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HomeMy WebLinkAboutMiscellaneous - 230 ABBOTT STREET 4/30/2018 % 230 ABBOTT STREET j 210/038.0-(,,,!08-0000.0 f 1 1 Town of North Andover, Massachusetts Form No.2 e NoRTh BOARD OF HEALTHOL p� _ -19...L Z- 3?._w. - ... 0 A6057- o � A DESIGN APPROVAL FOR SS4 USEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant---'RZer&T/ Vo ► L Test No. Site Location_ Reference Plans and Specs.k)eq) -!�W6 Z-49-6 6k6 • • ENGINEER DESIGN DSA E— Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee o`'� Site System Permit No. //0r TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845-2909 J. WILLIAM HMURCIAK,DIRECTOR,P.E. Timothy J. Willett of No ory Telephone(978) 685-0950 Water SuperintendentL Fax(978) 688-9573 0 ^i F p September 30,2003 �'s;;1.. t`9 Mr. Malcolm.Murphy 230 Abbott Street North Andover,MA 01845 RE: Sewer Connection Dear Mr. Murphy: Please be advised that the sewer main in Abbott Street from Thistle Road to Nutmeg Lane has been accepted by the town. Consequently,homeowners may connect their homes to town sewer at this time. In fact,many homeowners in this area of town have already connected to town sewer. Very truly yours, Timothy J. Willett Water& Sewer Superintendent CC: Brian Lagrasse . fie FORM U LOT RELEASE FORM 5�I` 03 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *************************** APPLICANT FILLS OUT THIS SECTION*********************** // APPLICANT G �� //**O l60 G PHONE ?!� Y4 `Co y7�' LOCATION: Assessor's Map Number 7 PARCEL__/,_e�o LOT(S) SUBDIVISION STREET.2-- 3 d S ST. NUMBER�� a OFFICIAL USE ONLY*********************************** ��REC ENDATIONS OF TOWN AGENTS: CONSERVATION ADMI TRATOR DTE APPROVED ATE REJECT a COMMENTS Nits { Fe I�. CJOI 'C�n,'t•r�x�� o� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED j DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 1� OAc.�tar� r Q tG'C....�t'�l W '}'� �1}�i�� i �� /Ex�St.�{ -�i�Vr a01a�►� � \ryy� --� � bc ^ PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR —DATE— Revised ATERevised 9\97 jm fir; F x 3^ Town of North Andover, Massachusetts Form No.3 40RTH BOARD OF HEALTH ots,�.o,,�tip {[y p 19 g9 4 �-`-- Jt sACHUSEt� DISPOSAL WORKS CONSTRUCTION PERMIT Applicant F• NAME ADDRESS TELEPHONE ` ' Site Location a • Permission is hereby r. y granted to Construct ( ) or Repair ( an Individual Soil Absorption }�. Sewage Disposal System as shown on the Design Approval S.S. No. J' CHAIRMAN,BOARD OF HEALTH i Fee-> D.W.C. No. S V i Town of North Andover f NORTH 14 OFFICEOT 3�O`t� ° COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 '� °4 •.0- <y WILLIAM J. SCOTT 1SSACHUs�t Director (978)688-9531 Fax(978)688-9542 August 27, 1999 Ben Osgood,Jr. New England Engineering 33 Walker Road, Suite 23 North Andover,MA 01845 Re: 230 Abbott Street Dear Ben: This is to confirm that on August 26, 1999,at their regularly scheduled meeting the North Andover Board of Health considered variances requested for the repair of a septic system at 230 Abbott Street. The following variances were granted by a vote of the Board. Local Upgrade approval: P;�' PP Allow the reduction in the offset distance between the bottom of the leach bed and the water table from the 4 feet required by Title 5 section 15.212 to 3 feet. Local Variance: Allow the reduction in the offset distance between the leach field and the wetlands from 100 feet required to 52 feet. With the granting of these variances,the proposed septic plan dated,July 15, 1999 is approved. Please feel free to call the Health Department at 978-688-9540 if you have any questions concerning this action. Sincerely, Sandra Starr,R.S. Health Administrator cc: Manoj Munjal File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Jul-29-99 11 :45A Paul D. Turbide, PE/PLS 508-465-0313 P.02 July 29, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for 230 Abbott Street(Map 38 Lot 108) Dear Sandra, I find that the design dated July 15, 1999 with revision date of July 23, 1999 adequately addresses the regulations. If you have any questions or comments please feel free to contact me. Sincerely L.