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HomeMy WebLinkAboutMiscellaneous - 2198 TURNPIKE STREET 4/30/2018 (2)ry c=) 00 C_— ::)o ::)7 Z m I/ C tNe.S IM s rt� � Lot & Street/ �� Map/Parcel_ CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Designer: Conditions: Water Supply: Town Well Well Permit: Driller: Well Tests: Chemical Bacteria I Bacteria II Plumbing Sign -Off: Comments: Form "U" Approval: Date Issued Conditions: Final Approval: Approved by: Plan Date: Date Approved Date Approved Date Approved Wiring Sign -off: Approval to Issue By:_ YES NO All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION CONDITIONS: Is the installer licensed? YES NO Type of Construction: NEW REPAIR New Construction: Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO Issuance of DWC permit: YES NO DWC Permit Paid? YES NO DWC Permit # Installer: Begin Inspection: YES NO Excavation Inspection: Needed: Passed: Construction Inspection: Needed: As Built Plan Satisfactory: YES: 0 Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: t JM ASSOCIATES LAND PLANNING -ENGINEERING -SURVEYING 325 MAIN STREET NORTH READING, MA. 01864 TEL. 978-664-6668 FAX 978-664-8155 www.jmassociateseng.com Letter of Transmittal Date: August 3, 2017 To: North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Septic System Repair Design 2198 Turnpike Street, North Andover, MA 01845 We are sending you: Copies Date Description RECEIVE® AUG 0 0 20; TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 2 8-2-17 Septic System Repair Design Plans 2 8-2-17 Application for Local Upgrade Approval 2 7-31-17 Request for Variance 2 7-31-17 Owner's certification letter Note: Digital Plan to be emailed this date. Homeowner to deliver check for plan review fee. Cc: Jorge Solano Jack NIcQuilkin JM ASSOCIATES Land Planning -Civil Engineering -Surveying 325 Main St. North Reading, Ma. 01864 Tel. 978-664-6668 Fax 978-664-8155 www.imassociateseng.com August 1, 2017 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: 2198 Turnpike St. Subsurface Sewage Disposal System Plan (Map 108C Lot 6) Dear Mr. LaGrasse In response to the comments noted in your letter of July 20, 2017 we are submitting revised plans dated August 2, 2017. We have addressed your comments as follows: 1. A Local Upgrade Approval request is required for only test pit within the proposed disposal system area (3 10 CMR 15.404(1)(k). I have enclosed the LUA request. 2. A Title 5 variance request is required to have no percolation test within the proposed disposal system area (3 10 CMR 15.104(4)). I have enclosed the variance request 3. A dote or chart is required to be on the design plan listing all variances and Local Upgrade Approvals (NA 3.2). A note has been added to the design plan 4. Please submit the Local Upgrade Approval request form 9A with the revised plan. The L UA request is enclosed 5. On sheet 1 of 2, the site plan view does not depict the proposed firish grading as shown on the profile view. Also make sure the proposed finish grading meets the breakout requirement for all trenches. The current existing grading does not meet the breakout requirement for trenches #I and#2. I have added finish grading to the site plan. Also I have re-evaluated the elevation of seasonal high ground water beneath the proposed trenches. I plotted a seasonal high ground water elevation line between test pits 6 and 7. This plot resulted in the revised seasonal high water elevations shown on sheet 2. These revised elevations allowed me to lower the system by 0. 78feet and as a result the system is no longer a mounded system. 6. Indicate on the design plan any Natural Heritage & Endangered Species Program mapped areas (NA 3.2). Mass GIS maps indicate an area in close proximity to the proposed disposal system. The Natural Heritage and Endangered Species Line has been added to the plan. 7. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and./or Approved for Remedial Use" w=ill apply. Please provide the following as required by the approval conditions Section II(18): - proof'that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; No specific trainin is by the designer for the design of technology - certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 13.000; and A note has been added to the designplan a certification, signed by the Owner of record for the property to be served by the Technology, stating that the properly Owner. - 1. has been provided a copy of the Title 511A technology Approval, the Owner's Manual, and the Operation and Maintenane Manual, and the to ,nivnly with all tpvm,c and ronditinn.c A certification by the owner is enclosed 2. for Systems installed under a Remedial Use Approval, the owner agrees to fia�fizll his responsibilities to provide a Deed Notice as required by 310 CTR 15.287(10) and the .Approval; -1 for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the .Approval to any nein Owner, as required by 310 CMR 15.287(5): Items 2 and 3 above are specifically waived b the he Infiltrator approval letter U 4. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 5. whether or not coveted 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 Departinent or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 3.10 CCR 15.303. A certification by the owner is enclosed addressing 44 and S S. In accordance with Section II(7) of "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use", please provide a best feasible upgrade plan. A best feasible upgrade plan is shown on the design plan. I trust that we have adequately addressed your comments and we hope to receive your approval of this design as soon as possible. Very Truly Yours, ja nt, dit, John McQuilkin PE Principal Engineer JM Associates Cc: Jorge Solano Commonwealth of Massachusetts City/Town of a Form 9A — Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or noncontorming 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 1. Facility Name and Address: Jorge Solano Name 2198 Turnpike St Street Address North Andover City/Town 2. Owner Name and Address (if different from above): Same Name City/Town Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: Residential Septi 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Unknnwn Ma State Street Address State Telephone Number ❑ Commercial ❑ Conventional 01845 Zip Code ❑ School ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Infiltration Chamber Trenches Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval- Page 1 of 4 Commonwealth of Massachusetts City/Town of a W Form 9A — Application for Local Upgrade Approval a ;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: Design flow of proposed upgraded system 330 gpd .3n gpd 330 Design flow of facility: 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: Existing leaching facility and septic tank to be removed and replaced with 1500 gallon septic tank and four infiltration trenches. 