Gray Luke, Sorry about the confusing messages today. I was ready to approve this and then noted that you were using infiltrators. Did you follow the standards conditions requirements? Specifically the highlights. Susan Since the (Infiltrator Chambers, Cultec Chambers, Eljen) 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. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system hat could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that is not capable of providing equivalent environmental protection;) iiSection 11(18): a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; C) certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: I. has been provided a copy of the Title 5 1/A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; ii. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to prov di e written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5);; iii. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and, iv. whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, 6clify or take any other action as required by the Department or the LAA, if the Department or the LAA determines he �ystem to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Owner's Certification for 217 Gray Street, North Andover, MA I, Paul Miller, owner of record of 217 Gray Street, North Andover, MA, hereby certify the following: I have been provided a copy of the Title 5 I/A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the agree to comply with all terms and conditions; ii. I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); iii. The design does not provide for the use of garbage grinders, the restriction is understood and accepted; iv. Whether or not covered by a warranty, I understand the requirement to repair, replace, modify 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. /kERNowledged: Paul Miller a 3 WO M Y .�....w� v v v v v • ' �.. ...r. IFNS NW..... ,r Uk k In codify aw: Gr/,'c R �• rrA%rn;l.racrmc.< Im< .mlisfecmdy completed Ou rzgnired tmbag prwemlm lin the INFII.TAA7TAm Icacltine NwnNr sYnen ( LMI•Si1e senI_ta dis timl or I. J� Itcr<MI - of iticd tc i1eW1 the INFILTRATOR^ Utm,lbcr Vn<sl..°Cph'rnrions. 7Li< <Invnehnurts DEI' ap7aw�l IcRer rnr IYFIL sysmm < t reNt by III- o"', ns sa frnh TUTOR Arab,field clumhers. All eaicr K,Iiti-It r" h Al the latest revttinl or 31 D CRM IS.aa cf Ti1k 5 will ,Pi,1),. 7Lis 1 I A isued 11ti< 391h day cf"Inc<•h 2.14 ' • Ccrlift"61-11: \IA 1144 Oq Lee V"I"idr• SYSTEMS INC �11i111UC Radal,y �,nnarr Environmental Onsite Wastewater Solutionss"' Luke Roy O'Neill Associates has satisfactorily completed the required training program for the installation of the INFILTRATOR® 4 leaching chamber system for on-site wastewater disposal applications. You are hereby certified to install the INFILTRATORO chamber system as set forth by the Massachusetts DEP approval letter for 4 INFILTRATORO drainfield chambers. All other guidelines asset forth by the latest revision of 310 CMR 15.00 of Title 5 will apply. This certificate was sealed and issued this 29t(tday of warch, 2004. 4 Certification No. 91144 Lee Verbridge Atlantic Regional Manager UR Engineering, Inc. Civil Engineers & Land Surveyors 234 Park Street North Reading, MA 01864 (978) 664-8141 Fax (978) 664.8142 To 0�}'h Prnd t1yiP.