� Carlton A. Brown,PE/PLS Abbott230a.doc i PORT ENGINEERING Civil Engineers It Land Surveyors One Harris Street Newburypurt,MA 01950 (978)465-8594 NEW ENGLAND ENGINEERING SERVICES lk INC August 13, 1999 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover,MA 01845 Re: 230 Abbott Street,North Andover, Septic system design Dear Sandra: Please accept this letter as a request to have the above referenced plan considered for approval at the Board of Health meeting on August 26, 1999. Specifically,the board needs to approve the following. LOCAL UPGRADE APPROVAL: 1. Allow the reduction in the offset distance between the bottom of the leach bed and the water table from the 4 feet required by Title 5 section 15.212 to 3 feet. LOCAL VARIANCE: 1. Allow the reduction in the offset distance between the leach field and the wetlands from 100 feet required to 52 feet. Please note that this letter is a revised letter and replaces a letter dated July 20, 1999. While obtaining a conservation commission permit for the installation of the system the wetlands on the site was expanded by the conservation commission agent. Revised plans showing the new wetland line will be submitted on Monday August 16, 1999. No other changes will be made to the plan. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, CT WN F 80AFNORTHAA DOVzF?/ U �--�.�OEALTH Benjamin C. Osgood,Jr.,EIT AUG ' l President 999 33 WALKER ROAD-SUITE 23-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 NEW ENGLAND ENGINEERING SERVICES lk INC July 20, 1999 Sandra Starr,Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 230 Abbott Street Septic n stem design p Y g Dear Sandra: Please accept this letter as a request to have the above referenced plan considered for approval at the Board of Health meeting on August 26, 1999. Specifically,the board needs to approve the following local upgrade approval request. LOCAL UPGRADE APPROVAL REQUESTS: 1. Allow the reduction in the offset distance between the bottom of the soil absorption system and the water table from the 4 feet required by Title 5 section 15.212 to 3 feet. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, TOWN OF NORTH aNIDOv�'2�/;..,...7 BOARD OF HEALTH !. Benjannn C. Osgood,Jr.,/IT - - •�--- President ?' JUL 2 3 1999 33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: j Q-7-CN9 CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE: O TELEPHONE# CHECK ONE: REPAIR: L'� NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only 575.00 Fee Attached? Yes Foundation As-Built? Yes No Floor Plans? Yes No Approval � ,�C7� Date: Aoliqa =.•Sir ti "f c_r.�`7 H OCT -t$ 1999 SEPTIC PLAN SUBMITTAL FORM LOCATION: Z 3o A� ,4 5'2 eet NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: ��Z3 ( qq DESIGN ENGINEER: �`e� E ��-.✓ � �� �•, �� c I DATE TO CONSULTANT: 1 *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. 1 t I Page 1 of 5 ! ! ! ! 9A-APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts '16,,2Ty 19006"IL , Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(t) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non-conforming system with a design flow of<10,000 gpd, where full compliance, as defined in 310-CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non-conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: -1 red i ,� ��v►o AA u *j13#t- Address: Z 3 0 h�b�k S bx�{- N. P v 0 bJ E !2. Zvi.A Phone#: Address of facility: 23o abbe' St2«T' ,j. iqN o<3je,z 2) Applicant (if different from above) Name-'- Address: ame:Address: Phone#: 3) Type of Facility: ---'-Residential Commercial School Institutional (Specify) S IN&LE �4►ti.