HomeMy WebLinkAboutMiscellaneous - 28 CEDAR LANE 4/30/2018 (2)I
Lot &
WO
Has plan review fee been paid:
Plan Approval: Date: 6 A
Designer:. jz�l___675
Conditions:
Map/Parcel
Ul"
NO Permit;#_tA22,
Approved by: - " 4- j
Plan Date: A
Water Supply: Town C��
Well Permit: Driller:
Well Tests: Chemical Date Approved
Bacteria I Date Approved
Bacteria 11 Date Approved
Plumbing Sign -Off:
Comments:
Wiring Sign -off:
Form "U" Approval: Approval to Issue: YES NO
Date Issued By:
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:
Is the installer licensed? E NO
Type of Construction: NEW EPAIR
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: NO
DWC Permit Paid? 44E� NO
DWC Permit # Installer: �S&V-Lq
Begin Inspection: YES NO
Excavation Inspection:
Needed:
Passed: By:
Construction Inspection:
Needed:
As Built Plan Satisfactory:
YES:
Approval of Backfill
Final Grading Approval
Date: By:
Date: By:
Final Construction Approval: Date:
By:
Certificate of Compliance: Approval: Date:
NUMBER
NUMBER
COMMONWEALTH OF MASSACHUSETTS
North Andover
Board of Health
Smith, Christopher & Jane
------------------------------------------ - ------------------------------------------
�ME
28 CEDAR LANE
--------------------------------------------------------------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Design Approval For Soil Absorption Sewerage Disposal System
This perruit is granted in conforinity with the Statutes and ordinances relating thereto, and
expires ------------------------------ --------------------- unless sooner suspended or revoked.
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June 02, 2003
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COMMONWEALTH OF MASSACHUSETTS
North Andover
Board of Health
------------------------------------- S-mith,- -Christopher- &- Jane ---------------------------------
NAME
28 CEDAR LANE
---------------------------------------------------------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Design A oval For Soil Absorption Sewerage Disposal System
d1l 0 c- 611-7163
This pennit is grantedyin conformity with the Statutes and ordinances relating thereto, and
expires ------ ----------- unless sooner suspended or revoked.
---------------------------------------------------------------
June 02, 2003
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FEE
$225.00
Board
Of
Health
FEE
$225.00
Board
Of
Health
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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: J� — a�L— e�9 CURRENT INSTALLER'S LICENSE#
LOCATION: 2 (�� 2-, g
LICENSED INSTAIAER:_ �T6, 1, 7:,4 W
i
SIGNATURE: TELEPHONE
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
$175.00 Fee Attached?
Foundation As -built?
Floor plans on file?
A
Administrative Use Only
Yes No
Yes No.
Yes No.
Date:
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
property at 9 (26Van Zamf - yelative to the application
of &W JA10 dat ed for plans by /9, !E. A^1:�, and
V
dated-IZ-1-5 =2� with revisions dated V4
- Lf
I understand the following obligations for management of this project:
I . 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 alann 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.
U
Date:.. 4
Disposalkorks Construct/on Permh
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( )'constructed;
)repaired;
by
located
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit #12", plan dated with a design flow
of 1ND gallons per day. The materials used were in conformance with those specified
on the approved plan; the system was installed in accordance with the provisions of 3 10
CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with
the approved plan. All work is accurately represented on the As -built which has been
submitted to the Board of Health.