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 in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater Local Upgrade Approval.doc • rev. 7/06 ft. min./inch ft. % reduction Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of Application for Local Upgrade Approval Form 9A - 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: 15.104(4) no perc test within the proposed disposal system area. 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 aroundwater evaluation determi r ec- Evaluator's Name (t pe or print) Sign ture to evaluation C. Explanation site Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: A conventional system was considered but due to excessive fill being placed on the lot in the past the 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: The system is in feasible and in compliance with the exception of only one test pit being excavated within the proposed leaching system and the perc test being performed outside of the proposed leaching system. Perc test could not be performed due to an excessive amount of fill. Second test pit could not be performed due to proximity of the existing system. . Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: Not applicable 4. Connection to a public sewer is not feasible: Prohibitive cost. 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other (List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Sig ture Jorge Solano Print Name JM Asso ates Name of Preparer 325 Main St. Preparer's address Ma 01864 State/ZIP Code Local Upgrade Approval.doc • rev. 7/06 Date 7-31-17 Date North Reading City(rown A78-664-6668 Telephone Application for Local Upgrade Approval- Page 4 of 4 JM ASSOCIATES Land Planning -Civil Engineering -Surveying 325 Main St. North Reading, Ma. 01864 Tel. 978-664-6668 Fax 978-664-8155 www.imassociatesene.com July 31, 2017 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: Variance Request 2198 Turnpike St. Septic System Dear Mr. LaGrasse On behalf of Mr. Jorge Solano I hereby request a variance from the North Andover Board of Health in regard to section 310 CMR 15.104(4) —percolation test. 310 CMR 15.104 (4) requires a percolation test to be performed at every proposed disposal area. An excessive amount of fill was placed at this site in years past. In our Test Pit #7 there is seven feet of fill and another fourteen inches of buried "B" horizon. The combination of that excessive fill and a groundwater table determined to be high up into the `B" horizon makes the possibility of getting a percolation test in the "C" horizon all but impossible. A percolation test was able to be conducted at Test Pit #6 in nearly identical material. It is my opinion that a level of environmental protection equivalent to that provided under 310 CMR 15.000 can be achieved without strict application of the provision of CMR 15.104(4). Thank you for your attention to this matter. Very Truly Yours, *4W,J" John McQuilkin PE Principal Engineer JM Associates Cc: Jorge Solano July 31, 2017 2198 Turnpike St. North Andover, Ma 01845 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: Septic System Design 2198 Turnpike St., North Andover, Ma 01845 Dear Mr. LaGrasse I hereby certify that I am the owner of the above property and that (1) I have been provided a copy of the Infiltrator Technology Title 5 I/A approval letter, Owner's Manual and Operation and Maintenance Manual and that I agree to comply with all terms and conditions of these documents, (2) I understand the design does not provide for the use of garbage grinders, (3) That, whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Dept. of Environmental Protection or the North Andover Board of Health if the Dept. or Board of Health determines the system to be failing to protect public health and safety, and the environment as defined in 310 CMR 15.303. Thank you for your attention to this matter. Very Truly Yours, g— orge olano JIM ASSOCIATES Land Planning -Civil Engineering -Surveying 325 Main St. North Reading, Ma. 01864 Tel. 978-664-6668 Fax 978-664-8155 NvNvw jmassociatesena.eorn July 31. 2017 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: Variance Request 2198 Turnpike St. Septic System Dear Mr. LaGrasse RECEIVED AUG 0 9 2011 l TOWN OF NORTH ANDOVER BETH DEPARTMENT On behalf of Mr. Jorge Solano I hereby request a variance from the North Andover Board of Health in regard to section. 310 CMR 15.104(4) —percolation test. 310 CMR 15.104 (4) requires a percolation test to be performed at every proposed disposal area. An excessive amount of till was placed at this site in years past. In our Test Pit =7 there is seven .feet of fill and another fourteen inches of buried "B" horizon. The combination of that excessive fill and a groundxvater table determined to be high up into the "B" horizon makes the possibility of getting a percolation test in the "C" horizon all but impossible. A percolation test was able to be conducted at Test Pit 46 in nearly identical material. It is my opinion that a level of environmental protection equivalent to that provided under 310 CMR 1.5.000 can be achieved without strict application of the provision of CMR 15.104(4). Thank you for -your attention to this matter. Very Truly Yours. John McQuilkin PE Principal Engineer JM Associates Cc: Jorge Solano July 31, 2017 2198 Turnpike St. North Andover, Ma 01845 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: Septic System Design 2198 Turnpike St., North Andover, Ma 01845 Dear Mr. LaGrasse I hereby- certify that I am the owner of the above property and that (1) I have been provided a copy of the Infiltrator Technology Title 5 UA approval letter, Owner's Manual and Operation and Maintenance Manual and that I agree to comply with all terms and conditions of these documents, (2) 1 understand the design does not provide for the use of garbage grinders, (3) That, Nvhether or not covered by a warranty. I understand the requirement to repair, replace, modify- or take any other action as required by the Dept. of Environmental Protection or the North Andover Board of Health if the Dept. or Board of Health detennines the system to be failing to protect public health and. safety, and the environment as defined in 310 CMR 15.303. Thank you for your attention to this matter. Very Truly Yours, Jorge Solano r' JM ASSOCIATES Land Planning -Civil Engineering -Surveying 325 Main St. North Reading, Ma. 01864 Tei. 978-664-6668 Fax 978-664-8.155 ss wNN-.iivassociat€sen�.cotti August 1, 2017 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 0184 Re: 2198 Turnpike St. Subsurface Sewage Disposal System .Plan (Map 108C Lot 6) Dear Mr. LaGrasse In response to the comments noted in your letter of Julx 20. 