+' 4_e (01 n� } IJoo0 0SG0od �j , SvOe 2-03� Nov+h AIIAOvev , nn r4 ci t 53y.s" WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter L❑����Q OO Lr � � � U�J�L�AJ���Lr,�L� DATE C, 3 e JOB T4 O rb f ATTENTIONS ,Oto SawlV er RE: 2-1-7YoLS{,tcf- 5 { t i -c wLet*es6% 2, 49v w% p e,e,{�yy rv%ofv-%u- a verve ad.cL" , Attached ❑ Under separate cover via the following items: Prints ❑ Plans ❑ Samples ❑ Specifications le'e'v. ❑ Change order ❑ COPIES DATE NO. DESCRIPTION -H I 1;78 -F 2, 49v w% p e,e,{�yy rv%ofv-%u- a verve ad.cL" , 3 , FoY w v+,a-j' V% wct p ho ten a. Atj . N o f a he o n s ajd e d to lay. K g .•u � A- s,Zc is, m&J< -.0 v, -t s o+ -G 'W- l Q C` Q S LY r 19 G4gr Of - Qyt ✓ty a ( moL 1'A Iz-1e.Q. r�L CA_ }E CE b , % Gf- f, n,c. S = 17.2 -010 s o r� w+�,'�►, a��c�/ %o Y1!,`n *-Zo a s i ew-e (saAej g g mve i� = 100 °�° - try �- - THESE ARE TRANSMITTED as checked below: 4 4� Ai TH I)EPARiM NT P1 For approval ❑ Approved as submitted ❑ Resubmit REMARKS 19/ For your use ❑ As requested ❑ Approved as noted ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ Submit ❑ Return copies for approval copies for distribution corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US N oj-e •fit- l S sf-q �e S no w e i- l o H d "- S ova 0.rec w ,l -H I 1;78 -F 2, 49v w% p e,e,{�yy rv%ofv-%u- a verve ad.cL" , 3 , FoY w v+,a-j' V% wct p ho ten a. Atj . N o f a he o n s ajd e d to lay. K g .•u � A- s,Zc is, m&J< -.0 v, -t s o+ -G 'W- l Q C` Q S LY r 19 G4gr Of - Qyt ✓ty a ( moL 1'A Iz-1e.Q. r�L CA_ b , % Gf- f, n,c. S = 17.2 -010 s o r� w+�,'�►, a��c�/ %o Y1!,`n *-Zo a s i ew-e (saAej g g mve i� = 100 °�° - 17.290 = 82 • S% 7. No fe- added reya cyv !!, +esf o -F ex is +j -'t wks I -y •� a w►o,� s w WG��''j�` COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. h to e;s S f - - .%� � 1 _ f _ _ .. _ + North Andover Health Department (ommunity Development Division September 23, 2014 Luke Roy, P.E. LJR Engineering, Inc. 234 Park Street North Reading, MA 01864 Re: Subsurface Sewage Disposal System Plan for 217 Gray Street (Map 107D, Lot 112) Dear Mr. Roy: The proposed wastewater system design plan for the above site dated August 14, 2014 and received on September 2, 2014 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. A. Please show any wetland resource areas within 150' of the proposed system or provide a Zstatement indicating none exist (NA 3.2) Please provide a pump performance curve (3 10 CMR 15.220(4)(r)). Please indicate if a weep hole is proposed in the force main within the pump chamber to allow the effluent to drain back after the pump turns off. �4. Please indicate the size and materials of the manhole covers above the septic tank and pump chamber. Please specify the required annual maintenance for the effluent filter (3 10 CMR 15.227(7). 6. Please explain how the 82.8% of sand was determined from the sieve analysis of the soil sample. It is not clear from the sieve analysis report. Since the existing septic tank and pump chamber are proposed to remain in place, the health department shall require them to be tested for watertightness. Please explain the proposed method in order to demonstrate that the existing tanks are watertight. 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 L 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, Sus n.. . P�.tic H� cc: Paul Miller 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 `. 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 toamofnorthandover.com WEBSITE: htW://« v.to-,vnofnortliandover.coni SEPTIC PLAN SUBMITTAL FORM RECEIVEOO LHEALTH EP U 2 2014 Date of Submission: r NORTH DEPARTMENTER Site Location: 2 17 b ✓4 y Sf YeG 4 - Engineer: L%� &h 0 ) A -GvV T 6 n, + h G- New Plans? Yes J $225/Plan Check # (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes '/ No Local Upgrade Form Included? Yes `/ No Telephone #: gig -66q- q 'I N 1 Fax#: g10-66cf -S0Z E-mail: I Y O r e yr q u e e r i'n ol . (moo h n Homeowner Name: PA V M i l le, r OFFICE USE ONLY When the submis 'on is complete (including check): ➢ Date stamp plans and letter ➢ _Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts City/Town of No qth "jMv' Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordce ff4bo�.ISZZ.