HomeMy WebLinkAboutMiscellaneous - 2245 TURNPIKE STREET 4/30/201861
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Lot & Street a l Map/Parcel 16,q6/3D
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES NO
Plan Approval: Date: i'
r �
Designer: ,
Conditions:
Water Supply: Town c2iD
Permit# //
Approved by:
Plan Date: A0 IJ -7, v
Well Permit: 0 f 7 Driller:2),aer51 1)1 !R
Well Tests: Chemical Date Approved / /cJ 9000
Bacteria I Date Approved za D
Bacteria II Date Approved
Plumbing Sign -Off: Wiring Sign -off:
Comments:
Form "U" Approval: / Approval to Issue: ajNO
Date Issued By: �5,5,5A C.% �
Conditions:
Final Approval:
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:
r
Is the installer licensed?
YES
NO
Type of Construction:
REPAIR
New Construction: Certified Plot Plan Review
.a ES
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: v By:
Construction Inspection:
Needed:
As—J944ilt Pla Saf factory: i
ES' Com- i
I
Approval of Backfill: Date:
Final Grading Approval:
Date: 42 v
By:
By:
Final Construction Approval: Date: 1JIMA By: 3L
Certificate of Compliance:
Approval: Date:
Commonwealth of Massachusetts RECEIVED
City/Town of NORTH ANDOVER MAY 112015
System Pumping Record TOWN OF NORTH ANDOVER
iG^M SV y
Form 4 HEALTH DEPARTMENT
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. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
Hauler'
Signature of Receiving Facility (or attach facility receipt)
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
5/1/15
Date
Date
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
A. Facility Information
Important: When
filling out forms
1. System Location:
on the computer,
use only the tab
2245 TURNPIKE STREET
key to move your
Address
cursor - do not
NORTH ANDOVER
MA
01845
use the return
key.
City/Town
State
Zip Code
2. System Owner:
MIKE SAWYER
rsAm
Name
Address (if different from location)
City/Town
State
Zip Code
Telephone Number
B. Pumping Record
15
1. Date of Pumping
2. Quantity Pumped:
15Il00ns
Date
o
3. Component: ❑ Cesspool(s)
® Septic Tank ❑ Tight Tank
❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No
5. Observed condition of component pumped:
GOOD CONDITION
6. System Pumped By:
JAMES H CURRIER II
Name
X SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD
Hauler'
Signature of Receiving Facility (or attach facility receipt)
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
5/1/15
Date
Date
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
W City/Town of NO. ANDOVER
System Pumping Record
Form 4
M
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
tab
temm
e
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. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
2245 TURNPIKE ST.
Address
NO.ANDOVER
City/Town
2. System Owner:
MICHAEL SAWYER
Name
Address (if different from location)
City/Town
MA
State
State
Telephone Number
01845
Zip Code
Zip Code
B. Pumping Record
1. Date of Pumping 11/28/12 2. Quantity Pumped: 1500
Date Gallons
3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ® No
5. Condition of System:
6. System Pumped By:
JAMES H. CURRIER
Name
J's SEPTIC & DRAIN
Company
7. Location where contents were disposed:
GLSD _.
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
11/28/12
Hauler Date
Signature of Receiving Facility
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
f
- I I
TOW0% vo_RrrH ANDOVER SEWAGE,DISPO.�.�r: SZ S`�'El-I
I- STALLA-fMI\' CERTIFY ATION 4
1 i
The uncersWned hw ereceriiv that the Se.La2e Disposal System (-X.co!.Su .ic,i at,
repaired!: v
by � �- 'd Oso.._ A- Co � 113�N1�t1a��c7�r
located at a a TU Sure -7- --- --
was installed in conrcrmance with the Non'
t dog er Board of Herith a�provea plan,
Svstem Design Pe::rit=I�.4�dated� i3 0 :with an accroved desilin
tlOw of +klD -gallons per day The maten'a:s used were in comormarct with those
specined oh the app"rovea plan; the system was installed in accordarc e- :.,.ith the provisions
of 3- 10 CNM 15.000, Title 5 and local re�--.ilatiors, and the final Rradipa. agrees
substantially .vith the approved plan. .-Nil work;s accurate:v_ represented :)r, the As -built
%vhich has been submitted to the Board c: Llealth.
Bed inspection date: ayo Di—
Engineer Rexi--se::;auve.
Final inspection care - q 0
Lns�ree: Represzraat: -e
t'er:� _ -Date: 57-7-0o
Lesi<T n Engineer: _ Dates
&ORTFI
� p
♦ -
SSACMUSE
Applicant T n u t
Town of North Andover, Massachusetts Form No. 3
BOARD OF HEALTH
6 f
1
DISPOSAL WORKS CONSTRUCTION PERMIT
NAME _ ADDRESS I tLtrnunt
Site Location a:W5
5 Z) (57 --
Permission is hereby granted to Construct ((fir Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee
16'
D.W.C. No. %a'XJ
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for
the construction of the septic system for the
property at relative to the application
of dated c�Tn)�x4or plans by "w 46aigf'1'fd Ei and
dated Adcx) with revisions dated A0 //7 `
I understand the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger, or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable.
2. 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 Tile 5 and the Board of Health Regulations may
result in a $50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With 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. Does not have to be
on site.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work 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 in the Town of North Andover plus
significant fines to all persons involved.
4. 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.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other
components.
5. 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 any other
persons shall absolve me of this obligation.
Undersigned L�gensed Septic Installer
Date:
Disposal Works Construction Permit #
r
Y N & M Job number 1770/
,y s /-4f"7
TOWN OF NORTH ANDOVER
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Site: 2- 7—t 5" 1'✓<✓vp/ s i,
Installer: P///Z- G- V G S
Final Date:
Tel:
Date Yes No Initials
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches, sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation, etc.