2017 Nve are submitting revised plans dated August 2. 2017. We have addressed your comments as follows: 1. A Local Upgrade ApprovaA request is required for only .est PIT within the proposed :Disposal svztem area (3.0 COIR 1 .?0 t(: fl" k). have enclosed the L UA request. _. Title var.a_ic - request is required to have no percolation tesi Nvtin the proposed disposal sti-stem ares (.) 10 C:i\riR 155.104'-4)). I have enclosed the I-arance request A. note or Chan is required to he on the design ,,)'an listing all variances and Local Lpygrade .Approvals 4 A note has been added to the design plan 4. Please sulit the Local L:pgrade Approval _CC :o bsrris 9A with the revised plan. The LU'A request is enelosed �. 0il Chi - C% ?1t. itc' plcIl i' eii' (yV�� 0_ Llc^p_ t itt' proposed finish zra4Ln2 as SIC% on the pro5l vic.,v, Aso t. a.KC sure the proposed finish VT''a inW mei t5 the breakout req ii"e C. t fp,' all trCnches. LIIC C' rleil_ exi5thiq Rradina ijoCS not 1 eet d e breakout reyliirernen for renCheS -1 aI 1 have added finish grading to the site plan. Also I have re-evaluated the elevation of.seasonal high ground (eater heneath the proposed trenches. 1 plotted a seasonal high ground water elevation line bella-een testpits 6 and 7. This plot r-esulted in the revised seasonal high i.t-ater• elevations shoivn on sheet 2. These remised elevations a11ol2ed nre to loll er the .sy,slern by 0.'8,feet and as a result the s�vslerrr is n0 lOnger a mounded .SVstern. a 6. Indicate on the design plan any Natural Heritage K Endangered Species Program mapped areas (_\ L.J. Mass � *?,2: incicate an a"Ca ,_. los f I"io5 iT i:t� t0 the I)'io ?C scC disposal s>>stenn. The 1Vatm al Heritage and Endangered Species Line has been added to the plan. Si ce the In i trator C:_ Her s sie n , " a i In is �:opc.sed an azteri: tine soil a sorpr on s L'stem t} , `Standa;'d Condition- fol Aia-i- e Soil Ab:orpiion S st _ s ti,.-i.h Ge _era: Use Cernlica ion and or Appro eci =or Rernemal ;:)c ' wii, apply. Piea7e protide the o.sing as require d'b, ;he :,enciiticns Section Ii(<8`: %'OOf tt at 12e ne.)ly�r c }?fI SC1ti�7ClCi�i'll'' GGMp'''G'd czny required ira.lnina �;: COm"'Cl'I% 10 7, ill !1eSUr! aieCi 1135.Ci1.Ct1'ZO11 Q, -tile '��o specific training is i'e z.rired by the deli ner for' the deli<<�ofthis technol C i"t JiCai oi, .'Cit .rte LIe:S`igii�i" `ha.i t%iB lde•)i 1, Colifiriw's x- :`lie nJ;zwroval, aiib' Compa ,Y Desivi? Gz.iiakmce, armm 310 C,1,,fR 1J.UJfI: an•.'i A note has been added to the design JI lyn p 7 t jrc?2l1 l it'ce �'rt dei. `. ' a. C % C'Giti!i 2. ` r i 0/ 1`e.CVv , ✓1" ii2ei ; 17j �,r'i',' !o be Fem--e � �1% iri .TeCr,, 'lfJ� s Ci,liic' %slat it?e pi'CJpc.r "i �?�i2ei': Lias seen r-i•ot,ided a coyFv o t'le Title = PA tec. ,zo om ,4lJpr :wi, 0,t'i%er > f,cii:r<_al; arta%1.1%,' O'reiration an! l lin ,t �.cttrtC'1tai1C',c, :�.iatiL.ai; (7i117 flit? ( /1'ri(ni' T �r'Pf i in i^/iii1T h% ? 'i;l^r /I?! ,%Ri'F"r7.S /lilt (..`OF2C11t`Ioi'7C' A cei`hflcatlon by the ownei" Is enclo.ml ?. for" SVster}is zrrstalled 2m d'ev a .Remedial U e �?ppr•ovu_.1., Zhe 01.'rtei" agrees to_fif7lill his responsibilities to provide a Deed _,notice as r eC1c ii ed b 31 0 CII' 1 and the _4ppr oval, 3. Joy S,.szerr?,s in.n stalled 2uer a Remedial C se.4ppr-oval, tl2e o1i:rer agrees tovf ll; 11 r`'2is !r <<,,onsifJilities fn ;ro, ide 1,'r'itten notificatiot 7 0!`ihe _7)Droval Wai%i' iteli' Q'st'iie'?', its 3'E'Cti!?i'ea fJ ' 31 CMR 1� �8 Items 2 and 3 above a -e specificcllly waived by the Infiltrator approval letter 4. 40he dc-Sicn does 72otprav;de fibr ihe zine of-gal-bage arinders the - I g ,esIr� ic'40n, R . is 'mclerstood and accepted; and I j 7 7ether or not coveredlbv atheSystern 0,.vner understaizds the req;1z),em.ent 70 7-epaz . 7-, replace, modify oi- takeanY Other action as reqm . i -ed h- ; 1he DePartmem or the L4.4, if the Depavtm,ew of the L.4..,4 de!e?-7-1-7z';2es the sv-slem to lhejaizinla to protect pubic healt' and safety aiidlh e e7` Vw, onment, as del M 310 CAIR 1.5.3003. A certification bi, the owner is enclosed addressing :44 and 5 S. in accordance vviull S--,Ction 11(7' of "Standard Condit-onsfor A'ternanlve Soli Absorption Svsierns vvitil Genera ll U.so Ccn..-Ficanon and. or A--oprm-Ited for Rcmedial U --,e"- picase Provide a -,beSt f'cas.0011-, uperaidc p I 11an. A best feasible upgrade plan is shoivn on the Iesign glcinv I trust that we have adequately addressed your comments and we hope to receive your approval of this design as soon as possible. Very 'Truly Yours, JI/ John McQuilkin PE Principal Engineer JM Associates Cc: Jorge Solano r• Commonwealth of Massachusetts —= City/-rown of =; 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 accordance with either the 1978 Code or 310 CMR 15.000. City/Town Zip Code 3. Type of Facility (check all that apply): Zl Residential ❑ Institutional OTIR State Street Address _.._._..... __........... __.._.._— state Telephone Number Commercial ❑ School 01845 __....__........ Zip Code 4. Describe Facility: Residential Septic System „......... - ........ ----.......... -- 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ❑ Conventional ❑ Other (describe below): Unknown 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Infiltration Chamber Trenches _ Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval- Page 1 of 4 A. Facility Information Important: When filling out forms 1. Facility Name and Address: on the computer, use only the tab Jorge Solano key to move your Name cursor - do not 2198 Turnpike St use the return ---� Street Address key.---- North Andover Q CityITown 2. Owner Name and Address (if different from above): Same Name City/Town Zip Code 3. Type of Facility (check all that apply): Zl Residential ❑ Institutional OTIR State Street Address _.._._..... __........... __.._.._— state Telephone Number Commercial ❑ School 01845 __....__........ Zip Code 4. Describe Facility: Residential Septic System „......... - ........ ----.......... -- 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ❑ Conventional ❑ Other (describe below): Unknown 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Infiltration Chamber Trenches _ Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval- Page 1 of 4 r Commonwealth of Massachusetts r City/Town of + W Form 9A - Application for Local Upgrade Approval s !`` 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: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 330 gpd 330 gpd 330 .gpd 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: Existing leaching facility and septic tank to be removed and replaced with 1500 gallon septic tank and four infiltration trenches. _ __ —_....._....