�;ode or 310 CMR 15.000. A. Facility Information Sep 0 2 2014 1. Facility Name and Address: TOWN OF NORTH ANDOVER VO OM 641U -6'r HEALTH DEPARTMENT Name 2 17 - trQ 4 S1�Y-GC} Street Address go t[+ W lov City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code 3. Type of Facility (check all that apply): d Residential ❑ Institutional Telephone Number ❑ Commercial ❑ School 4. Describe Facility: �► 19e roo wt c i owy I e �a n4 i' l y ct vte-,(t I ►may 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) [9' Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): S fiovu- 1 V'e'vtt kt- s t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* pproval• Page 1 of 4 Commonwealth of Massachusetts City/Town of MovrV- dovw� 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: q gpd Design flow of proposed upgraded system 4q gpd Design flow of facility: gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): aVoluntary ❑ 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: Co,,sfvvt -t av, of nGw Stq--S cv., t'syo QvcckH s-I�Jkd a -ed cha.w41PZvS 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ft. min./inch ft. t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of Ptd WY W 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater Use of only one deep hole in proposed disposal area [� Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name (type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: F_x;s4-f,e7 4-e Ce V1 S. ' o -1 -w& --s - focah'" of e�r►Lfs�wM P -ill. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: K S'I LyvOf O t -k,4 — t/A- 01 w f Av4e, � C,O�.,et n" L-1 l- e-e-bef req vw-skd t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/ Town of Noft* Pmdpolw�- 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. C. Explanation (continued) 3. A shared system is not feasible: No al"ftt'ys U»,a radr X-C 4. Connection to a public sewer is not feasible: NO sewer 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): [j Application for Disposal System Construction Permit E' Complete plans and specifications [V Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Sec aHvrhed I Facility Owner's Signature Print Name Luke 7, RD Name of Preparer 2-3q PC rk Siytk+ Preparer's address MA ot2)6H State/ZIP Code a -P a�l->1anZat�an Date q I211"j Date Mor rk City/Town li6-66�t-�tN1 Telephone t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4 fotrevL+ Soi( SIEVE SIZE PERCENT FINER SPEC.* PERCENT PASS? (X=NO) 1.5" 100.0 Particle D30= 0.1777 1 " 96.6 Size Distribution 3/4" 93.8 USCS= SM 3/8" Report #4 79.5 #10 71.2 #20 59.8 #40 < .� #50 41.2 0 000 #100 26.8 0 o00 0�0 #200 17.2 100 I I I I I I I I I I I I I I I I 90 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I 1 I I I I I I I 1 I I I I I I I I 80 I I I I 1 I I I I I I I I I I I I I I I 1 I I I I I 1 I I I I I I I I I I I I I I I I 1 I I I I I I I I I I ! I 70 I 1 I I 1 I I I I I I I I 1 I 1 I I I I 1 I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I 1 I t I 1 I 1 I I I I I I I I f I I 1 I I I I 1 1 I ! I I I I Z 60LL 1 I I 1 I 1 1 I I 1 I 1 I I 1 I I I I I 1 I 1 1 I I 1 I 1 1 1 1 I I Z50 I I ! 