Comments: (Use back of sheet for diagrams.)
B. Retaining Wall ✓"
1. Wall height and width as,9'pecified
2. Waterproofed/'�� .✓��
3. Wall minim mii 10' to leaching facility
4. Wallets specifications of plan
Comments: �—
C. Building Sewer
1. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Inlet to tank cemented :f
4. Slope minimum 0.01 or 1/8" per foot minimum
5. Pipe properly set on compact firm base z/
6. Pipe laid on continuous grade in straight line
7. Cleanouts precede all change in alignment and grade v-
8. Manholes at any 90° change
9. 10' minimum offset to water line
Comments:
CU
Septic Tank - 1-
1. Level
2. 1,500 gal minimum -
3. Gas baffle present on outlet
�r
4. Manhole to w/in 6" of grade
5. Manholes over center and each tee
6. 3-20" manholes r.-
7. Outlet line cemented v-
8. 2" — 3" drop from inlet to outlet
9. Pipe set
10. Compact base with 6" of'/" crushed stone under tank
11. Tank is watertight J-
12. Tees 12" off side of tank ��
------------
V
N & M Job number 1770/
Date
Comments:
E. Pump Chamber
1. If separate from tank, compact base with 6"
2. Minimum 2" pipe to d -box if gravity system
3. 20" access manhole
4. Tank level
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm iri`building on separa ircuit
10. Alarm functions
11. Manual operating switch
12. Pump delivers liquid to d -box
Comments:
underneath
Yes No Initials
F. Distribution Box
1. D -box level
2. Minimum 0.1 T' (2") drop from inlet to outlet
3. Minimum 6" sump
4. Outlet pipes show equal distribution
5. Compact base with 6" of stone beneath box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe
9. First 2' from box laid level
Comments:
G. Soil Absorption system
1. All ston doDble-ashed — 3/a" - 1 '/2"
u/
-pea stone
Bucket test done?
2. Minimum 2" of pea stone above distribution lines
3. Minimum 6" stone beneath pipe
4. Distribution lines capped or connected together
5. Toe of slope stops minimum 5' from edge of property,
5a. if not, then swale.
Comments:
N & M Job number 1770/
Date Yes No Initials
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agrees with plan. (Max. length 100')
3. Width of trenches agrees with plan - Minimum 2'; maximum - 4'.
4. Vent present if>50 feet or specified
5. Minimum distance between trenches 10'
6. Pipe slope minimum 0.005 or 6" per 100'
7. Depth of trenches below outlet invert minimum of 6".
8. Pipes set on stable base.
Comments:
I. Leach Field ^�
1. Maximum length of field 100' /�
2. Pipe slope minimum 0.005 or 6--- r 100'
3. Separation between pipe
Pipes connected at en ' maximum
4. d & vent end raised
5. Separation between adjacent fields 10' minimum
6. Pipes set onsstable base
7. Maxon-uim 4' separation from edge eld to first line
8. Minimum two distribution lines
Comments:
J. Leaching Pits
1. Minimum inlet pipe 4" -�
2. Pits of concrete
3. Sidewall between 12" and -48" wide
4. Access manholes.odch pit.. ---
5. Pipes cemented with hydraulic cement�'„,• -�
6.
Comments. �- --`
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9" soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
6. Grading meets 3:1 slope
7. Minimum of 9" of fill graded over system
KINGSTON READY -MIX CONCRETE 10/3/01
KINGSTON MATERIALS
OA Division of Torromeo Industries, Inc., P.O. Box 2308, Methuen, MA 01844 978-686-5634
Kingston Plant at 18 Dorre Road, Kingston, NH Methuen Plant at 33 Old Ferry Road, Methuen, MA
SIEVE SIZE
WEIGHT
INDIVIDUAL
PERCENT
RETAINED
CUMULATIVE
PERCENT
RETAINED '
TOTAL.%
PASSING
ASTM C33
PROJECT.
SPEC.
3/8"
0
0
0
100
100 TO 100
#4
9.3
1
1
99
95 TO 100
#8
79.3
10
11
89
80 TO 100
#16
151.5
19
31
69
50 TO 85
#30
128.8
17
47
53
25 TO 60
#50
139.8
18
65
35
10 TO 30
#100
135.6
17
83
17
2 TO 10
#200
107.4
14
97
3
0 TO 5
PAN
26.4
3
TOTALS
778.1
100
F.M.:
"2.4
2.1 TO .3:1;
120
z 100
00 80
a
60
40
° 20
0
O
SIEVE ANALYSIS OF SAND
TOTAL %PASSING
-0-MIN. DEVIATION
-W MAX DEVIATION
1 2 3 4 - 5 6 7 8
SIEVE SIZES
6-lv.okt ri
J
AS -BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
LOCATION & ELEVATIONS OF BENCHMARK USED
11
d
NEW ENGLAND ENGINEERING SERVICES
INC
October 18, 2000
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: 2241 Turnpike Street, North Andover, Septic system design
Dear Sandra:
Enclosed are five copies of revised design plans for the above referenced property. The
changes made to the plans are as follows:
1. Names of abutters have been added to the plan view. The 100 scale locus plan at
the bottom left of the sheet has all of the abutters for the lot.
2. Effluent lines have been noted as to be capped on the profile.
3. One copy of the plan with an original stamp is enclosed.
4. Construction note # 2 has been revised to include inspections.
If you have any questions please do not hesitate to contact this office.