__._._—._...--..._ 3. Local Upgrade Approval is requested for (check all that apply): Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up ito 25% —.... SAS..._size.sr,__— __—.ft._ - ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ft. min./inch ft. % reduction Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval, Page 2 of 4 !� Commonwealth of Massachusetts —_-- City/Town of r. 1 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 Z 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: 15.104C444�0 �erc test within thepro�osed disoosastem area. _______.._. . _......._.__-- .... 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 determinLd,_ y -/` Evaluators Name (type or print) Signature / Date ,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: A conventional system was considered but due to excessive fill being placed on the lot in the past the site had limited area. -- ---- 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: The system is in feasible and in compliance with the exception of only one test pit being excavated within the proposed leaching system and the perc test being performed outside of the proposed leaching system. Perc test could not be performed due to an excessive amount of fill. Second test pit could not be performed due to proximity of the existing system_.— Local Upgrade Approval.doc • rev. 7106 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of Application for Local Upgrade Approval Form 9A - 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: Not applicable 4. Connection to a public sewer is not feasible: Prohibitive cost. 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 Z Complete plans and specifications 0 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.' rf' .-T __._. .. .... Facility Owner's Signature Jorge Solano=:'_ Print Name JM Assocfates Name of Preparer 325 Main St. Preparers address Ma 01864 State/ZIP Code �L-.......;. ...1� .....___.... ........�............_ Date 7-31-17 Date North Readinc City/Town 978-664-6668 –.._—_-_.__.—..... TeiepFone Local Upgrade Approval.doc • rev. 7/06 Application for Local Upgrade Approval- Page 4 of 4 `t � NORry i! - O LSSA C H US�� North Andover Health Department Community and Economic Development Division July 20, 2017 John F. McQuilkin, Jr., P.E. JM Associates 325 Main Street North Reading, MA 01864 Re: Subsurface Sewage Disposal System Plan for 2198 Turnpike Street (Map 108C, Lot 6) Dear Mr. McQuilkin: The proposed wastewater system design plan for the above site dated June 20, 2017 and received on June 27, 2017 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. A Local Upgrade Approval request is required for only test pit within the proposed disposal system area (3 10 CMR 15.404(1)(k). 2. A Title 5 variance request is required to have no percolation test within the proposed disposal system area (3 10 CMR 15.104(4)). 3. A note or chart is required to be on the design plan listing all variances and Local Upgrade Approvals (NA 3.2). 4. Please submit the Local Upgrade Approval request form 9A with the revised plan. 5. On sheet 1 of 2, the site plan view does not depict the proposed finish grading as shown on the profile view. Also make sure the proposed finish grading meets the breakout requirement for all trenches. The current existing grading does not meet the breakout requirement for trenches # 1 and#2. 6. Indicate on the design plan any Natural Heritage & Endangered Species Program mapped areas (NA 3.2). Mass GIS maps indicate an area in close proximity to the proposed disposal system. 7. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Please provide the following as required by the approval conditions Section 11(18): Pagel of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 proof that the Designer has satisfactorily completed any required training by _ the Company for the design and installation of the Technology; ' - certification by the Designer that the design conforms to the Approval, any Company Design Guidance, and 310 CMR 15.000; and - a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 511A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; 2. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval; 3. 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); 4. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and 5. 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 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. 8. In accordance with Section II(7) of "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use", please provide a best feasible upgrade plan. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Since y, ti. rian J. LaGrasse, CEHT Director of Public Health cc: Jorge Solano File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 on (lP JM ASSOCIATES LAND PLANNING -ENGINEERING -SURVEYING 325 MAIN STREET NORTH READING, MA. 01864 TEL. 978-664-6668 FAX 978-664-8155 www.jmassociateseng.com Letter of Transmittal Date: June 22, 2017 To: J� N North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Septic System Repair Design 2198 Turnpike Street, North Andover, MA 01845 We are sending you: Copies Date Description 1 6-22-17 Septic Plan Submittal Form 1 6-20-17 Septic System Repair Design Plans 1 Form 11 1 Form 12 Note: Digital Plan to be emailed this date. Homeowner to deliver check for plan review fee. Jack McQuilkin I. TOWN OI= NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540 Phone 978.688.9541. FAX I�-MA1L: t�ealti7det�t��t=norttaat�dove�n�a.gov WEBSITE: tixtp:;Iw�vw,northandovern�a. ov SEPTIC PLAN SUBMITTAL FORM Date of Submission: 6/22/17 Site I,ocatioci: 2198 Turnpike Street Engineer: JJ.M. Associates, 325 Main Street, North Readinq, MA 01864 New Plans? Yes X❑ $275/Plan Check # (includes.1' submission and one re- review only) _ v" Revised Plais?Yes $125/Plan Check # to ti Site Evaluation Forms Included? Yes ® No Local Upgrade Form Included`? Yes No............ N/A Telephone #: 978-664-6668 1 Fax #: E-mail: jack@jmassociateseng.com .Homeowner .Name: lJorge Solano OFFICE USE ONLY When the s 1. , ion is complete (including check): _ Date stamp plans and letter Y _.... _...... Complete and attach Receipt Copy File; Forward to Consultant yEnter on Log Sheet and Database A SO Commonwealth of Massachusetts VI 2� �1p11 ��� City/Town of North Andover � _ Percolation Test a Form 12 j°TA��NO� C *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: When filling out forms A. Site Information on the computer, Jorge Solano use only the tab key to move your Owner Name cursor - do not 2198 Turnpike Street use the return Street Address or Lot # key. MA 01845 North Andover Q City/Town State Zip Code Contact Person (if different from Owner) Telephone Number B. Test Results t5form12.doc• 08/15 Perc Test • Page 1 of 1 4/13/17 12:00 6/6/17 12:50 Date Time Date Time PT 1 PT 2 Observation Hole # 30"/18" 54'717" Depth of Perc 12:00 12:50 Start Pre -Soak 12:18 1:05 End Pre -Soak 12:18 1:05 Time at 12" 12:59 1:15 Time at 9" 1:57 2:10 Time at 6" 58 min. 55 min. Time (9"-6") 19.33 mpi 18.33 mpi Rate (Min./Inch) Test Passed: ❑ Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Thomas Hector Test Performed By: Issac Rowe, Mill River Consulting Board of Health Witness Comments: t5form12.doc• 08/15 Perc Test • Page 1 of 1 "ORT" 7920 3s F 9 Town of North Andover `ti'•',,,,, :. HEA TH DEPARTMENT ,SSACM�St� CHECK #: DATE: j LOCATION: OC I1U( 6 H/O NAME:,_ O 4 no a CONTRACTOR NAMEa:!s,5o C--.,: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWCr $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) i 3 White - Applicant Yellow - Health Pink-- No Andover J&S Development dba 1600 Osgood St Stewart's Septic Building 20 Suite 2-36 Andover Septic No. Andover, Ma 01845 58 South Kimball Street Bradford, MA 01835 Date Name & Address Gallons Comments 1 -Ma Patter reality 81 Sawmill Rd 1500 Good 2 -May Mulcahyt350 Sharpners Pond Rd 1500 Good Grreeene 62 Willow Ridge Rd 3 Grandville 1000 Good 2500 Good -May; _¢apros59 4-MayRnco"n�115 Sherwood Dr 9-May,CaJlahn '40 Foster St 1500 Xsolids HG 1500 Good 10 -Ma Meler rn 1444 Salem St 1500 Xsolids 15-MayzDir ffRh Brenkin ridge Rd 1500 Good CDepari,175 Stone Cleave Rd 1500 Good 16 -May Martin 701 Forest St 1500 Good R Murphy16 Carleton Lane 1500 Good 18-May.anderg aaf 267 Old Ca ay 1500 Good ;Solano"2}1,9 Tnok S -rbAN �) j�7� 1000 Rh 21-May'Tfomicho f:15 Laconia Cir 1500 Good Reti 42 Cross Bow 1500 Good 24WACarbonell 1560 Salem St 1000 Good 29 -May Thurber 210 Farnum St 1500 Good C31ZMayC!! ary ,05 Winter green Dr 1000 Good * TOWN OF NOR'rH ANDD,UC- HiALTH DEPARTN?I=NT vo- Co r15e�^I/�i � 4lv® TOWN OF NORTH ANDOVER ¢s`w'ED.' G�0 Community & Economic Development HEALTH DEPARTMENT F_ 120 Mainn Street pp�� Q�QP NORTH ANDOVER, MASSACHUSETTS 01845 �� 978.688.9540 — Phone 978.688.9542 — FAX healthdept@northandoverma.gov www.northandoverma.gov APPLICATION FOR SOIL TESTS DATE: May 23,..2017 MAP&PARCEL: Map 108C Parcel 6 LOCATION OF SOIL TESTS: 2198 Turnpike St., (rear yard) OWNER: Jorge Solano Contact#: 978-857-4313 APPLICANT: Same Contact#: ' ADDRESS: 2198 Turnpike St., North Andover, Ma 01845 ENGINEER: JM Associates Contact#: 978-664-6668 CERTIFIED SOIL EVALUATOR: Thomas Hector/Jack McQuiIkin, P. E. Intended Use of Land: Residential Subdivision cSIZmil Commercial X Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11" Plot Dlan & Location of Testine (please indicate test Dit sites on the Plan ➢ Fee of $585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $440.00 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 Connnissio Proval Date: Signature of Conservation Agef Date back to Health Departmen (star in): w L 0 ra -0 (X, 0 (D U. CL (D o by V) cn a u c -W � �LLm 'u b -Ei CL waj 0) V� to . f f- �UJ V) 4`0 a ' c - .0 LLJ w 0 Lu to :6-- ti M = -cr 0� 0 SO N 1;" "% t - A V. NN." 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Town of North Andover ` '-�,,.,o .• HEALTH DEPARTMENT ,SSACNUStS / CHECK #: //o DATE: fs-1 LOCATION: o� / /4 S �nQ/ f H/ O NAME: .mS� a,no CONTRACTOR NAME: Ile C Type of Permit or License: (Check box) ❑ Septic - Design Approval ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ X—SepSEPTICS stems: tic- Soil Testing ��((��jj�� $� I o ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Hea gent Initials White - Applicant Yellow - Health Pink - Treasurer 40 54 )2, Lb Z: IA/ 2 sl I ■ 54 )2, Lb Z: IA/ 2 sl I A i TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street NORTH ANDOVER, MASSACHUSETTS 01845 APPLICATION FOR SOIL TESTS DATE: March 6, 2017 978.688.9540 — Phone 978.688.9542 — FAX healthdept@northandoverma.gov www.northandoverma.gov MAP & PARCEL: Map 108C Parcel 6 LOCATION OF SOIL TESTS: 2198 Turnpike St., (rear yard) OWNER: Jorge Solano APPLICANT: Same Contact #: 978-857-4313 Contact #: ADDRESS: 2198 Turnpike St., North Andover, Ma 01845 ENGINEER: JM Associates Contact#: 978-664-6668 CERTIFIED SOIL EVALUATOR: Thomas Hector intended Use of Land: Residential Subdivision mil Commercial Is This: Repair Testing: X Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter fiom owner permitting test) ➢ 8.5"x -11" Plot plan & Location of Testing (please hit icate test pit sites on t/re PkW ➢ Fee of $585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $440.00 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 Signature of Conservation Agent: Date back to Health Depart»rent: (stamp in): 7 cr % A % 1% +r,' a . 'F" .1 .'a L .ey„ w 1 '�. �,L .� �,...� ., -.i.• '4 \. y,i''11.x t t.i 't '. `i e \. t, *. !+*".,+ w ,!'M� v IL, V% I I, A % I Ni, %L\• Y I% lit % IN N 1, N •IN 'N y. "WIN VA 10! 1. *Vk **,1 -'N ly% -�N % "14. Ok i..'' "NIL \ IV ' Z N� '00i A % ,x� N A%�NNN.V N IN ,I No %y- '4 ±:.♦ «i' "15.5 ,♦ `4'a i`i 4�, 4"i,5� %N11I vv N, %o IN 11. -S y!,",1`5 % IN N %IN \s NN 4N tis. `l1%.`+ I N*S IN *L NA N. NN.` NON" N% 102' 0* V,% IN , 4'1;{. N O%N *1 NN N N, t , , % N, A .0A., IN, N. % \N A. N. 's. IN IN N'O�VNN,\ IA I. NN%4� YN *N`Nsl%%- NN NI. 0 X\ S Xfc A N N, N N, 11 -1 ro if U R5 u m OL o -'m C L k A6 .r.A—"- aj W u �c 00 uj co (Z 6- 0 v V) zcr < ol < 7 cr % A % 1% +r,' a . 'F" .1 .'a L .ey„ w 1 '�. �,L .� �,...� ., -.i.• '4 \. y,i''11.x t t.i 't '. `i e \. t, *. !+*".,+ w ,!'M� v IL, V% I I, A % I Ni, %L\• Y I% lit % IN N 1, N •IN 'N y. "WIN VA 10! 1. *Vk **,1 -'N ly% -�N % "14. Ok i..'' "NIL \ IV ' Z N� '00i A % ,x� N A%�NNN.V N IN ,I No %y- '4 ±:.♦ «i' "15.5 ,♦ `4'a i`i 4�, 4"i,5� %N11I vv N, %o IN 11. -S y!,",1`5 % IN N %IN \s NN 4N tis. `l1%.`+ I N*S IN *L NA N. NN.` NON" N% 102' 0* V,% IN , 4'1;{. N O%N *1 NN N N, t , , % N, A .0A., IN, N. % \N A. N. 