Bed inspection date:
Final inspection date:
Installer:
firw I -
Engineer:
10A a wpA_4tM 41
Engineer Representative
Engineer Representative
Lic.#: Date:
Date:
CHECKLIST FOR NORTH ANDOVER
SEPTIC SYSTEM PLANS
Job
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant: 0116111:5 Name of Designer:
601�& A- A/
-
"lo
Plan Date: Revision Date: Date of Review: 4611516C5
Property Address: 6U,41e Map: -A9-i�k Lot:
BOH Reviewer: Type of Plan (new or upgrade):
Number of Bedrooms in Assessor's Records: gpd) Garbage Disposal Allowed:
General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5
NA
t,�Problem
Street number and map/lot - 220(4)(u)
Maximum scale of 1 "=40' for plot plan - 220(4)
Maximum scale of 1 "=20' for profile and component details - 220(4)
Legal boundaries of the facility being served - 220(4)(a)
Names of abutters from recent tax map - NA 8.02j
Number of bedrooms, design calcs., - NA 8.02i
Name & address of record owner & applicant - NA 8.02k
Name & address of designer - NA 8.021
Holder and location of all easements - 220(4)(b)
Date plan drawn & any revision date - NA 8.02m
All dwellings and buildings, existing and proposed - 220(4)(c)
Location of all existing or proposed impervious areas - 220(4)(d)
All distances on site plan - NA 8.03a -c
Elevation of proposed driveway - NA 8.02t
Location and elevation of foundation drain - NA 8.02y
Location dimensions the incl.
and of system reserve (ematemat.) - 220(4)(e)
Limits of excavation of leach area on site plan - NA 8.02z
Locus plan - 220(4)(t) (Not to scale)
North arrow - 220(4)(g)
Existing and proposed contours - 220(4)(g)
Locations and logs of deep holes - 220(4)(h)
Locations and logs of percolation tests - 220(4)(i)
Date(s) of soil testing - 220(4)(h) & (i)
Existing grade elevation of each deep hole - 220(4)(h)
Elevation of percolation tests - N.A. 8.02n
Name of approving authority representative - 220(4)(h) & (i)
V.-
Name of soil evaluator - 220(4)0)
Soil logs and perc test logs match BOH records
Locations of waterlines, drains, and subsurface utilities - 220(4)(m)
Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n)
Complete profile of the system to scale - 220(4)(o), NA 8.02c
Cross section of leaching facility - NA 8.02w (Not to scale)
Locatiop of benchmark(s) within 50-75 feet of facility - 220(4)(q)
Note listing all variance requests with proper citations - 220(4)(p)
Local upgrade approval request form submitted - 403(l)
,s,� -
i7--
-1><
Original R.S./P.E. stamp, signature & date - 220(l) & (2)
P.E., discipline specified within stamp. MGL C. 112 s. 81M
sfc. supplies (w/in 400% pub. wells (w/in 250% pvt. wells (w/in 150') - 220(4)(
Location of watercourses, wetlands, wells, etc. w/in 150' of system — NA 8.02r
Wetland disclaimer — NA 8.02s
RLS plan reference & certification required (prop line setbacks) - 220(3)
Plan contains designer's certification statement
Use approvals / standards checked for I/A system - DEP docs.,
Perc rate >30 W1 - not allowed for new, LUA for upgrade - 245(1)&('3)
Perc rate > 60 MPI - must use modified tight tank or YA technology - 245(4)
Proposed system qualifies as "shared" system - 002 (definitions)
Flow is over 2,000 gpd - No R -S. allowed - 220(l)
Design flow was set in accordance with code - 203
Existing system location and note on proper abandonment - 354
Leaching facility at least I' above Base Flood elevation — NA 9.05
All piping Sch 40 minimum — NA 10.0 1
Basement floor mini -mum I' above groundwater elevation — NA 5.04
Foundation drain present with elevation — NA 8.02y
On-site Soil and Groundwater Review
OK Problem N/A
Proper deep observation hole logs on plan - 220(4)(h)
All deep holes and percs shown, including aborted tests — NA 8.02n
Soil evaluation forms submitted within 60 days of field work - 018(2)
Proper percolation test log - 220(4)(i)
Ample deep observation holes in primary disposal area (minimum 2) - 102(2)
Ample deep observation holes in secondary disposal area (minimum 2) - 102(2)
74 Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4)
Deep hole testing conducted within two years — NA 7.05
Hole Identification Numbers:
ground elevation el.
ZI 6J
27, ff
acceptable soil el.
Leach facilitv invert el.
C,
ground water el.