Sincerely,
i15,C D'
Benjamin C. Osgoo4fr., EIT
President
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
1�
� NoarH q
O.4.,�ao .•a NO
3'T a..: a •. • OL
9$S4CNUSEt
Fax 978-688-9542
Board of
Appeals
(978) 688-9541
Building
Department
(978) 688-9545
Conservation
Department
(978) 688-9530
Health
Department
(978) 688-9540
Public Health
Nurse
(978) 688-9543
Planning
Department
(978) 688-9535
Town Of !North Andover
Community Development & Services
27 Charles Street
North Andover, Massachusetts 01845
October 13, 2000
Ben Osgood, Jr.
New England Engineering
60 Beechwood Drive .
No. Andover, MA 01845
Re: 2241 Turnpike Street
Dear Ben:
This is to inform you that the proposed plans for the site referenced above have
been disapproved and have technical deficiencies as followed:
William J. Scott
Director
(978) 688-9531
1. Names of abutters from recent tax map do not occur on the plan as required by
North Andover 8.02j.
2. Effluent distribution lines are not shown as capped or connected as required
by CMR 15.251 (9).
3. Engineer's seal and signature is not original.
4. Change to #2 under "construction notes" by adding "inspections".
If you have any questions, please do not hesitate to call the Board of Health
Office.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
cc: Sawyer
file
f ,10RTIy
o
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p
K ;
,S,SACHUSE4�
Town of North Andover, Massachusetts
ROARII OF HFAI TH
Form No. 2
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No. / 76
Site Location s (,t�`r nR,� -0 Q
Reference Plans and Specs. 1,01171,0a
ENUNEER DESIG DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee
CHAT N, OARD OF HEALTH
Site System Permit No.
June 8, 2000
To Whom It May Concern:
Please be advised that I am the owner of 2241 Turnpike Street, North
Andover referred to in town records as Map 108C, Block 50 and which
contains approximately 1.3 acres.
I hereby give permission to New England Engineering Service and the
Town of North Andover or its Agent to enter onto said land for the purpose
of performing perc tests upon 24-hour notice to me at 688-1169.
1 understand that I will be held harmless for any personal or property
damage incurred by the Town of North Andover and/or its Agent(s) and
Buyers' Agents while on my property. I understand that no unreasonable
damage will be done to my land other than what is necessary in order to
conduct the test and that the land will be returned to its original condition
as much as possible given the nature of the testing to be performed.
Please find a copy of my deed and plot plan accompanying this permission
letter. Note that my husband passed away several years ago and the land
is owned solely by me.
Furthermore, I give my Agent, Lyndsie Reynolds, permission to answer any
questions of a technical/administrative nature regarding the said lot. Her
number is 978-255-1500.
F
Doris M. Rosten
Owner
Attachment
�ce5�
:F,77 �� % DEA% s
CAL
-AUT
p i o e(6 rev% �--
�� A)6 UNC � o s7Z,
Oct -09-00 02:41P Paul D_ Turbide, PE/PLS 978-465-0313 P.02
PTOR
ENGINEERING
Civil Engineers &
Land Surveyors
One Harris Streel
Newburyport, MA
01950
(978)465-8594
October 9, 2000
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School Street
North Andover, MA 01845
RE: Title V review for new construction at 2241 Turnpike Street
Dear Sandra,
Enclosed find our review of the "Checklist for North Andover Septic System Plans' for
the septic system upgrade at the above-mentioned site. The following is a list of
technical deficiencies that Port Engineering has found.
o Names of abutters from recent tax map do not occur on the plan as required by NA
8.02j
o Effluent distribution lines are not shown as capped or connected as required by
CMR 15.251(9).
If you have any questions or comments please feel free to contact me
lncere y
Pau D. Turbide; PE/PLS
\\Server ANAMP2884WORNUM STREET 210 -DOC
Oct -09-00 02:40P Paul D. Turbide, PE/PLS 978-465-0313 P.01
Facsimile Cover Sheet
To: SANDRA STARR
Company: NORTH ANDOVER BOH
Phone: 978-688-9540
Fax: 978-688-9542
From: Paul D. Turbide
Company: Port Engineering Associates, Inc.
Phone: (978) 465-8594
Fax: (978) 465-0313
Date October 9, 2000
Pages Including This
Cover Page: 2
Comments:
Sandy,
I have attached our review of the SDS for new construction at 2241 Turnpike Street.
Thanks,
Paul Turbide
Civil Engineers &
Land Surveyors
One Harris Street
Newburyport, MA
01950
(978)465-8594
FORM 11 - SOIL EVALUATOR FORM
Page I of 3
No. Date:
Common*wealth of Manachusetts
Massachusetts
Soil Suitability Assessment fQr On -s& SewageDisposal
PerformedBY: .......... ............................ .... ................... ..... Date:. . .................... ...............
Witnessed By: ....... ......... . -- V
..... .................................... . ..... ................................ . .. .. ..... ....... ... .... ... . ....
L=M1= Ad&M or -17' . 0"00's Nwan.
tar A"=. OW
utphow 1
•
No. 4;V:Ve04"9 Mw 01046*
lew construction IN Repair F-1 I
Office Bevl!tff
Published Soil Survey Available: No FJ Yes ❑
Unit Year Published ............. Publication Scale 0 19 Soil Map . .. ....
Drainage Class ...... Soil Limitations ............. .......................................... .... .... .. .. .
..... ......................... .. ....
Surficial Geologic Report Available: No Yes 0
Year Published Publication Scale
GeologicMaterial (Map Unit) .............................................................. . ........... . .................................. . .. ..... ............
Landform........................... ........................... . ............ .......................... ......................... ......................................
1%
Flood Insurance Rate Map:
Above 500 year flood boundary No E]Yes
Within 500 year flood boundary No 0 Yes ❑
Within 100 year flood. boundary No E]Ye I s ❑
Wetland Area:
National Wetland Inventory Map (map unit) ........................... ....... ... ........................ .........
Wetlands Conservancy Program Map (map unit) .................. .......................... ............. ... .......... ...... I....... ..... ..