1 I W I I I 1 1 ! I 1 I I I I I I U I I I I I I I I I ! I I 1 I I I W 40 I I I I I 1 I I I I I I I I I I I I I I I I I I 1 I I 1 1 1 1 I I I I I I I I I 30 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 20 I I I I I I I I 1 I I I I I I I 1 1 I I 1 1 I I 1 I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I 10 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I ! I 1 I I I I I I I I I I I I 1 I I I I I I I I I 1 I I I I 0 I I I I I I 1 1 1 1 JL I I 1 I I I I I I 100 10 1 0.1 0.01 0.001 GRAIN SIZE - mm. % Gravel % Sand % Fines %+3" LCoarse I Fine Coarse I Medium I Fine Silt Clay 0.0 6.2 1 14.3 8.3 1 22.7 1 31.3 17.2 SIEVE SIZE PERCENT FINER SPEC.* PERCENT PASS? (X=NO) 1.5" 100.0 D50= 0.4608 D30= 0.1777 1 " 96.6 Cu= Cc= 3/4" 93.8 USCS= SM 3/8" 86.8 #4 79.5 #10 71.2 #20 59.8 #40 48.5 #50 41.2 #100 26.8 #200 17.2 Material Description F -M SAND, SOME GRAVEL, LITTLE SILT Atterberg Limits PL= NP LL= NV PI= NP Remarks (no specification provided) Source of Sample: ON SITE, EXISTING Sample Number: 926 Date: 8/01/2014 UTS OF MASSACHUSETTS, INC. Client: LJ R ENGINEERING, INC. 5 Richardson Lane Project: 217 GRAY STREET, NORTH ANDOVER, MA Stoneham, MA 02180 Project No: Figure Coefficients D90= 12.9890 D85= 8.0182 D60= 0.8602 D50= 0.4608 D30= 0.1777 D1 5= D10= Cu= Cc= Classification USCS= SM AASHTO= A -1-b Remarks (no specification provided) Source of Sample: ON SITE, EXISTING Sample Number: 926 Date: 8/01/2014 UTS OF MASSACHUSETTS, INC. Client: LJ R ENGINEERING, INC. 5 Richardson Lane Project: 217 GRAY STREET, NORTH ANDOVER, MA Stoneham, MA 02180 Project No: Figure 1 '10 �- jo -,Otv t"I 100 90 80 70 w w 60 Z LL Z 50 W U W 40 i- 30 20 10 0 Se'etil. SpahA F� I I Particle Size Distribution Report VRFIIIV JILC - IIIII I. %+31. % Gravel % Sand % Fines Coarse Fine Coarse Medium Fine Silt Clay 0.0 0.0 0.0 7.1 54.7 34.8 3.4 SIEVE SIZE PERCENT FINER SPEC.* PERCENT PASS? (X=NO) #4 100.0 100.0 Coefficients #10 92.9 D85= 1.3272 D60= 0.6558 #20 71.1 D15= 0.2509 D10= 0.2000 #40 38.2 Classification #50 21.1 10.0-100.0 #100 6.6 0.0-20.0 100% OF THE MATERIAL PASSED THE 3/4" SIEVE. 3.8% #200 3.4 0.0-5.0 Material Description SEPTIC SAND STATE ENVIRONMENTAL CODE TITLE V SEPTIC SAND GRADATION REQUIREMENTS Source of Sample: ON SITE, TITLE V SAND Sample Number: 925 Date: 8/01/2014 UTS OF MASSACHUSETTS, INC. Client: LJR ENGINEERING, INC. 5 Richardson Lane Project: 217 GRAY STREET, NORTH ANDOVER, MA Stoneham, MA 02180 Proiect No: Fiaure Atterberg Limits PL= LL= P1= Coefficients D90= 1.6762 D85= 1.3272 D60= 0.6558 D50= 0.5335 D30= 0.3632 D15= 0.2509 D10= 0.2000 Cu= 3.28 Cc= 1.01 Classification USCS= SP AASHTO= Remarks 100% OF THE MATERIAL PASSED THE 3/4" SIEVE. 3.8% BY WEIGHT OF THE SAMPLE RETAINED ON THE NOA SIEVE. STATE ENVIRONMENTAL CODE TITLE V SEPTIC SAND GRADATION REQUIREMENTS Source of Sample: ON SITE, TITLE V SAND Sample Number: 925 Date: 8/01/2014 UTS OF MASSACHUSETTS, INC. Client: LJR ENGINEERING, INC. 5 Richardson Lane Project: 217 GRAY STREET, NORTH ANDOVER, MA Stoneham, MA 02180 Proiect No: Fiaure 0 CL 6 a) m 3 1 0 L- 0 O H-� N Q N cv � N � R �sCl) Z cn � 1 od � O r E E E L- 0 O O U U LL O E 1_ 0 C LL. A � r 0 0 a cuLX2 N T 4LA � m N U E 45E z r -o — Q a) 1 V 3 ( w O in CU CL c ca n m c°n � 0 a) U U N U) c c �0 0 Z 0 a. 