7L
refusal el.
bottom of leach facility el.
thickness of acceptable soil
40t/7
Zj
before & after soil R&R
separation to groundwater
7
separation to refusal
soil class
2
IV OL f-,
pere rate
loading rate
septic tank below g.w. table
pump tank below g.w. table
11 in fill
Setback Distances (Given in feet) 15.21 1
(yes or no)
(yes or no)
-255(l)
YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02
OK Problem N/A
Septic Tank Leach Facility
Property line 10 10
Cellar wall 10 20
Lqground pool 10 20
Slab foundation 10 10
V/ Deck, on footings, etc. 5 10
/ Waterline 10 10
A.L Private drinking well 75 100
Irrigation well 75 100
Wetlands 75 100
Public well 400 400
Wetlands bordering surface 150 150
water Supply or trib.
(in Watershed)
LZ Trib. To Surface Water supply 325 325
Ll-� Reservoirs 400 400
_Z Tributaries to reservoirs 200 200
I,- Drains (wat- supply/trib.) 50 100
L/ Drains (intercept g.w.) 25 50
Foundation drains 10 20
Drains (Other) 5 10
Drywells 20 25
Downhill slope 15' to 3:1 slope
M
3
4
w/o barrier
Building
Sewe
OK Problem Vel
Tank is accessible - 228(3)
Grease trap required for certain uses (check 230 for details)
No structures above tank — (228(3)
Pipe diameter listed (4" miniirnum) - 222(l)
Tank can accommodate both primary & reserve — NA 9.04
Pipe schedule listed - 222(3)
211% of flow (required,& provided given. 1100 min.) - 220(4)(1) & 221)(1)(a)
Pipe cast iron or Sch 40 PVC — NA 11.02
2-3" drop from inlet to outlet - 227(5)
Watertight joints specified - 222(3) & (4)
Minimum of 4' liquid depth - 223(2)
Pipe laid on compact, fin base - 222(5)
Pipe laid in line
3" air space above tees/baffles (minimum) - 227(4)
on continuous grade straight - 222(7)@
9"air space above flow line (minimum) - 227(4)
Cleanouts precede all changes in alignment and grade - 222(8)
Tees are not to be replaced by baffles - 227(l)
YZ
Cleanout provided every 100 feet - 222(8)
Tees extend 6" above flow line - 227(l)
Manhole at any 90 degree alignment change - 222(8)
Inlet tee extends 10" below flow line (minimum) - 227(6)
Invert elevation at building: W, /
Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6)
—
Invert elevation atseptic tank: R-6 , &L6
Gas baffle installed on outlet - 227(4)
Length of run: OIC -1, /
Access manhole cover above center of tank & each tee (except 2 compart)
Slope: Q.V�— (minimum of 0.01 - 0.02 desired" - 222(6)
228(2)
10' offset to private well or suction line - 222(2)
Septic Tank
OK Problem
N/A
Tank is accessible - 228(3)
No structures above tank — (228(3)
Tank can accommodate both primary & reserve — NA 9.04
211% of flow (required,& provided given. 1100 min.) - 220(4)(1) & 221)(1)(a)
2-3" drop from inlet to outlet - 227(5)
Minimum of 4' liquid depth - 223(2)
3" air space above tees/baffles (minimum) - 227(4)
9"air space above flow line (minimum) - 227(4)
Tees are not to be replaced by baffles - 227(l)
YZ
Tees extend 6" above flow line - 227(l)
Inlet tee extends 10" below flow line (minimum) - 227(6)
Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6)
Gas baffle installed on outlet - 227(4)
Access manhole cover above center of tank & each tee (except 2 compart)
228(2)
3-20" manholes - 228(2)
I childproof, 24" riser/manhole w/in 6" of final grade if <1000gpd- 228(2)
Inlet and outlet tees on center line - 227(l)
Soil compaction below tank specified (if soil is non-native) - 221(2)
6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(l)
If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(l)(b)
If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(l)(c)
Buoyancy calcs. required if tank at or below water table - 221(8)