Current Water Resource Conditions (USGS): Month,4AW4
Range :Above Normal WNormal Ehelcw Normal 0
Other References Reviewed:
IT
DEP APPROVED FORUM - 12/07/95
FORM 11 - SOIL EVALUATOR FORM
page 2of3
Location Addressor Lot N6. a % /�"��� �4..`I ✓ .
On-site.Review
� o
Deep Hole Number .., . Date:,°'%�� Time: B� Weather
Location (identify on site plan)
Land Use .. � !�` 4 Slope (%) /_ Surface Stones .
Vegetation
Landform .. ..lP��?/fij� !1%•�,.�/„�tl ...
Position on landscape (sketch on the back)
Distances from:
Open Water Body 14a4:9 feet Drainage way-4�, feet
Possible Wet Area feet Property Line ..4.. feet
Drinking Water Well feet feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horfizon Soil Texture Soil Color Soil Other
Surface (inches) (USDA) IMunsell) Mottling (Structure, Stones, Boulders, Consistency, %
Gravel)
Parent Material (geologicl _C- ��ti�-s <IL� Deptht000drock:
Depth to Groundwater: Standing Water in the Hole: ,l,I�Weeping from Pit Face: -
Es(imated Seasonal High around Water:
i
DEN APPROVED FORM - 12/07/95
gyp
Jv
;P' 14
,_— "5;v'0,5'e.'
Parent Material (geologicl _C- ��ti�-s <IL� Deptht000drock:
Depth to Groundwater: Standing Water in the Hole: ,l,I�Weeping from Pit Face: -
Es(imated Seasonal High around Water:
i
DEN APPROVED FORM - 12/07/95
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address ot1 Lot (Jo. 2?Y�ra.�
On-site_,iReview
o
Deep Hole Number ..-... Date:,O/-Time:
Location (Identify on site plan)
Land Use �,...fl�?�� Slope (%1 Surface Stones ,
Vegetation
Landform..
Position on landscape (sketch on the back)
Distances from:
Open Water Body/4� feet Drainage way`s. feet
Possible Wet Area � feet Property Line .-44�. , .. , feet
Drinking Water Well /4; � feet Other.
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Sol[ Color Soil Other
Surface (Inches) (USDA) {Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
Gravel)
V
&7
7Z R-Iee4d—
C �� � � � � � � /✓"tom �'��
Parent Material (geologic! %l
DeptMoeedrocic•
Depth to Groundwater: Standing Water In the Hole: Weeping from Pit Face:
r.
Estimated Seasonal High Ground Water:
7C
DEN APPROVED FORM - 12/07/95
r
FORM 11 • SOIL EVALUATOR FORM
Page 2 of 3
Location Addressor Lot No. /EIii'vp/,,� 3> /w 4�PIOA
On-site ,review
a
Deep Hole Number `3 Time:
/��a.�3�� Time:'. Weather'' ��
��
Location (identify on site plan) • <....dl.�C?I.,Y�
Land Use .,.. • /.�?�F4 , 2 Slope (%) Surface Stones.
Vegetation . v%d� __......: �.......,...• ..........,....
Landform
Position on landscape (sketch on the back) ..11- .La? ..•
Distances from:
Open Water 6ody/4� feet Drainage way` . feet
Possible Wet Area 0:�>feet Property Line feet
Drinking Water Well % feet Other ...,
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
NMunsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, '%
Gravel)
_A:9
d
551.
MINIMUM
rww�w-
Material (geologic) %%G L-. Oepthtoaedrock: --
pepth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
H .
Estimated Seasonal High 'Ground Water:
i
DEP APPROVED FORM • 11!07/95
FORM 11 - SOIL EVALUATOR FORM
Page 2of3
Location Address or Lot No. 094/ A AAP.,,A�ZI� 4 P,
On-site ,review
Deep Hole Number Time: ?1-140 Weather ,!%/,?— 7-V
Location (identify on site plan)
Land Use .-720W Slope (%) Surface Stones
Vegetation
Landform �oT�eijJ ,. ,?�JO•✓!�/,�'
Position on landscape (sketch on the back)
Distances from:
Open Water 13ody/4400 feet Drainage way--6—exp feet
Possible Wet Area '¢ feet Property Line.. -4 feet
Drinking Water Well feet Other... .,
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (Inches)
Soil Horizon
Soil Texture .
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravel)
KAI
0 -/o/
.�4-
. •.no,yvm v. �, nvLw nC%i V1ncW M1 CVCnT rnV? U.7tV IJQWUbAL AREA --
Parent Material (geologicl ��/?7��CT %!+� L-- DepthtaBodrock,
Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seas6nal High around Water:
DEP APPROVED FORM - 12/07/95
O
FORM 11 -SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. W IDK_Y '
Method Used:
❑ Depth observed standing in observation hole ................. inches
Depth weeping from side observation le ..q .. inches
Depth to soil mottles inches .�
❑ Ground water adjustment .................. feet ox --4.9 "-/- 44P �
Index Well Number .................. Reading Date .................. Index well level ..................
Adjustment factor .................. Adjusted ground water level.........................................................
Death of. Naturally Occurring_ Pervious Material
Does at least four feet of naturally occurringpervious material exist in I areas
observed throughout the area proposed for the soil absorption system?�
If not, what is the depth of naturally occurring pervious material?
Certification
1 certify that on (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature
DEP APPROVED FORM. 12/07/4S
Y
FORM 11 - SOIL EVALUATOR FORi1T
Page 1
............. Date...... ..Z�a
Commonwealth of Massachusetts
lA/v A;raez--e-4— , Massachusetts
Soil Suiitability Assessment for On-site SewaU Disposal
0 d- ................................
Performed By:...........'S......................