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Sawyer, REHS, RS 978.688.9540 - Phone Public Health Director 978.688.8476 - FAX healthdept a)townofnorthandover.com www.townofnoi-thandover.com APPLICATION FOR SOIL TESTS DATE: 61 :2 S ( I I MAP & PARCEL: 167. D /I 1 Z. LOCATION OF SOIL TESTS: 2-17 Gv& V S tvee } OWNER: PC. y I M i 1 I eiy Contact #: 1j)0 -;q77 -52o,3 APPLICANT: h C A I H S i A4 0-Y- j Contact #: SD — q s$- Z 0 U Z, ADDRESS: P.O. V�pk ENGINEER:9 ��"� YvtGG�1 V�l� �VIG • Contact#:RE CERTIFIED SOIL EVALUATOR: L V [ e Roy � CEIVE® Intended Use of Land: Residential Subdivision ingle Family Ho e Commercial JUL 0 2 2014 Is This: Repair Testing: Undeveloped Lot Testing:_U rade for Addition: TOWN OF NORTH ANDOVER p g' ppg e HEALTH DEPARTMENT 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 Testing (please indicate test nit 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. ➢ Oniy 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: Signature of Conservation Agent: Date back to Health Department: (stamp in): North Andover MIMAP 217 Gray St., N. Andover June 25, 2014 _:::�Jc:-:_I,r.::_:`',•._:'"I!� 107.D-0013 iy::::: =.vl ,�:.. .: '.._: I •! •.. 10 STILES ST \ "- 107.D-0014 i�Ll. ':.iii... J\I.l. .":.:: • 15.�FG:. .'b -',.�_I( .:..:1 u `::•:: ,SJ< :_:_ �� ',"'..:::alr� .:.... 169 GRAY ST 107.D-0012 ::. -::lir..:_: '-:::.... 1SlI,r .:_::. ••:. "'_: '•�.... :�::. :.S C. .. :::: S?�/.l..:�::. :SSI/.l. •.' a tee alu . , �,..:I.:-::.:: T' :: •,1..: aUc•. '"::: 107.D-0110 _:.: vli� , ._:._ _..,1u _:..• : 193 GRAY ST le ._:_:.; .:_ t, l!? :: i.., -�x.U^'. ':`•-::.. �(,,� :: �,::: •�,1�07.D-0011 IA-::: V . 107.D-0111 -� �.U� .:_ _: : ,;.::-•-=;.0 ' ` ':::'_:::::' 205 GRAY ST 107.D-0052 wl(c tr, .::::•'•;z,.lu.'�'_.:aJ.0 : Sit ,i�� :==.s•.: rl . ...... 107.D-0112 _::' '-- "�' '== 217 GRAY ST I�z ' &N 107.D-0130 6 % 6 190 GRAY ST _ Y 107.D-0113 229 GRAY ST 212 GRAY ST 107.D-0129 {'. 230 GRAY ST r� 107.D-0122 107.D-0128 U:. 107.D-0127 107.D-0123 107.D-0126 — Rail Line late I rstates — Horizontal Datum: MA Stateplane Coordinate System, Datum NAO83, — SR pORTM Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of Roads r Easementse O! a o qa s r `e OQ North Andover. Additional data provided by the Executive Office of Environmental Affaim/MassGIS. The information depicted on this map is 0 MVPC Boundary3 C3 Municipal Boundary L for planning purposes only. It may not be adequate for legal boundary definition or regulatory Interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING - Trails 11 r► THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY Parcels • .; Y 1F OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT • o9 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF [ : Hydrographic Features .J�'o�... THIS INFORMATION Streams SSACMUS� - Wetlands Exempt Lands 1"= 115 ft "'�" June 30, 2014 To: Town of North Andover Re: Simard Construction- Septic 217 Gray St. Please use this letter as authorization for Simard Construction to perform whatever service is necessary on my property at 217 Gray St. North Andover, including testing, permits and excavation concerning my septic system. If there are any questions, please call me at 978-697-5203. a u, Z Paul E. Miller N 0 Y U O J m W CD 0 0 J w U Q a ate V Go Q Lu W LU J J w J Q c in as w QN lx �... a�JJ .�p N Z 00 00 IT (D rno � N 0 m rn c6 d ! 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W >1 i) vn t6 �• FMi 1� `w 2 LL i.. = ILL 1p'CI ,E v', i a° cn 0 m rn c6 d Blackburn, Lisa From: Isaac Rowe <irowe@mill riverconsulting.com> Sent: Tuesday, July 29, 2014 4:18 PM To: Blackburn, Lisa; Sawyer, Susan Cc: 'Pam Lally'; 'Isaac Rowe' Subject: RE: 217 Gray St. Attachments: 217 Gray St - Soil testing results 7-29-14.PDF Susan/Lisa, Attached are the soil testing results for the above referenced property. There is a good amount of sand fill from the existing system above the C layer. Luke and I both took a sample of the sand fill for