�. ��o►ry.G Page 2 of 5 4) Type of Existing System: i privy, cesspool(s) conventional;system , other(describe) Type of soil absorption system (trenches, chambers, pits,etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system ? gpd Approved: des Approval date. no Why: b) Design flow of proposed upgraded system,jS�gpd Why c) Design flow of facility 6S'a gpd 6) Proposed upgrade of existing system is: a). Voluntary required by order, letter, etc. (attach copy) /Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) vti G10 w,✓ (date) b) Describe the proposed upgrade/ to the system: --PXISrihc S[r�hC I—Q'"A �,7/v /Crnc,rn. /Vfw pJ.»L!� W•t±/� f 4 o%ro�i��[.p Al rT .SCWASc C1 new lG'4C h c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) Percolation rate of 30-60 minutes per inch (state actual perc rate) Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) eduction of required separation between bottom of SAS & high groundwater(specify proposed reduction & perc rate) i�ej x. '�mm y 7 13 , ' I Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) F , System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) 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 ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater ?j feet As determined by: Evaluator's name: /1/L Evaluator's Signature: Date of evaluation: a8199 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. -If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. a Page 4 of 5 List of affected abutters: Abutter Name Date notified Address , F Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain Nvhy full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: tr b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. PAD AJ c) A shared system is not feasible. /V. .S 00 6 A aareas d) Conne�cbon to a sewer is not feasible. Z/ O .Scow,(/` C X r s 7j .t �C 4 rL•t 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. 1s the DSCP application attached? ✓ yes no Page 5 of 5 11),Certification , -1, the facility otivner, certify under panalty of law that this document arld all attachments, F 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 knowing violations." Facili Owner's Sign Date /67�nICl Nor �S f 6-j r Print Name e-li .%^ Qs ou 2 7 20 7 Name of Preparer Date X78- 6816- 1768 3-3 /14 .S,k z 3 Telephone No. &Address of Preparer NOTE: Title 5, 310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. NEW ENGLAND ENGINEERING SERVICES lk INC July 20, 1999 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 230 Abbott Street, Septic system design Dear Sandra: Enclosed you will find five copies of a septic system design for the above referenced property. Also enclosed are the soil evaluator sheets and the local upgrade approval request form. These documents are being submitted so the town may review and approve the plans. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benjarnirt'C. Osgood,Jr., President 33 WALKER ROAD-SUITE 23-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 FORM 11 - SOIL EVALUATOR FORNt Page 1 of 3 No. i Date: a t i Com ionwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal ed B '�- .. � ......................... Date: ��a71. .. ..... Perform y WitnessedBy: ._._. � '`'� ...." 'e .........................__._ . ............................. .. ... _.... .. .......... Lonlivn Address a 'f Dwrcrs w�. `/Z, 6T/ La/ Addros,and Z 30 i1 BJv✓� �r Tckphom 1 New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Nil Year Published I'Fel....... Publication Scale /��'� U Soil Map Unit C_ t lom Drainage Class � �.L,.......... Soil Lim tations � . / ... _._................... Surficial Geologic Report Available: No © Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) _ ....... Landform _. ........_..... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes El Wetland Area: National Wetland Inventory Map (map unit) ........... Wetlands Conservancy Program Map(map unit) __.