Witnessed By:
...:.....Y:..:....:???!?.:.:..:.................................................................................................................................................
Loaaa A4&= or G vi C['4� Oiw�x�� H-- �=4 Pssw /i"hC�i" ec✓ S vv
La Mdrar. as yLfl w� K tom✓ +fr►�e.c—
&9(— .7
New Construction ❑ Repair l9
office Review
Published Soil Survey Available: No ❑ Yes
s
Year Published /1. 0.... Publication Scale ..� `Sb�v� Soil Map Unit ..............
Drainage Class .... �..... Soil Limitations.................................................................................. � ,rte, ,rz1l
Surficial Geologic Report Available: No Or"" Yes ❑
Year Published ................... Publication Scale
Geologic Material (Map Unit)............................................................
Landform...................................................................................................................
Flood Insurance Rate Map:
Above 500 year flood boundary
NoEl
Within 500 year flood boundary
No l�
Within 100 year flood boundary
No Imo'
Wetland Area:
National Wetland Inventory Map (map unit) .............
Wetlands Conservancy Program Map (map unit)
..........................................................................................
Yes
Yes ❑ _ 3
Yes ❑
Current Water Resource Conditions (USGS): Month ......
Range : Above Normal ❑ Normal ❑ Below Normal ❑
Other References Reviewed: „14Civ •
troRKI it - SOL EVALUATOR vote
Palo Z
off11 ' �.
Deep Hole Number -F- Time: Weather
Location (Identify on site plenl
Lend Use Slope (!61 -- a 8urfeoe 6tbnee _...... tz.f.
Ve06tetion....._.I,...r.r_.,��vt2_..__......_....._..___..._.........._.____....__�.__ _. __
Landform -�
Position on landscape (sketch on the back) .--.......... -
Oistanoee from:
Open Water Body ZJ-col feet Drainage way? feet,
Possible Wet Area _` feet Property Una . !! t feet '
Drinking water Wag feet Other
n
from 6urtea I 6oY Nort:an 'dam • I I BoN I AetWnp I Ig��M� 6Mn!!. �Mu�� I
�!%4�
5r6p/z
A74-
parent
'4
Parent Material (geologlcl--t ° u w .- -- -� - - •�-•••• Depth to Bedrock:.
Beeth to,Gmundweter. Standing Water In the Hole: K •On►—Weeping from Pit Face:
u
Estimated Seasonal High Ground Water:. 5...
troRhl It - 6011. E'VAMOOR vo
ItM
hate Z
lll.y.- A.�.,
Deep Hole Number _ lf! Data: 4E:Zvto Tim:_L'_� Weather _5-"a.4d
L
t aoation (kdenti onw-- site plant
nd Use W..- 6� Stop& 1161 Surface Stones
Vepbtatlon _... ,,5���.. _ ._ _.�.__.,_......_....._..__..... _..........
�.____....__�.
position on landscape (sketch on the back] _....__...._—_...
Distanoe4 from- •
Open Water Body : ' feet Drdnaoe way -25912-11 feet,
possible Wet Area —EZ21 feet Property Una feet '
Drinking Water well x'jc�-` feet other
0
00*4 r�e6urt�a I 6oY flet -:an • B 1U8D111 I I BoM �A. .
eo
5y fj� P -� L ---a.
parent Material (oeologid ---- - -- .--....... Depth to Bedrock:. -� •--
Mama Standing Water In the Hole: -- -- Weeping from Pit Face:
Estimated Belmont] High around Water:$ ��
. , �� • FORM 11 • SOIL EVAWMR MRM
Page 3
Method Used;
❑ Depth observed standing In observation hole ---- inches
❑ Depth weeping from side pt observation hole w Inches
(Depth to soil motdee Inches
❑ Ground water adjustment. feet
Index Well Number ._ . Reading. Date Index well 1ave1.... a..._
Adjustment factor Adjusted ground water level
Does at least four feet of naturally occurring pervious material exist in.eil areas
+ observed throughout the ares proposed for the soil absorption system?
If not, what is thedepth of natutaliy, occurring pervious material?
rtiflsftoQII
0
1 certify that on ( Idetel I have passed the examination approved by the
Department of Environmental Protsotion and that the above analysis was
performed by me consistent with the required trainingo expertise and expedenoa
described In 310 CMR 16.017.
0
Signature QMe L�
0
FORM 12 - PERCOLATION WST
COMMONWEALTH *OF MASSACHUSETTS
�l�L�-v-�► , Maseechusetts
Percolation Test
Date: w .7 _ .._. __.__.__............_..__
Observation Hole #
Depth of Pero
Start Pre -souk
End Pre-soak
Time at 12"
Time at 8"
,o
Time at 6"
/0 , �y
Time W-6`1
Rate Min./inch
Site Passed 13 Site Failed ❑
Performed By: . x
Witnessed By: rL, Pe j-PL
Comments: .......................... ._............................
_....................................................__........................................._.............__._.
IAA
_. I [
''1
`- LCA-ION
C T-1 0IN1 Ute. 77, C, F _ .0 I` I.
71ME C=
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INi= i_�'
J
0 7 -1 0 Iry I C Sz T 37�:z r In
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lu �'vZ
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INC -
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NEW ENGLAND ENGNIc EERING SERVICES
October 3, 2000
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: 2241 Turnpike Street, North Andover, Septic system design
Dear Sandra:
Enclosed .are five copies of design plans for the above referenced property. Also enclosed
are the following documents.
1. Soil evaluator sheets.
2. Plan submittal form.
3. Check to cover review fee.
If you have any questions please do not hesitate to contact this office.