's. IN IN N'O�VNN,\ IA I. NN%4� YN *N`Nsl%%- NN NI. cn- 9 v% X\ S Xfc A N N, N N, 11 -1 IN IS & o' lz C) 174 A, IN k A6 .r.A—"- cn- 9 0 s 7803 (i Of pORTq 1y � � a s r Town of North Andover � � r HEALTH DEPARTMENT ,SSACMU A ! e U CHECK #:1_ DATE: LOCATION: H/O NAME: SCJ /a,/) 4 31- CONTRACTOR NAME: %9 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : xSeptic Soil Testing - ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Hea Agent Initials White - Applicant Yellow - Health Pink - Treasurer 4/5/2017.?.A NOOVER Massachusee#ts:� 2198 Turnpike Street 1 message Town of North Andover Mail - 2198 Turnpike Street Toni Wolfenden <twolfenden@northandoverma.gov> Toni Wolfenden <twolfenden@northandoverma.gov> Wed, Apr 5, 2017 at 2:46 PM To: Isaac Rowe<irowe@miliriverconsulting.com>, Dan Ottenheimer <dano@millriverconsulting.com>, Pamela Lally <plaliy@millriverconsulting.com>, Michele Grant <mgrant@northandoverma.gov>, Brian LaGrasse <blagrasse@northandoverma.gov> Good Afternoon, Please find attached additional paperwork for 2198 Turnpike Street. Jen Hughes has signed the application however, JM Associates would like to test on the old septic system, please do not per Michele Grant. Thanks so much, Toni K. Wolfenden Health Department Assistant 978-688-9540 2198 turnpike st soil test info_1.pdf https://m ai I.google.com/mai l/u/0/?ui=2&i k=aOc6f4e4cf&view=pt&search=sent&th=15b3f7Obaefle36f&si m 1=15b3f7Obaefl e36f 1/1 x TOWN OF NORTH ANDOVER Go Community & Economic Development �00V 4J`Lp�1 �� HEALTH DEPARTMENT p� 120 Mainn Street PQ���o�������t NORTH ANDOVER, MASSACHUSETTS 01845 �<��O�e 978.688.9540 — Phone 978.688.9542 — FAX healthdept@northandoverma.gov www.northandoverma.gov APPLICATION FOR SOIL TESTS DATE: March 6, 2017 MAP & PARCEL: Map 108C Parcel 6 LOCATION OF SOIL TESTS: 2198 Turnpike St., (rear yard) OWNER: Jorge SolanoContact#: 978-857-4313 APPLICANT: Same Contact#: ADDRESS: 2198 Turnpike St., North Andover, Ma 01845 ENGINEER: JM Associates Contact#: 978-664-6668 CERTIFIED SOIL EVALUATOR: Thomas Hector Intended Use of Land: Residential Subdivision m'1 Commercial Is This: Repair Testing: X Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X 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 elan & Location of Testing (please indicate test pit sites on the plan ➢ Fee of $585.00 per lot for neve construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $440.00 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. N.A. Conservation Comn fission Signature of Conservation Date back to Health Department: Please Do Not Write Below This Line 151117 -- 0 0 a) r_ 0 CL CL CL -0 4� L) E CA CA Lf 0cla V) CL oj -Z; cra 0 -0 .2 a) W ui E ul m m T_ cu co o CL o LU M fo ca N 0 > LL —1 z 0- ZU) za A'A lb FR z .......... . . . . . . . . . . . . . . . . . . ................ ®r . .. ... .. CL ui R_ I .2t vl� 1 0;:, m Nilm Q Oil �-' NK F T., l!k K R M .4— CL Lul U 71 4-j 0. uj Cb— N TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street NORTH ANDOVER, MASSACHUSETTS 01.845 978.6889540 — Phone 978.688.9542 -- FAX healthdept@northandoven-na.gov www.northandoverma.gov APPLICATION FOR SOIL TESTS DATE: March 6, 2017 MAP & PARCEL: Map 108C Parcel 6 �°�a p _g RIEC21 ED LOCATION OF SOIL TESTS: 2198 Turnpike St., (rear yard) L 17 OWNER: Jorge Solano Contact #: 978-857-4313 . ---..-----tvCRTHANDCVER ................ APPLICANT: Same Contact #:�HEr���TH DEPARTMENT ADDRESS: 2198 Turnpike St., North Andover, Ma 01845 ENGINEER: JM Associates Thomas Hector CERTiFiED SOIL EVALUATOR: Contact #: 978-664-6668 Intended Use of Land: Residential Subdivision Famil Commercial Is This: Repair Testing: X Undeveloped Lot Testing: Upgrade for Addition: in the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WiTH THIS FORM No X ➢ Proof of land ownership (Tax bill, or letter fi•om owner permitting test) ➢ 8.5"x ]]"Plot plan & Location of Testinc (please indicate test pit sites on the plan) D Fee of $585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $440.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date hack to Health Department: (stamp in): N O CL N B d O L O d 7 v � to o � c CO y. Q O E r Zo � O C O E � L O :t! 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N �1 J _ o O o� N cw r c O N m U = J LL O y 00 OD L 00 1 r C 00 0) 0 z m C 0 Q 0 a) 0 En 0 O ilA 0 r8U- k/§ \ /- ca)2 G2W a°0 \CL\ �©o � 3k� n�- Z!2 .\k� § ED ice\ a §A0 \/g 7c2 f$( ESS% Ee> - ƒ\fLo > O_ 46 �2k2 §\-2 . �Ek2 /SSS O �a U) kC S a>®c m oe $ �2to « (D - S ■=$o 0 :3 @ E02 �cCf) m � \2/ _ X228 U) .2 6 | \ / 0 0 4/5/ "'7 Town of North Andover Mail - 2198 Turnpike Street Test Pit Locations NOR' x WEAN OVER Massachus�t�is:W Toni Wolfenden <twolfenden@northandoverma.gov> 2198 Turnpike Street Test Pit Locations 1 message tom@jmassociateseng.com <tom@jmassociateseng.com> Wed, Apr 5, 2017 at 3:08 PM To: twolfenden@northandoverma.gov Hi Toni, Please see the attached proposed test pit locations. i The proposed test pit locations will have to be dug around the existing leach field. It is our intent to put the septic system in the same location as the current system. We have wetlands and natural heritage priority habitat issues to the rear of our lot and to left of our lot so we want be as far away as possible. Please let me know if you need anything else. Thanks Toni, Thomas Hector JM Associates 978-664-6668 2198 Turnpike Street Test Pit Locations.pdf 164K 1 https://m ai I .googl e.com /m ai I/u/0/?ui=2&i k=aOc6f4e4cf&view= pt&search= i nbox&th=15b3f852a5f2b246&si m l=15b3f852a5f2b246 1 /1 110 d), �6 tR a) �(o — C) ';-= -W 0 L) CL Lij v I CA , : '0 E W) a_ Er — '4�, 40 .0 0 S v Z c 2 C 0 �z z III z a a- -Z J, 4 cr X %NN SI N"I, 'N N, "I -�o - Z , * Iv. P', o7l IV 1. e'Av %. 4• lk 1% N ti N N v%,\ , < % IN f Nlk,k v� IL . NA 11, A 6 Is. NA Is As, % lk % % % I-1':. 61 10, Cl) %�,A A 104. 0 a \,' ; . „as h R\a.'e�y "Yk \iy+yq.k�_k� k` U 00 N %, Co . N t.F Nt %,N - *L S6 IDDN A 0. 004 00� , N, NI."N - N % &N N, NN ev-i 10 Is, V% vs VN N AI - s "AN '+.'a4 C) IN 'IN pa\s`4% N, rt I a., 4!7/2017 NO SAN OVER' Masuchus tis Town of North Andover Mail - 2198 Turnpike Street Toni Wolfenden <twolfenden@northandoverma.gov> 2198 Turnpike Street 2 messages Toni Wolfenden <twolfenden@northandoverma.gov> Tue, Apr 4, 2017 at 1:11 PM To: Isaac Rowe <irowe@millriverconsulting.com>, Pamela Lally<plally@millriverconsulting.com>, Dan Ottenheimer <dano@millriverconsulting.com>, Brian LaGrasse <blagrasse@northandoverma.gov>, Michele Grant <mgrant@northandoverma.gov> Good Afternoon Everyone, Please find attached a Soil Test Application for 2198 Turnpike Street Map 108.0 Parcel 6 Thanks, 0 2198 turnpike st 1.pdf I Toni K. Wolfenden Health Department Assistant 978-688-9540 Pamela Lally<pially@millriverconsulting.com> Fri, Apr 7, 2017 at 9:15 AM To: Toni Wolfenden <twolfenden@northandoverma.gov>, Isaac Rowe <irowe@miliriverconsulting.com>, Dan Ottenheimer <dano@millriverconsulting.com>, Brian LaGrasse <blagrasse@northandoverma.gov>, Michele Grant <mgrant@northandoverma.gov> Hi Toni, We've schedule this soil testing with Thomas Hector for Thursday, April 13th. Thomas will arrive around 7:30 and Isaac will be there around 9:30. Let us know if you have any questions. Take care, Pam Pam Lally Administrative Assistant hftps:HmaiI.google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&view=pt&search=inbox&th=15b39f3l826eO855&simI=15b39f31826eO855&simI=15b488e789ab367f 1/3 417/2017 Town of North Andover Mail - 2198 Turnpike Street `20f#. .AN N IVERS'AR`y -RIVER. CONSUCTING' 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014, x805 