Tank is watertight - 221 (1)
9" of cover over tank (minimum) - 228(l)
11- 10 loading (min.) - H-20 if traffic - 226(3)
Top of tank <=36" below grade - 221(7)
All pumping to tank (if applies) in accordance with - 229
Tank is set to keep old system in service during install if possible
Tight Tank (Check here if not present: )
OK Problem N/A
500% of design flow or 2000 gallons provided — 260(2)(a)
3- 20" manholes — 228(2)
Soil compaction below tank specified (if soil non-native) — 221(2)
6" of <=3/4" stone beneath tank specified — 221(2) & 228(l)
Buoyancy calcs. Required if tank at or below water table — 221(8)
Tank is watertight — 22 1 (1)
9" of cover over tank specified (minimum) — 228(l)
14- 10 loading (min.) — H-20 if traffic — 226(3)
Top of tank <= 36" below grade — 221(7)
All pumping to tank (if applies) in accordance with — 229
AN alarm set at 3/5 tank capacity — 260(2)(c)
Min. 1-24" frame w/cover at finished grade — 228(2)(f)
Year round access for pumping — 228(2)(g)
Distribution Box (Check here if not present:
OK Problem N/A
IZ
Inletelevation: 160, V7
Outlet elevation: /00. 30
0. 17' drop from milet to outlet (minimum) - 232(3)(b)
6" sump (minimum) - 232(3)(e)
All outlets at same elevation - 232(3)(b)
Outlet pipes laid level for first 2 ft. - 232(3)(c)
Pipe Sch 40 - NA 10.0�
Number of outlets: 40 Number of laterals:
Size of outlets: V ",'
Inlet baffle/tee min. I" over outlet invert for all d -boxes - 232(3)(a),
Soil compaction below distribution box specified (if soil is non-native) - 22 1
6" of stone beneath distribution box specified - 221(2)
Box is watertight - 221 (1)
Top of box <=36" below grade - 221(7)
Buoyancy calculations required if box is at or below water table - 221(8)
Pump Chambe (Check here if not present: V/ )
OK Problem N/A
Volume specified: 220(4)(r)
Pump on elevation- 220(4)(r)
Pump off elevation: 220(4)(r)
Alarm on elevation: 220(4)(r)
Number of cycles per day - 220(4)(r) (also 254(l)(d) if gravity from d -box)
Minimum 2" delivery line to d -box if gravity - 254(l)( c)
Pressure dosed Lf if flow >= 2,000 gpd - 254(l)(a) & 254(2)(a)
Cycles per day is consistent with chamber volume - 23 1
Volume calculations include flowback volume - 2') 1(2)
Leach lines capped, vented, or connected together - 251(9)
-iZ Pressure dosing guidance followed if pressure distribution - 254(2)(c
t,-*"' Pressure dosing required over 2,000 gpd or with I/A remedial use - 23 1 (1)
Leaching Trenches (Check here if not present: LI -11,
OK Problem N/A
Number of trenches:
Minimum of 2 trenches - NA 9.01(2)
Depth of trenches (max eff. 2'): -247(l)
Width of trenches (2'min., 4'max.): - 251 (1)(b)
Length of trenches (100' max.): - 25 1 (1)(a)
Trenches are vented (when > 50') - 251 (11)
Trenches follow contour lines - 251(2)
Trench spacing 3 times effective width or depth minimum- 251 (1)(d)
In fill or reserve between trenches, 10' min. - NA 14.0 1 & 14.03
Available leach area given (Min. 500 s.f.) - NA 9.01(2)
Bottom = L x W x # s. f.
Sidewall = L x D x # x2= -s. f
Effective leach area given
Loading factor:
Effective area = total area s.f x LTAR g/day
Effective area is >= design flow of facility being served
2"of 1/8"- 1/2" 2x washed peastone.- 247(2)
Trench depth of 3/4" to 1 1/2" double washed stone - 247(l)
Leaching Pits (Check here if not present:
OK Problem N/A
# of pits/pit systems: _ (dosing chamber if > 1, 23 1 (1))
Dimensions of each pit or system: L W D
Depth of pits (max eff. 2'): - 253(lXa)
Available leach area given
Bottom = L x W x # of systems s. f.
Sidewall = L + W x D x 2 x # of systems s.f
Total area = bottom + sidewall s. f.