Sincerely,
r� ( 0
, Jr.,
Benjamin C. Osg� EIT
President
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
SEPTIC PLAN SUBMITTAL FORM
LOCATION:
NEW PLANS:
YES
REVISED PLANS: YES
SITE EVALUATION FORMS INCLUDED:
DATE: D c)o
$125.00/Plan
$ 60.00/Plan
YES NO
DESIGN ENGINEER: /� ew } ; '_'Q E7,,,::? r _I e& .4'
DATE TO CONSULTANT:
*If you want your plans expedited, please submit three plans and included a
stamped envelope with the correct amount of postage to mail plans to Port
Engineering.
When the submission is all in place, route to the Health Secretary.
TOWN IOF NORTH ANDOVER
BDA" OF HEALTH
27 CHARLES STREET
NORTH ANDOVER, MASSACHUSETTS 01845
SANDRA STARR, R.S., C.H.O.
Health Director
October 27, 2000
Ben Osgood, Jr.
New England Engineering
60 Beechwood Drive
No. Andover, MA 01845
Re: 2241 Turnpike Street
Dear Ben:
000TH q
3? off;° of
h A
�4SSACHUS ��
Telephone (978) 688-9540
FAX (978) 688-9542
This is to inform you that the revised septic system plans dated 10/17/00 for the
site referenced above has been approved for a maximum nine -room house.
If you have any questions, please do not hesitate to call the Board of Health
Office at 978-688-9540.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
SS/smc
cc: Sawyer
File
Town of North Andover, Massachusetts Form No. 1
ORTH BOARD OF HEALTH
F N 0116 0'191
AL
r
* Cp 0y
APPLICATION FOR SITE TESTING/INSPECTION
9 ApRA TED
LSSA C HU`-'��
Applicant—
NAME
licant
pp NAME ADDRESS TELEPHONE
Site Location—e�' Tq
14 Engineer t�f�/.� "V_4_ &-A
NAME— ADDRESS TELEPHONE
iVf --r
Test/Inspection Date and Time
CHAIRMAN, BOARD OF HEALTH
Fee / Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
�� ,..,
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Permit #
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BOARD OF HEALTH Z 7 G ►� a r E �s Sf:
NORTH ANDOVER, MASS. Dtp95
APPLICATION FOR WELL AND PUMP PERMIT
Date
A permit is requested to: drill a well ✓ install a pump t�
LOCATION : /aL 10� C Lot #
Owner Address Tel
Well Contrctr'\-'�OWynea.� Tel��d3�
0316 o
Pump Contrctr�c,�`'' '�`ci. Samc (�s ",y- Tel��p3�
WELLS (To be completed at time of pump test.)
Type of well
Diameter of well
Use
Size of casing
Depth of bed rock
Depth
casing
into bedrock
Seal been tested? Yes (_)
No (_)
Date
of test
Depth of well
Depth to water.
Water -bearing rock
Delivers
Drawdown feet after pumping
GPM for
(how long?)
hours at GPM
Date of completion
Signature of well contractor
PUMPS (To be filled in before installation.)
Name & size of pump,
Type
Size of tank Pump delivers GPM
Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_)
Sleeve used to protect pipe? Yves (_) No (_) Type well seal
Date
Signature of pump installer
Date water analysis report submitted to Board of Health
Plumbing inspector Wiring inspector
Board of Health `
y, Department of Envlronrt ental iManagement/Division of Water Resources
WELCICCMPLETION REPORT
WLLL LOCATION GEOGRAPHIC DESCRIPTION
Address a,140 ftjrnf7t idg zA- _!__t_� N E W of
Neyrl 1 1=�r1C�C�\!�Y i'�Ii C�1 U� (feet) (circle)
City/Town
Well owner. ll, O P ` u c K=.( (road)
Address -70 Ba rr,,) cd t" up 4t _L 2 N S COW of
(l
(mi. in tenths) 77cci'rrccle)
No��h ' nl�Ll�
Board of Health permit obtained: yes no ❑ intersect. w/ `7
(road)
WELL USE WELL DATA
DomesticG� Public El Industrial ❑ Total well depth y 7a _ ft.
Monitoring ❑ Other Depth to bedrock !{ ft.
Water -bearing rock/unconsolidated material:
Method drilled A!WA- r `i
Description
Date drilled b G
Water -bearing zones:
CASING
1) From To f9_ _ -
TypeS�^
2) From To -
Length �ft. Dia(I.D.) in.
3) From To
Length into bedrock CC ft.
Gravel pack well: _7 dia7
Protectivewell seal:�r[ r✓ , f/, �
y dia. j
Grout [ ( Other
Screen:
Slot# `lengthfrom _ to
STATIC WATER LEVEL (all wells)
Static water level below land surface ft. Date 0
WELL TEST (production wells)
Drawdown 2K —'2J—ft. after pumping
2.- hr. min, at gpm
How measured Recovery
ft. after— hr. min.
LOG of FORMATIONS COMMENTS
0
Materials IFroml To
L d
i" r �..i Driller U Lt co 0
f,
Supervising Driller
®-- ' �.
BOARD OF HEALTH COPY
11-1d-2000 11:12AM FROM DOWNEAST"DRILLING 16036642113
4prittlftt Atatt
main om"ILab"Ory
22 Nie► Rd. J At 2$
owry, NM Nose
cs0M 432-MM4
ilia &Wvwtvt
oinc*
At: Tramway MVt400m
ROUte 16 & 25
weal Oss", NH 03M
(Q.Tertificate of ;kualiasia for Prinking Water
SENT TO: DOWNEAST DRILLING TEST NO.: 0011-00280-001
23 PIERCE
BARRINGTON, NH 03825 SAMPLE 2243. TURNPIKE RD.