www.millriverconsulting.com From Toni Wolfenden [mailto:twolfenden@northandoverma.gov] Sent: Tuesday, April 04, 2017 1:11 PM To: Isaac Rowe; Pamela Lally; Dan Ottenheimer; Brian LaGrasse; Michele Grant Subject: 2198 Turnpike Street Good Afternoon Everyone, Please find attached a Soil Test Application for 2198 Turnpike Street Map 108.0 Parcel 6 Thanks, Toni K. Wolfenden Health Depar1#ft1"tnAftftfe W 978-688-9540 https:HmaiI.google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&view=pt&search=inbox&th=15b39f3l826eO855&sim1=15b39f3l826eO855&sim1=15b488e789ab367f 2/3 4/7/2017 �i Town of North Andover Mail - 2198 Turnpike Street All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the Massachusetts Public Records Law. Visit us online at www.northandoverma.gov. https:Hmail.google.com/mail/u/0/?ui=2&ik=aOc6f4e4cf&view=pt&search=inbox&th=15b3gf3l826eO855&siml=15b39f3l826eO855&siml=15b488e789ab367f 3/3 JM ASSOCIATES Land Planning -Civil Engineering -Surveying 325 Main St. North Reading, Ma. 01864 Tel. 978-664-6668 Fax 978-664-8155 www.imassociateseniz.com Dec. 12, 2016 Brian LaGrasse Director North Andover Health Dept. 120 Main St. North Andover, Ma 01845 Re: 2198 Turnpike St. Sewer Connection Dear Mr. LaGrasse JM Associates has been contracted by Mr. Jorge Solano, 2198 Turnpike St., North Andover to provide a preliminary engineering design in order for him to connect his house to the sanitary sewer located in the right of way of Turnpike St.. Ourfirm conducted a limited survey and preliminary design in order for Mr. Solano to obtain a cost estimate of this work (see plan attached). Unfortunately the sewer is located on the opposite side of Turnpike St (the west side) from Mr. Solano's house. Mr. Solano then obtained a cost estimate from JW. Watson Jr. Excavating, Inc. This estimate is $52,625 (see attached). In addition to that amount, $12,000 would be required if flowable fill is required within the Right of V�, ay by MassDOT. Thus this project could cost upwards of $65,000 and although sewer is technically available it would be an economic hardship to do so. I. Based on this estimate Mr. Solano would like td pursue a repair to his existing septic system which would most likely cost less than half of the cost to tie into the town sewer. We would appreciate your review of the attached data and allowing Mr. Solano to go forward with the repair to his septic system, I Thank you for your attention to this matter. Very Truly Yours, John McQuilkin PE Principal Engineer JM Associates Cc: Jorge Solano J.W. Watson Jr. Excavating, Inc. lw We,801 J, 43 Lowell Junction Road Andover, AIIA 01810 - 978-475-32.62 Fax -475-0413 NOVEMBER 14, 2016 JORGE SOLANO Proposal SEWER INSTALL .@ 2198 TURNPIKE STREET 2198 TURNPIKE STREET NORTH ANDOVER, MA NORTH ANDOVER, MA 978-857-4313 1. SAWCUT ROADWAY PAVEMENT (RTE 114) 2. EXCAVATE AND DISPOSE OF PAVEMENT 3. SUPPLY AND INSTALL A 6 PVC SCH 40 GRAVITY SEWER LINE FROM CONNECTION ACROSS 114 TO FRONT YARD OF 2198 TURNPIKE STREET 4. BACKFILL AND COMPACT TRENCH 5. PATCH BACK ROADWAY 6. SUPPLY AND INSTALL PROPOSED SEWER MANHOLE 7. SUPPLY AND INSTALL CAST IRON COVER FOR MANHOLE 8. SUPPLY AND INSTALL BRICKS FOR SLEUTHWAY INSIDE MANHOLE 9. SUPPLY AND INSTALL A 2" PVC FORCES SEWER MAIN FROM MANHOLE TO PROPOSED E -ONE PUMP 10. ENCASE PIPE IN SAND 11. SUPPLY AND INSTALL E -ONE PUMP 12. PUMP, CRUSH AND FILL EXISTING SEPTIC TANK 13. CONNECT EXISTING 4" CAST IRON SEPTIC LINE TO PROPOSED E -ONE PUMP 14. INSTALL ELECTRICITY TO PUMP 15. BACKFILL AND COMPACT TRENCH 16. RELOAM, RAKE AND SEED GRASSED AREAS PRICE: $52,625.00 • SUPPLY AND INSTALL FLOWABLE FILL FOR TRENCH IF REQUIRED BY THE STATE WOULD BE ADDITIONAL., . ' $12,000 • POLICE DETAIL INCLUDED UNLESS THE STATE PERMIT REQUIRES CRUISERS PRICE DOES NOT INCLUDE: THE REMOVAL OF ANY ROCK LARGER THAN 1 CU. YD. THE REMOVAL OF ANY LEDGE. .REPAIR OR REPLACEMENT OF ANY UNMARKED UTILITIES OR SPRINKLER LINES. REMOVAL OF ANY BURIED DEBRIS OR HAZARDOUS MATERIAL. ANY DE -WATERING. THE MAINTENANCE OF THE GRASS SEED. IF WE SEED THE LAWN, THE OWNER MUST WATER IT TWICE A DAY—MORNING AND NIGHT. We Propose hereby to famish material and labor - complete in accordance With the above specifications:' All material is guaranteed to be as specified. All work to be completed in a workmanlike L manner according to standard practices. Any alteration or deviation from the above spec- Authorized ifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, acc- Signature idents or delays beyond our control. Owner to carry fire, tomado and other necessary ins- urance. Our workers are fully covered by Workmen's Compensation Insurance. Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature, SOOC:M _O 3903 �_� lz IKj 3 1 ^ z N z U a 0 o Z1 � w 4r 3x p Ym w . U W� o vl 3 O ti 0 o a v X aK Q 3+ O 0 Z O N O - U ZaY r< i >O Z > N a FqU Il o YZ N N Z p K ww^1 N Q 10 w oIt O4zWm}Q ZO Ot wH0 ONO NO O¢ VI 0. NONp O�11 t'j �a o c al�� 0.4 a`arc 06 Mu wl�_ a atm 3 SOOC:M _O 3903 �_� lz IKj 3 1 ^ z N z U a 0 o Z1 � w 4r 3x p Ym w . U W� o vl 3 O ti 0 o a v File Edit Tools Data Maintain Process View Report did' Windows Help / /'; �?A- � � r-- � � MEMO Project: 11770.A t Gffice ofthe Health Department 27 Charles Street, North An Billing Group ID: P771 Billing Type: Fixed Fee Billing Fee: 200.00 Card ID: ToNA ract Info —++1oMQin Billing info lassific-ation— = GLAcc iAjerts _IdSta1 g jy ti itiesn Proposal Number: ssignTo l Department: Contract Number. Contract Date: 12-1102 Work Start Date: 1 Ix Expected Finish Date: 1 QjL2A82 Ouse Government Invoice Style Description: Engineering services required for soil inspection. Engineer: NEES, Inc. # 978-686-1768 Assessors Map t 08C, Lot 16 Applicant: Jorge Solano 2198 Turnpike Street, Rt 114 Save Close - Notes... / /'; �?A- � � r-- � � Client Id: ToNA Project Request Record Town of North Andover Date: / / -Z-/e Z_ Card Id: ToNA Client/Company Namd- Board of Health Car&Tyae-Client Contact Name:, Ms; Sandta.Starr Phone:. 978-688-9540r- 78-688=9540rTitle: -Title:,,-Director Director Fax: 978=688=9542. r %? ,,.Ad'dress: 27 Charles Street Email: sstarr@townofnorthandover-.comr Notes:. Town:. Nortfi.Andover I State MA Zip:Code 0`1845r '« Other contacts, i£ apphcafile ie ngine /rinstaller 1 Name:: D'1J :S Phone:' i TiETe.r Fax: :rt Address- Email: %i r Notes ,,. State:. Zip Cbde:1. r - -- - - -W.CV. I Proiect: Project Id: 1770 *A, Project Title: Town of North Andover. Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: (i' Billing Cod4. Fixed Fee r2- Cbntr-actInfo:.Project,Description for each, billing group BG/ Applicant- Eo"r G E S O G /P 'eu 9 Assessors;lVlap /o $ C 'Lot: % 6 Street Z/ 9 8 Tv,-�`v�i�c �= . y y` ye Type. of service '- A'—S ae: Sa i C— /-ov s /fie- e-- i Pte/ rr: j.: Officdforms/jbrqutona 0 v FORM 11 - SOIL EVALUATOR FORM Pane 2 of 3 Location Address or Lot 1-40. -Z 9 r -'(/M v,4//4C e— J °y— jo a r On-site Review _ Deep Hole Number Date: /0 1JYA0 Z-- Time: Weather e -G a ✓oY 19K o Location (identify on site plan) Land Use 22" --D Slope M ' Surface Stones. e—VC70✓4 Vegetation 4oZA--T Landform Position on landscape (sketch on the back) y Distances from: i Open Water Body 7/A0 feet Drainage way, "9 feet ) Possible Wet Area 0p feet Property Line ZC5- feet [� 1 Drinking Water Well feet Other -/ -a Pty lit DEEP OBSERVATION HOLE- LOG' Depth from Surface (inches) Soli Horizon Sol Texture (USDA) Sol Color (Munsell) Soil (Mottling Other (Structure, Stones, Boulders, Consistency, % Graven ,,;, - 7� �- 7O - A i , �T% Parent Materia[ (geologic) Cap&xogmdroi*. Depth to Groundwater Standing Water in the Hole: Weeping from Pit Face: .0y 0'v, 4 -- lEstimated Seasonal High Ground Water: r VV r r/-1 a 5 5 e-- A $Y r/ . /'_ /►� 47 Q -V LXc'AVA -ro;z ; DE? APPROVED FORM _ 1=7195 n. FORM 11 -SOIL EVALUATOR FORM Paas 2 of 3 Location Address or Lot Ido. �,1, 9 $ fi"J2et>—P ' e- tC- ,E7 - t7 O rr- 7/-f ,19 Np -0 V r On-site Review _ Deep Hole Number n� Date: ��.../3' �Q Time: Weather _G Y fe f Location (identify on site plan) Land User_-� Slope (°.6) _— Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body �/j�© feet Drainage way J/ASO feet Possible Wet Area 00 feet Property Line _ ®_' feet Drinking Water Well � °17 feet 'Other �...�.:_ DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Sol Texture (USDA) Sol Color (Munceln Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Graven �'v S L krY� Parent Material (geologic) OapthmBadr'd: Ir'9 Depth to Groundwater, Standing Water in the Hole: / Weeping ftorn Pit Face: �..' Estimated Seasonal High Lound Water:!_ /l/ a r jpo!r ,T'—'y lCq_ "C_D V 5e7--Pl, t P �+ W i 7-/z c 5 5 e 17 a Y d ✓ w �- /1/' 0 - E X C A VA -ro s:2 ; DEP APPRONIM FORM - 1210719S FORM 12 - PERCOLATION TEST i; Location Address or Lot No. t:T- Ag IT' 7 - COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS /vorc7-rY- ^^ao0vr;rr,_ , Massachusetts Percolation Test* Date:.::.// o.. Z. Time:, Observation Hole .# Depth of Perc `� �$9 Start Pre-soak End Pre-soak 0:37 Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch / I"'JI Minimum of 1 percolation test must be performed in both, the primary area. AND reserve area. Site Passed 10, ite Failed ❑ ................................................. ............................................. :....................................... ._.................... .. Performed By: A m7yd a -r f o o Z) Witnessed By: _ ,10)y -,ev l ,v v o,- n 7 Comments: D E P DEP APPROVED FORM - 12/07/95 Nov -12-02 13:2a BOARD OF HEALTH P.04 NORTH ANDOVER, MA 01845 RECEIVED 978-688-9540 P�j NOV 12 2002 / APPLICATION FOR SOIL TESTS NORTH ANDOVER CONSERVATION COMMISSION DATE: I I l ��? oo Z r MAP & PARCEL: HA P L U� C LOCATION OF SOIL TESTS: Z r `(� "'I'f 571 OWNER: -Tor-/�6 Sagf� TFI.. NO.: 7 Gaff ADDRESS. ( 16 Tu f 1/ P, ke '5 ENGINRF.R: /(1 P, ✓ TBL. NO.: 4 7& -6 8G - 1 7G CERTIFIED SOIL EVALUATOR- R: C 41-6 C T.9NG,,frd Intended Use of Land: Residential Subdivision![ Howe-� Commercial Is This: f Repair Testing: C/ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No —6 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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 $225.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic pians. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smailcr than I "-I00') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forces shall be submitted. Please Do Not Write Below 'Phis Line N.A. Conservation Commission Approval: mate Received: _ // �o%{_ _ Check Amount: Check Date: Nov -12-02 13:28 P_05 4 ov-12-02 13:27 P.01 TOWN OV NORTH AND()VER UFT ICL C)y THE, 11-FALTH DEPARTMENT (,C),vIMUN]'['Y DEVELOPMENT AND SERVICES DIVISION 27 (:IJARI.F. S STREET N 0 RT H A N r) ()'V L K, NI A S S, A C 11 u s B TT S n 15 8 4 5 FA[:SIMILF. TRANSMITTAL SHF.F.T TL), FROM: C(UMPANV __------- --- DATE: � t I 1 Z PAX NUtd�ft ' `J TOTAL. NO. PAt:TS INCLUDING GOVFK; qtea( � � �� 1'HONI? NUMBbK: MIONL NUMBER: YOUR REPERRNCE. MIIMflrR: D LIRULNT X FOR REVIEW ❑ PI.F.A$F. COMMENT D PLL -:ASL RI;P(.Y 1] PI.F.ASF. RF.0 YC:I.F: 0 Town of North Andover, Massachusetts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Applicant e;19�s - Form No. -1 19 Site Location Z-/ ���/�/��/�� �✓'. Engineer ✓i, ', 51 ell Tri roun�ir Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee �ol �� Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. NORTH 9A Q tT�ED �6 "YO OZ - 0 Town of North Andover, Massachusetts BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 - Applicant f7Y 9 Applicantf7Y z' 0 �u"�/! �41':' g'nz�6ffyo? NAME Q� ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH ' Wim/,,% Test No. Fee S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 1 zbz? 06 z MAP & PARCEL: MAUPC gr(e LOCATION OF SOIL TESTS: Z 1 q 6 -tu (ti Plt'`e �J-1 OWNER: So (-66 So 1,41va TEL NO.:g17�-- GaP G �Z ADDRESS: 2 i le (U f tJ O, ke '5 % ENGINEER: /Ue.-) 6,t16(W yf Cy&y ee f -N6 TEL. NO.: 176 -6 %G - (7�'6 CERTIFIED SOIL EVALUATOR: R 'c 44rd e 7.4,y6drd Intended Use of Land: Residential Subdivision `gle Family H� Commercial Is This: / Repair Testing: C/ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes Q THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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 $225.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for alladditional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: /l 8� Check Amount: Check Date: "O ,l 0 -I— r BOARD OF HEALTH v =- NORTH ANDOVER, MA 01845 DECEIVED 978-688-9540 if' -j NOV 12 2002 APPLICATION. FOR SOIL TESTS NORTH ANDOVER CONSERVATION COMMISSION DATE: I /p)i? oc Z MAP &PARCEL: MA P Up 04r -C e ( (o LOCATION OF SOIL TESTS: Z /gl b ?cl(ti tolt'�e 15;-1— OWNER: 3o rC�E So 1,4Iyo TEL. NO.: ��- 6 0 G � 8Z ADDRESS: Z I qE Tu f U P ke �5% ENGINEER: /V e,) TEL. NO.: 2 76 --6 96 - r 71�'6 CERTIFIED SOIL EVALUATOR: R , C 441-6 C 7-,g v6,jr-C( Intended Use of Land: Is This: Repair Testing: Residential Subdivision m le Famil H Commercial C/ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No �-- THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. 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 $225.00 per lot for repairs or .upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION L Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH. _repre_ _sentative,_ 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than l"400') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: x p'O Check Amount: -41-2.57 '�Q Check Date: / p t