Effective leach area given
Loading factor:
Effective area = total area s.f. x LTAR _____,g/day
Effective area is >= design flow of facility being served
Minimum of 2 pits at least IYX 16' - NA 9.01(3)
Distribution for galleries/chmbrs. in trench config. - pipe every 20' - 253(6)
Distribution for galleries/chmbrs. in bed config.-ea.pipe serves <= 40 s.f -253(6)
Spacing - 2 times the effective width or depth (the greater) - 253(l)(c)
2"of 1/8"- 1 /2" 2x washed peastone.- 247(2)
3/4" to 1 1/2" double washed stone - 247(l)
Each pit has at least one 20" access cover. 24" Cl to grade over 2,000 gpd
-253(3)
Surrounding aggregate thickness between F (min.) and 4' (max.) - 253(l)(b)
Vents, if necessary, extend under covers of pit(s) - 241 (e)
Leach Fields (Check here if not present:
OY Problem N/A Number of fields: (need dosing chamber if > 1, 231 (1))
7
24 hour storage capacity above pump on elevation - 231(2)
Number of pumps: 2 if system serves >2 dwelling units - 231(6)
Capacity of pump(s) - gpm @ 'TDH - 220(4)(r)
Pump can pass 1 1/4 "solids (minimum) - 231(7)
Pump controls specified - 220(4)(r)
Alarm equipment specified - 231(2)
Alarm is in building and powered on separate circuit from pump - 2') 1(9)
Pump sequence correct (off -lead on -lag on-alan-n on) - 231(8)
Pump performance curves included - 220(4)(r)
Manual operating switch - NA 12.01
Check valve, bleeder hole - NA 12.01
1 childproof, 24" riser/manhole to final grade - 2'31(5),
Soil compaction beneath pump chamber specified (if soil is non-native) - 221(2)
6"of <=3/4"stone beneath chmbr. specified - 221(2) & 228(l),
Buoyancy calculations if chamber is at or below water table - 221(8)@
9" of cover over chamber (minimum) - 228(l)
H- 10 loading (min.) - H-20 if traffic - 226(')),
Chamber is watertight - 221 (1)
Top of chamber <=36" below grade - 221(7)
Leaching Facility (general - complete for all designs)
OK Problem N��
50% larger if garbage disposal - 240(4)
Trenches to be used whenever possible - 240(6)
No vehicle or imperv. area above U unless unavoidable - 240(7); NA 13.02
Vented if under impervious cover - 241 (1)
Vented through same pipes as distribution system - 241 (1)(a)
Vent protected from precipitation/animal entry - 241 (1)(b)
Vent is placed beyond traffic or impervious area - 24 1 (1)(c)
All lines connected to vent if bed or trenches - 24 1 (1)(d)
9" cover over peastone - 240(9)
Reserve area provided (new construction) - 248(l)
Reserve 4' from primary leach area — NA 9.04
4' (5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b)
4' (down to 2' with variance or I/A - upgrades only) of natural soil under U
GW separation is adjusted to highest existing grade if facility cuts into a hillside
Pipe slope minimum of 0.005 - 251(9)
Require 5'removal and replacement if in fill - 255(5)
Top of leach facility <= 36" below grade - 221(7)
Final grade over 11 minimum 0.02 ft/ft -240(l 0)
Surface & subsurface drainage away from 11 - 240(l 1) & 245(5)
Minimum design flow 440 gpd without deed restriction — NA 13.01
3:1 slope where grading required - 255(2)
Toe of fill slope stops 5' from property line or swale installed - 255(2)
Impermeable barrier if < 3:1 slope or < 15 feet to —3: 1 slope - 255(2)
Impermeable barrier/retaining wall poured concrete — NA 9.02
Retaining wall stamped by P.E. - 255(2)(b)
Top of retaining wall >= top of peastone elevation - 255(2)(1)
10' offset from edge of leach facility to edge of ret. wall - 255(2)(g)