LOCATION: NO.ANDOVER, MA
P. 2
DATE & TIME SAMPLED: 11/13/2000 13:00
EPA
PATER RESULT RECOMMENDED
(mg/1) MAX. LEVEL
------
Turbidity 2.0 5 NTU
<
LESS �TxM OUR LOWEST CALIBRATION POINT
> GRpATER THAN OUR HIGHEST CALIBRATION POINT
1 FLxGS PARAMETERS THAT EXCEED PRIMARY STDS: CAUSES TEST FAILURE.
2 FLAGS PARAMETERS THAT EXCEED SECONDARY STDS: DOES NOT FAIL TEST.
* MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID.
NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY.
Authorized by
11-14-2000 11:12AM FROM DOWNEAST"DRILLING 16036642113
IM7, W��'
i ='1-1 1
Main Office i Laboratory At: Tramway Marketplace
22 Manchester Rd. / Rt. 28 Route 16 S 25
Derry, NH 03038 West Ossipee, NH 03890
(603) 432-3044 1-$00.699-1920
P. 3
Tertificatr
of Analgais
for Prinking Water
SENT TO: DOWNEAST DRILLING
TEST NO.: 0011-00054-001
23 PIERCE
BARRINGTON, NH 03825
SAMPLE 2241 TURNPIKE ST.
LOCATION: N.ANDOVER, MA
DATE & TIME SAMPLED:
11/02/2000 12:00
EPA
PARAMETER
RESULT.
RECOMMENDED
(mg/1)
MAX. LEVEL
2 pH
8.70
6.5 - 8.5 Units
Calcium
41.7
Magnesium
4.9
None Set
Hardness
124
None Set
Nitrate
<0.20
10.0 mg/l
Nitrite
<0.100
1.0 mg/l
Sodium
26.1
250 mg/l
Iron
0:460
0.30 mg/1
Manganese
0.089
0.05 mg/1
1 Color
20
15 CPU
1 Turbidity
5.5
5 NTU
Alkalinity
135.5
None.Set
Specific Conductance
350
None Set/umbos
Sulfate
23.7
250 mg/1
Coliform Bacteria
ABSENT
ABSENT /100 ml
E. Coli Bacteria
ABSENT
ABSENT /100 ml
---------------------------------------------------------------------
* LESS THAN OUR LOWEST CALIBRATION
POINT
* GREATER THAN OUR
HIGHEST CALIBRATION
POINT
1 FLAGS PARAMETERS
THAT EXCEED PRIMARY STDS: CAUSES TEST FAILURE.
2 FLAGS PARAMETERS
THAT EXCEED SECONDARY STDS: DOES NOT FAIL TEST.
* MICROBIOLOGICAL ANALYSIS RUN PAST
30 HOURS OLD MAY NOT BE VALID.
NOTE: SUBSEQUENT SAMPLES FROM THE SAME
WATER SOURCE MAY VARY.
A —1—r: wa 1.0
11-14-2000 11:12AM FROM DOWNEAST"DRILLING 16036642113 P.1
Date 11/14/00
NumW of panes including cover sheet
TO. Susan - Inspector
@Town of Andover
Phone 978-688-9540
Fax Phone 978-688-9542
CC:
FROM: Shelly La/os
Downeast Drilling
Company, Inc.
Barrington, NH 03825-
3615
Phone 877 -374 -5546 -
Fax Phone 603-664-2113
REMARKS: ® Urgent ❑ For your review ❑ Reply ASAP ❑ Please Comment
Please find the following Water Test for 2241 Turnpike, N. Andover for Michael and Brenda
Sawyer.
Please let me know if I can be further assistance. My toll free number is 1-877-374-5546.
PERMISSION TO ACCESS PROPERTY
Upon receipt of Certificate of Insurance, I, Doris M. Rosten, owner of record
of Parcel 1 (Map 108C Lot 36) and Parcel 2 (Map108C Lot 50) located at
2241 Turnpike Streetin North Andovr grant permission to
out eCiS r I i ('o tM PO 0 yiU -
to utilize my driveway located Parcel 1 and to cross over my land to gain
access to the. adjoining Parcel 2 in order to clear trees, make the property_
accessible to dig a well and to dig a well on Parcel 2..
The hemlock tree, which is marked and is in front of the fencing is not to be
taken down. Access is to occur to the left of that tree.
All Contractors will give 24-hour notice of anticipated access to me at 978-
688-1169 or my Agent; Lyndsie Reynolds at 978-255-1500.
DorisRosten
OCT -27-00 01:38 PM SAWYER & KOBIERSKI 978 686 7852 P.01
PERMISSION TO ACCESS PROPERTY
Upon receipt of Certificate of Insurance, 1, Doris M. Roston, owner of record
of Parcel 1 (Map 1080 Lot 36) and Parcel 2 (Map108C Lot 60) located at
2241. Turnpike Stree kn Ngrth Andoy�r grant permission to
�c: t.i. ! H ('� d+ =gyp ►a VAC.
to utilize my driveway located h Parcel I and t6 cross over my land to gain
access to the adjoining Parcel 2 in order to clear trees, make the property
,accessible to dig a well and to dig a well on Parcel 2.
The hemlock tree, which is marked and is in front of the fencing is not to be
taken down. Access is to occur to the left of that tree.
All Contractors will give 24-hour notice of anticipated access to me at 978-
688-1169 or my Agent, Lyndsie Reynolds at 978-255.1500.
Ooris M. Roston
FORM - U - LOT RELEASE FORM if -
INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from complia.: „ w%�i any applicable requirements.
APPLICANT M I CE IA �` ��)p�>:lf�c _G� < qtr ��PHONE z
ASSESSORS MAP NUMBER ' C) �� LOT NUMBER S~ 6
SUBDIVISION LOT NUMBER
STREET r(4, r—n o I k e' STREET NUMBER Z��S
OFFICIAL USE ONLY
........................................................................M..