__........................._....... ... ....:................ Current Water Resource Conditions(USGS): Month / /'Y' Range :Above Normal ❑Normal ❑Belcry Normal Other References Reviewed: -- DEP APPROVED FORM-12107M FORM 11 - SOIL EVALUATOR UbRI I Page 2 of 3 Location Address or Lot lqo. I ©n-site Review j 9 Deep Hole Number` . / Date:. Time �'/ `Weather/Z' 57 Location (identify onsite plant Com ..:::: ..::: .. . : . _ .... . _. .. ,. : .. Land Use � ! '� Slope 1%) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body 7�� feet Drainage way 2 feet Possible Wet Area feet Property Line .. .. .. feet Drinking Water Well feet Other . ...... DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inchesl (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, Gravell —off �G z �8 (24V ,;2-� �s Z_ MINIMUM OF HOLES REQUIRED AT EVERY PROPOSED DISPO L AREA Parent Material (geologic) L- DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: y Weeping from Pit Face: - A 7 Estimated Seasonal High Ground Water: �4r/ DEP APPROVED FORM-12/07/95 Ay tom' 7i 1vcr i FORM 11 - SOIL EVALUATOR FORNI Page 2 of 3 Location Address or Lot leo. - On--site Review 1p ,�� 9 Deep Hole Number Date:./ !� Time:�0 / Weather %`'/� Location (identify on site plan) L� .. ._... Land Use Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body ©� feet Drainage way z�� feet Possible Wet Area ��feet Property Line _. .. feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) w �Z OY�y/Y r z 3 9 2 � cZ L s Parent Material(geologic) 1 f TGA DopthtoBedrock- 7! Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face*_ Estimated Seasonal High Ground Water: _552� _ -- DEP APPROVED FORM-12107/9S ��� � 3 FORM 11 - SOIL EVALUATOR FOR(17 Page 2 of 3 ti n Address or Lot leo. �30 ez7 y� �� Location On-site Review Deep Hole Number `� Date:... Time- ��`-� ''�• Weather Location (identify on site plan) � ••. !b � / Land Use � Slope (%) Surface Stones r Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body ��� feet Drainage way feet Possible Wet Area '73-- feet Property Line 3 feet Drinking Water Well .. ." feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell► Mottling (Structure,Stones,Bounders, Consistency, % $//Y/ iso Z- a / e MINIMUM UF]I I] Z71, Parent Material(geologic) ��� �C L DepthtoBedrock: Doth to Groundwater: Standing Water in the Hole: 7 Weeping from Pit Face: Estimated Seasonal High Ground Water: t�9 DEP APPROVED FORM- 12/07/95 �/ 1 3 ( FORM 11 - SOIL EVALUATOR FOAM Page 3 of 3 Location Address or Lot No. Determination for Seasonal Nigh Water Table F € Method Used: ❑ Depth observed standing in observation hole ...... inches ❑ Depth weeping from side of observation hole. inches ® Depth to soil mottles inches ❑ Ground water adjustment .................. feet �7 Index Well Number .................. Reading Date .............. . Index Well level ....,.... . Adjustment factor ................... Adjusted ground water level .......................__....... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I 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 Signature Date 99 DEP APPROVED FORM-12107195 � y HHUNE NO. 781 334 0115 r� i FORM 1I - SOIL EVALUATOR FORA rage2of3 Location Address or Lot ;�o. I On-site Review Deep Hole Number Date: k :�� � Time. Weather Location (identify on site plan) J Land Use 7 S Slope ('/o) ""—' Surface Stones Vegetation GU �� Landform Position on landscape (sketch on the back) Distances from: I Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet. Drinking Water Well feet Other DEEP OBSERVATION HOLE `OG* i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, ?b Gravel) �15r 5 fAREA Parent Material fgeologir) DepthtoBedrock:_ _ Doth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: __- Estimated Seasonal High Ground Water:- --ROVED Fo ater:--ROVEDFo "i- IV07M I ' FF1,1 �: F. C. TANGAFD PHONE HO. 731 334 0115 I i FORM 11 SOIL ENALUATOK FORM Page 2of3 i Location Address or Lot No. l Ort-site Review Time: /P � F Weather L/ Deep Hole Number Date: Location (identify on site plan) Land Use S Slope (%) Surface Stones Vegetation G�CU�f landform . Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage Way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (tnchss) (uSDA) (Mvncell) Mottling (Structure, Stones,50 Gravol)rs, Consistency, °h 1 S L V-117 ' Co f 711911\ elk jk Parent Material(geologic) _ _ _ Depthto8edrock:_ Depth to Groundwater: Standing Water in the Hole: Warping from Pit Face; _�--- Estimated Seasonal High Ground Water. _1> DEP APPROvf0 FORA'- 12/07105 DATE: LOC AT1CN: �NGIN�_�,. BOH WITNESS. l PEP.00L-"�T10N Tc ST BOi iONiD`lminOrPDRC TEST- 2D TIME OF SOAK: (At least I S m1nutes Icnc) TIME AT 11E 7 TIME A T 9" / 3 TIME ,AT E-z" SO,=.K TIME ST/-'.FT D N E X T D.'`,Y K. T I vl F_ 2 T IME ,Y,T T11EAT i DATE: LOCATION: 7 ENGINL�,,. -- - — - - 60H VVl i NE.,.,. PERCOLATION TEST BO i i OM DEPTH OF PERC TEST: 3 TIME OF SOAK: _ t (At le--st 11 S minutes Icr,c) TIME AT 12" Ily TIME AT c" -' / � TIME AT ., � f ' ® Y OLE ,NIGHT -GAK E � � I I ME I r.i-'� I ED C i 1e�si mInu esj NEST D.�Y „GMK: T NI E AT 1 2" TIME L.T TIME AT DATE: ^ �C LOCATION: 00� - - LENGINEEz BOH BVI FIN PEF,C0LAT10N -1 ST 507 1 ONl UCr r Or �r �C I ES I a --� Lt Z {� j `� T1M` �F JCr.K.. !i G� (, ` J ( ^ EcS Tlnuies .cr'c) - -j o -,i I Tiiv1E T TIME IME S l P 1 H NEXT D,L-IY T 12" i NI E 'a.-I I iNIE AT E I DATE: LOCATION: �� ENGINEEE. BOH VVITNESS S: FEPlCOL^\TION TEST BOT OM DEPTH Or FERC TEST , TIME OF SOAK: _ _ a2 (At legis linctus Icrc) TIME T " '2 —d T IM"El , I TIMEA AP f9- C�� i 77 - I _ I " tet/-e 1°�'� 't t Alp- BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: LOCATION F SOIL TESTS: F30 Assessor's map & parcel number:_M ;3�4 �Jokk OWNER: TEL. NO.: ADDRESS: Z 3z� /U ENGINEER: 4)e,� ��51� Fi,,4rTT TEL. NO.: J 7u - G-2 6,-17E- CERTIFIED SOIL EVALUATOR: r �s��c, , L2L,� , C lc.�u Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing 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 of2$ 75.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. sT(-. ?&1±of 51.O=1TH A.NCNC` ,__�V. �Lsri rig I , ha � 4 {341, z �sta file Gc.Ci s f��A •i k t c � 9 �t•k '� �+1 v r ,,����d a.t #��r�'��t if ( fv l e 6p is i'• a q,.;}x�tp�.+�� �„h t3,a'# '€' �'� x �tr a y�r t 3 4y x � t �1b« s►P� r t #�” a. 'd+''"'^ � �' I!f 4d `5; ,r .z s 3i�E r t Ii� �"adiat ad r 44+'' q fs a dyn t , i t 3t x v � "{i Arp apt rcMgl.:pr kt iji ••",5 d � . `-t t.E at t { ed t,,.xr d r§d�� e�a�� ..i �r n � �C��€� i '. •i i. t�I€2 �l: s's3 a:d E k��d���}��..����r st�a ���"S, iY �..:.. _ i."�1 "�t+ ?�r_�d�'Sc�t'fP7i>� ���`�'•-a�,2.�� e3. Town of North Andover, Massachusetts Form No. 1 ,AORTH dd.1- BOARD OF HEALTH Q��T LED ,6 46'l —/ -19 OL a *CDs 4 °°°° Ew.°• �' APPLICATION FOR SITE TESTING/INSPECTION QDAATED PPP'`'�y �SSACHU$ Applicant y NA E ADDRESS TELEPHONE v Site Location � d Engineer NAME AD ESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH FeeTest No. 1171-1) S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH A BOARD OF HEALTH ED Y o� 19 O t � A Ew,k APPLICATION FOR SITE TESTING/INSPECTION ��A�RATED PPa��S SSACHU5� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time C91/ �P•�Q� CHAIRMAN, BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SAIL TESTS I DATE: S13)29 LOCATION F SOIL TESTS: e3O Assessor's map & parcel number: M ,3 3 �a9 OWNER: a��NI�w��_ TEL. NO.: GP7-0?60(0 ADDRESS: Z 3 ENGINEER: A)e,.--- �1 5�,.�� .Y TEL. NO.: 775 - G(96-17L9 CERTIFIED SOIL EVALUATOR: j�t, Intended use of land: residential subdivision, single family home, commercial Repair testing _i Undeveloped lot testing 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. 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. TOWN OF NORTH ANDOV5/ BOARD OF HEALTH i J 7 I i lv li ip i 1IIi .j I I i I i