Perc test(s) done in most restrictive layer - 104(2)
Perc test 4' below leaching elevation — NA 7.06
Design flow listed and required/provided leach area given - 220(4)(f)
Leach pipes SCH40 PVC — NA 10.0 1
Leach pipes minimum 4" diameter except for dosed system — NA 14.04
6
jz
Final Grading
OK Problem N/A
A/
5/24/01
1-1
Length (100'max.): 252 (2)(b)
Width: AO "
Total area: L V,5- x W f,
Minimum 900 square feet - NA 9.01(l)
Distribution lines connected with solid pipe — NA 15.01
Effective leach area g1ve
Loading factor: 7Y
Effective area = total area 17 s.f x LTAR & g/dav
Effective area is >= design flow of facility being served
Minimum of two distribution lines - 252(2)(a)
6' line separation (max.) - 252(2)(d)
4'maximum separation from edge of field to line - 252(2)(e)
10' minimum separation between adjacent leach fields - 252(2)(f)
Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2)
2"of 1/8"-1/2" 2x washed peastone, 247(2)
Slope over leach area minimum of 0.02 feet/foot — 240(10)
Grading shall divert drainage away from leach area — 240(11)
Grading slopes away from dwelling
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NEW ENGLAND ENGINEERING SERVICES
lk INC
Sandra Staff, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 0 1845
Re: 28 Cedar Lane, North Andover, Septic system design
Dear Sandra:
May 30, 2003
I Tc
,""; C,.'- , "-)R7'4-1 A
BO OF
'U;�! 2 2003
4J
Enclosed are the following documents regarding the above referenced property.
1. 5 copies of septic system design plans, one with an original stamp.
2. Copy of soil evaluator sheets.
3. Local upgrade approval request form.
4. Application for approval.
5. Check to cover fee.
This plan is being submitted for approval. If you have any questions regarding the
information submitted, please do not hesitate to contact this office.
Sincerely,
/3—
Benjamin C. )d, Jr., EIT
President
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
SEPTIC PLAN SUBMITTALS
LOCATION: 2P? Ci-7f>y�a 1-6AJE Map&Parcel 106,0' -/YO
3 el
NEW PLANS: $225.00/Plan Check #:
REVISED PLANS: YES $ 60.00/Plan Check #:
SITE EVALUATION FORMS INCLUDED:
LOCAL UPGRADE FORM INCLUDED
DATE:—
CYEDS NO
NO
DATE TO CONSULTANT:
DESIGN ENGINEER: C -LAO 0 )�/v (7--� Telephone #: '9 -7 S - 6 �3
When the submission is complete (including check), date stamp plans, COPY for
Conservation, and place in existing rile with green Design Approval form.
04/23/2003 13:43 1782.33412115 TANGARDR PAGE 01
FORM. 11 - SOIL EVALUATOR FORM
I Page 2 or 3
L&ntion Address or I-01, No,
it Vif!W
IDeep Hole Number Date, Timc
Lo,,-ation (identity on site plan)
Slope 1%) SurfaCO Siones
Land Use
Vegetation
Landform
Position on landscape
DivenceS frorn' feet
open Water Body f eet Drainage wAy feet
possible Wet Area feet Property Line
Drinking Water Well feet other.
DEEP OBSERVATION 'HOLE LOG 0
Depth irorn soil Hrrizon soii Texture Soil Color
surlace ;Inches) (LISDA) (Munsell)
k
Weather
Soil Otner
Mertfing (Structure, S -or", SoQjdert, ConsistCnCY, NO
Gravel)
Pa-ent materiel lgeologirl
De2!'11 to Grqundwa0f: Standing Watef in the.-,, Hole: weeping frorn Pit Face;
$easorjal High Ground YVR§f!-
DEP APPROVED POP0 I - 12-TV95
Pre
Pa-ent materiel lgeologirl
De2!'11 to Grqundwa0f: Standing Watef in the.-,, Hole: weeping frorn Pit Face;
$easorjal High Ground YVR§f!-
DEP APPROVED POP0 I - 12-TV95
04/23/2003 13:43 17813340115 TANGARDIR PAGE 02
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
C—A
C-- I t
Location Adelmss or Lot No.