analysis. He also took a soil sample of the C layer as it was too wet to conduct a perc test. Please confirm that you would like us to send the sand fill sample out for analysis and review. Also 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(@millriverconsultine.com www.millriverconsulting.com -----Original Message ----- From: Blackburn, Lisa [maiIto: LBlackburn@townofnorthandover.com] Sent: Thursday, July 03, 2014 10:38 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: 217 Gray St. Good Morning, Please contact Luke Roy to set up a date for soil testing. Have a great 4th of July! -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Thursday, July 03, 2014 10:45 AM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). �.._ , �`±"1L�L..r. L.�.4 I� �i�_�I �_ ,.. i1 �.�-,,rtra i""��_!/2.�U��:�fJLy'a'�� k Blackburn, Lisa From: Pam Lally <plally@millriverconsulting.com> Sent: Tuesday, July 08, 2014 10:52 AM To: Blackburn, Lisa; 'Isaac Rowe' Subject: RE: 217 Gray St. Hi Lisa, We have scheduled this soil testing with Luke Roy for Tuesday, July 29th. Isaac will be there at 9:30am. Please let us know if you have any questions. Thanks, Pam -----Original Message ----- From: Blackburn, Lisa [mailto:LBlackburn@townofnorthandover.com] Sent: Thursday, July 03, 2014 10:38 AM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Subject: 217 Gray St. Good Morning, Please contact Luke Roy to set up a date for soil testing. Have a great 4th of July! -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Thursday, July 03, 2014 10:45 AM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 07.03.201410:44:59 (-0400) Queries to: noreply@townofnorthandover.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/preidx.htm. Please consider the environment before printing this email. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 I J 5LOPE , ejEOV /f EAWEO (/50) X /50 -- = . . DES/CSN EL EVdT/ON AT.........(FOR OF 57 -ONE) _ . . EX/5T/N� FLED, rlm .or ......... REOU/iPzr'o F/LL = _ ...................... . . . FZEy,4FT101V5 DE5/0;1v .45 BU/LT /NY. P/PE OUT 0,-'-1-101-1.5E - /NV PIP,! /HTO T4Mlt' /NV PIPE OUT OF T4mv , „ - /NI/ PIPE /HTO D. BOX, /NV. P/PE OUT OF 0,30X - /NV. END OF PIPE !�t/, JTE2 EL E!/.4 T/ON .4 VE240E 5 TOS C DEPTH 47- f'EOBE NOTE.- 7///5 PL 4N /5 NOT,4 gY4,e,e.4NTY OF T11E SYSTEM BUT 4 YE2/F/C,4T/O/V OF T1 -/E 40"T/ON OF 7WE" E,Y/37/1V6 S7-lE'UC7-&e65. UU/L/ SUB-SU.PF.4CE O/SPO. SYSTEM /N FOR 5C.4LE: ; 1 DOTE: c11,ei5Ti4NSEN EN61NMEIN4�', INC. //4 XE/V0z.4 .411E. 1/4YE,e11M L, A44. OF VA 4, 00 O 9 9+ �9SSACMUSEt'� Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VSLMA �I Application for Septic Disposal System , � 6AY- S DAT Construction Permit - TOWN OF TOD'E ir NORTH ANDOVER, MA 01845 $250:00—Fu��ponent Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* 5D Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information 217 Tay sc Address or Lot # h/, A/VOOL/Vr City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ➢ ❑ Conventional System (pipe and stone system) ➢ ❑ Infiltrator 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 No if yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? 2. Owner Information PAuc /1A�It-c6 Name M n Address (if different from City/Town Email address What is the Model. State Zip Code 919 6 q I S"2o3 Telephone Number 3. Installer Information -'ohm Name Name of Company IkSk/N/-n& Jff 110 h' City/Town 4. Desianer Information Lupo tz A o V Name 73 `1 !'Allk sf- Address N./362APlyb City/Town M& State C wvse 01421 Zip Code 17 � f31S S7sy Telephone Number (Cell Phone #ifpossible please) L, I rt rN&. Name of Company State Zip Code q? 00 GG y f1It/ Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Application for Septic Disposal System TODAY'S DATE Construction Permit — TOWN OF $ 250.00 — Full Repair NORTH ANDOVER, MA 01845 $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential 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. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. 6-s-ls Name Date tion Approved ( a'rd o Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. FeeAttaclredP Yes No 2. Project Manager Obligation Form AttacbedP Yes No 3. Pump S sy tem? If so, Attach copy of Electrical Permit Yes No Applicant received copy of `Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approvalletter, all paperwork received. Yes No 5. Foundation As -Built? (new construction only): Yes No (Same scale as approved plan) 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 ' SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 2/1 (,RAY St - (Address of septic system) For plans by � / t rN61 & 94 n /N(. (Engineer) Relative to the application of —JaAx / vTd— (Installer's name) And dated (Original ate Dated o ay s ate With revisions dated I understand the following obligations for management of this project: (Last revised date) 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans rior 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. 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 of Bed - Generally, this is the first (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: healthdept@townofnorthandover.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 simple 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 license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff 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 am solely responsible for the installation of the system as per the approved -plans. No instructions by the homeowner, general contractor, or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 6-,4-1S Name - Print (Today's Date) (NameSigned) 7104 Town of North Andover SA­� HEALTH DEPARTMENT C14us CHECK DATE: LOCATION: Acn� st- H/0 NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) 0 Animal $ • Body Art Establishment $ • Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type. $ 0 Funeral Directors $- 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ 0 Tobacco $ • TrashlSolid Waste Hauler $- • Well Construction $ SEP77C Systems: 0 Septic - Soil Testing $ 0 Septic - Design Approval $ 01 7 Septic Disposal Works Construction (DWC) $15L -17 Septic Disposal Works Installers (DW[) $ 0 Title 5 Inspector $ 0 Title 5 Report $ 0 Other (Indicate) $- Health Agent Initiah White - Applicant Yellow - Health Pink - Treasurer 2,l Commonwealth of Massachusetts Map -Block -Lot 107.DO1 12 BOARD OF HEALTH ----------------------- Permit No North Andover - BHP -2015- - 02 - 50 ---- ------------ -- -- FEE $250.00 ----------------------- DISPOSAL WORKS CO T UCTION PERMIT Permission is hereby granted John -Butt --------- - --- ------- --- -------------------------------------------------------------------- to (Upgrade) an Individual Sewage Disposal Syst . , I atNo 2_17 GRAY -STREET ------------------------- -------- U ------ as shown on the application for Disposal Works Cons tion Peru .1 Issued On: Jun -08-2015 -- ----------- I -------------------------------------------------- BBP-2015-025 Dated June 08, 2015 to -------------- ------------------------------------------------- ------------------- ----------- --------------- BOARD OF HEALTH