RECOMMENDATIONS OF TOWN AGENTS
�■ ■.iL�.......■.......................�....................■ ■.M■ ■.Monson
✓� DATE APPROVED �� t
CONSERVATION ADMNISTRATOR
DATE REJECTED
COMMENTS,',� —rte a, r,r ,��y �— — s , �)D
DATE APPROVED
TO:7S
Lor Lol
DATE REJECTED
CO
FOOD INSPEC - HEAL
61-�S-Ju SkIkTOR - HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED 14�A —e
DATE REJECTED
PUBLIC WORKS — SEWER / WATER CONNECTIONS b — DO
DRIVE
WAY PERMIT
FIRE DEPARTMENT
rN
/D —/O
?'-0 CDATE APPROVED
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATF
0q,J
,\Jj ot-,) \Ulm. C)
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May -27-99 12:45P Notrth. Andover Com. Dov. 508 688 9542 P-01
SEPTIC PLAIN SU13MITTAL FORM
LOCATION: Z Z 9 A i 2e c,
i
SIE\w' PLANS: ES $125.00/1'lan_ u/
REVISED PLANS: YES $ 60.00/Plan
SITE- EVALUATION FOR -NIS INCLUDED: ES NO
DATE:
DESIGN ENGINEER: /1); .,,,n�-Cr N_a MC-t"i kztvtom.
DATE TO CONSLrLTANT:
*If you want your plans expedited, please submit three plans and included a
stamped envelope with'the correct amount of postage to mail plans to Port
Engineering.
When the submission is all in place, route to the Health Secretary.
Jun -23-00 12:31P Paul D. Turbide, PE/PLS 978-465-0313
Facsimile Cover Sheet
To: SANDRA STARR
Company: NORTH ANDOVER BOH
Phone: 978-688-9540 ,
Fax: 978-688-9542
From: Carlton A. Brown
Company: Port Engineering Associates, Inc.
Phone: (978) 465-8594
Fax: (978) 465-0313
Date June 23, -2000
Pages Including This
Cover Page: 4
Comments:
Sandy,
Enclosed are results of testing for 2241 Turnpike. (4 test pits were logged). Note that
perc tests were not performed. Benji Osgood looked at the soil, (and knew what the soil
maps said the soil was) and decided that it was going to be an overnight soak, so he
decided to postpone the perc testing until July. He will get back to you on that.
Thanks,
Carlton T
P
JUN 23,
P.01
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BOARD OF HEALTH TEL. 688-9540_
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: �� I z�
LOCATION OF SOIL TESTS: 7_Zgi TV,zn pk)4e.
Assessor's map & parcel number: .1o96- �&c>cA c -D
OWNER: TEL NO.:L�c9a -
ADDRESS: �I5 h ti . ►Ws7
ENGINEER: %ew &0L'-LtqNc�
CERTIFIED SOIL EVALUATOR:���-tR�2�
Intended use of land: residential subdivision single family home,,, ommercial
Repair testing Undeveloped lot testing iz'
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $275.00 per lot for new construction: This covers the minimum two deep holes
and two percolation tests required for each :disposal area. Fee of $75.00 per lot for
repairs or upgrades.
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. r
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 smaller than V-100') shall_ be. submitted to
the Board of Health showing the location of all tests (including abortred'tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.',�I
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BOARD OF HEALTH TEL. 688-9540_
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE:
LOCATION OF SOIL TESTS:
Assessor's map & parcel number: fn 8 G 1,c)c K s�
OWNER: TEL; NO.:
ADDRESS: ;;, 4t Ty y 5,- AJ . 14 -JT)
ENGINEER: �ew �Nc�U ►ti�? �%TEL. NO.: b- 17 G S
CERTIFIED SOIL EVALUATOR:
Intended use of land: residential subdivision sin le family home, ommercial
Repair testing Undeveloped lot testing
N. A. �onserva ion Commission Approval:
P((r L1 k'4 7
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $275.00 per lot for new construction: This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75.00 per lot for
repairs or upgrades.
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 all additional 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. -
vi�i`1 12
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE#
LOCATION: l t/ e
LICENSED INSTALLER: _ O o s. d s 4 1,4111C."
() r
SIGNATURE: , - TELEPHONE# j'`1 �- �`�✓ 1- 6 ° j
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
$160.00 Fee Attached?
Foundation As -Built?
Administrative Use Only
Yes ✓ No
Yes L-*� No
Floor Plans? Yes No
Approval 2UIZ �
Date: 0
�L\ Commonwealth of Massachusetts
W City/Town of NO. ANDOVER R� v
System Pumping Record
Form 4
'M
DEP has provided this form for use by local Boards of Health. Ot ery be g the
information must be substantially the same as that provided here. .1 m, eck with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
B. Pumping Record
1. Date of Pumping 2/3/10
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLS.
—2. uantity Pumped: 1500
Gallons
Septic Tank ❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
2/3/10
Date
t5form4.doc• 06/03 " System Pumping Record • Page 1 of 1
A. Facility Information
Important:
When filling out
1. System Location:
forms on the
computer, use
2245 TURNPIKE ST.
only the tab key
Address
to move your
NO. ANDOVER
MA 01845
cursor - do not
use the return
Cityrrown
State Zip Code
key.
2. System Owner:
0111
MICHAEL SAWYER
Name
Address (if different from location)
City/Town
State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 2/3/10
Date
3. Type of system: ❑ Cesspool(s)
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes
5. Condition of System:
6. System Pumped By:
Benjamin Shute
Name
J's Septic & Drain
Company
7. Location where contents were disposed:
GLS.
—2. uantity Pumped: 1500
Gallons
Septic Tank ❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
H79 406
Vehicle License Number
2/3/10
Date
t5form4.doc• 06/03 " System Pumping Record • Page 1 of 1