On-sit-e-R-e-vikw-
2— ;?w Weatlhe4ov/2 .0
Deep Hole Nurnbor , Date:�*<7-&,�, Time,/
I
Location (identity—on site plan)
Land U$e slope Surface'Stones '!`7
Vegetation
Landform
Position on landscape
Distances from:
Open Waier Body feet Drainage wey feet
Possible Wet Area feet Property Line feet
Drinking Water Well f eet Other.
DEEP OBSERVATION'HOLE LOGO
Depth from
Swrface (Inches)
soil Horizon
Soil Tex%vf6
�USDA)
Soil C:01cr
Imunselll
Soil
Mottlino
Other
ncv, o
(Structi.ire, Siones, Boulders, Consisiee
Gravel)
.0 -OP 'Pal/
C,
1:074— 4 -
Parent Material (geologic) V*hto9adroc$::
Depth to Croundwater: $1aridingW8t01ln1hP1`Ql0! Weeping from Pit Face:
Estimated Seasonal Hjg�t Ground Water:
7
DEF &PPROVED FORM - 1210119S
Page I of 5
9A - APPLI�ATTON FOR LOCAL UPGRADE APPROVAL
Commonwealth ofMassachusetts
North Andover, Massachusetts
Application for Local Upgrade Approval
Title 5, 3 10 CMR 15.000
DEP approved form required by 310 CMR 15.403(l)
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 3 10- CMR 15.404(l), is not feasible.
To be submitted to DER For the upgrade of a failed or non-conforining 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 3 10 CW 15.404(l), 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 3 10 CUR 15/000.
1) Facility/System Owner:
Name: I A AJ C- 5/%4 ( T71
Address: 2, 8 <� ED 1q (Z L_ P� AJ /V0,ZT)-(
Phone#: q713-6124.- 91GI3
Address of facility: ;z C07 C)
2) Applicant (if different from above)
Name: _,!;A_�- c -
Address:
Phone #:
3) Type of Facility:
,---Residential -Commercial School Institutional
(specify) r7, I '-j & L' e "/1', 1 �j 0L"'JZL..'. I /J 6-
-0
Page 2 of 5
4) Type of Existing System:
__privy cesspool(s) -"conventional system
gther(describe).
Type of soil absorption system (trenches, chambers, pits, etc.) ?, T -5
5) Design Flow Based on 310 CMR 15.203:
a) Design, flow of existing system ? ---nA
Approved: _��yes Approval date:
no Why:
b) Design flow of proposed upgraded system Why__R6,00kpa-�
c) Design flow of facility 91) gpd
6) Proposed upgrade of existing system is:
a) _ Voluntary
— required by order, letter, etc. (attach copy)
_,X Required following inspection required by 31 CMR 15.301
(provide date inspection form was submitted to the approving authority)
(date)
b) Describe the proposed upgrade to the system:
'XN -S -1,9 L-%- 4jz-'�' --p90 it, ' A/- J�> I- i� &C H Pt CZ
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)
Ve"'Reduction of required separation between bottom of SAS & high
groundwater (specify proposed reduction & perc rate) j�-' p J1 ' 4 R lwcq
46
Page 3 of 5
Other requirements of 3 10 CMR 15.000 that cannot be met (specify sections
of the code)
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(l)(1)(1). The evaluator must be a member or agent
of the local approving authority:
Distance from soil absorption system to high groundwater I/ feet
As determined by:
Evaluator's name: —'-. Aj V* izA-
Evaluator's Signature:
Date of evaluation: js 1 2S-) zc,,�- 3
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 fonn and
shall reference the standards set forth in 3 10 CMR 15.402 through 15.405.
*1
Page 4 of 5
List of affected abutters:
Abutter Name
Date n6tifi eld
Address
Abutter Name
Date notified
Address
Abutter Name
Date notified
Address
Abutter Name
Date notified
Address
9)* Explain why full compliance, as defined in 310 CMR 15.404(l), is not feasible
(each section must be completed):
a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
'41,& 1 OU (a- I- "i (. TL> ^,% w Lj Q #-y% #+VC &,- (2- A 0 Cr- 1�� ro e e-4
C -p- -I '-S*C�A-k-- PIM"6 (zc"h,;, r -"n' ika- con-s-z"s 11**"� eN 6r
t+ 6�+LA- OND '1-94F ;�O 0 - I Zr q- e 0,-I j>.
b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible.
- COS- -r- I_,;- P ro �'Ao "L-fi -j c-
c) A shared system is not feasible.
/VO e. ac- 6 1 T�S 0 ary vq-c-
d) Connection to a sewer is not feasible.
�) %-I S 6110 & ez iFX /
10) An application for a disposal system construction permit, ' including all required
attachments (e.g. plans & specifications, site evaluation forms), must accompany
this application. Is the DSCP application attached?
L---- Yes no
Page 5 of 5
11) Certification 1.
"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 knowing violations."
V— ( -,. g:4, roo �
Facility OwnerkAgnature -/ Date
JILU-C.6- ..., e
Print Name
C 0,>,S) 5tz
NameofPro
-�;-/ -,3, Z'/ & �,
Date
(e V L -F c H wo-,z PALYL Al. 4NP 0-e/L 7 5, 6 S 6 —/,;7(,
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.
lkNEW ENGLAND ENGINEERING SERVICES
INC
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
June 18, 2003
F
H
Re: 28 Cedar Lane, North Andover, Septic system design 19 2C33
Dear Sandra:
Enclosed are revised septic system design plans for the above referenced property. The
following revisions have been made.
A. The house has been noted as not having a foundation drain.
v2. The connect pipe ends note in the profile has been modified to indicate the use of
solid pipe.
""'3. The percolation test elevation has been added.
,4. A swale detail has been added along the house to indicate how the water will drain
from around the house.
-5. The existing system location has been added to the plans.
One other issue you wanted addressed is the reduction in offset distance to the water table
request. Several facts were examined by this office while determining if the reduction
was warranted. In order to maintain a 5 foot separation in the offset to the water table a
pump system would have to be designed. Also, the site is sloping and the water table
slopes with the site as indicated by the test pit information so at least half of the system
has a water table offset approaching 5 feet or greater. It is the opinion of this office that
the installation of a pump system in lieu of a gravity system poses a greater maintenance
responsibility. The potential of a problem with the system that would result in a public
health threat would outweigh any minute amount of increased treatment that would be
gained by raising the entire system one foot.
This plan is being submitted for approval. If you have any questions regarding the
information submitted, please do not hesitate to contact this office.
Sincerely,
A'�. C. �' � -
Benjamin C s 0 Jr., EIT
President
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
BOARD OF HEALTH
NORTH ANDOVER, MASS. 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: )03 MAP & PARCEL: 106,9 P;"o
RECEIVED
MAR 0 5 2003
NORTH ANDOVER
CONSERVATION COMMISSION
LOCATION OF SOIL TESTS: 2�3 CFPVJjQ 1, Iq Aj F'
k
OWNER: CH-gi3Tc, P�(Eg � 3-tIME -5MI-17i TEL.NO.:-978-6,�6-�/67
ADDRESS:—,,I- B C -F ID A IZ I- A Aj I-- luc; IL -77e /�eup co cr'e_
ENGINEER:- 06Lk-, :F-fJ6i-Atj'P F-O&WOve(k) 6— TEL.NO.: q79- 9
CERTIFIED SOIL EVALUATOR:
Intended use of land: Residential Subdivision Single Family Home Commercial
Is This:
Repair testing 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, deed, or letter from owner permitting tests)
2. Plot plan
3. Fee of $425.00 per lot for new construction. This covers the rn�inirnurn two deep holes and two percolation tests
required for each disposal area. Fee of $200.00 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 I"-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: Check Amount: Check Date:
A-0 A
too
�Wj
Mp
��t own
A-0 A
too
�Wj
. 4
0
Town of North AndoVer, Massachusetts Form No. 1
BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
Applican4-�' W'rl�m 4�
NAME ��ADDR S TELEPHONE
Y4"
17
Site Location
Engineelt--�o_-4�-
NAME /Zi ADDRESS TELEPHONE
Test/inspection Date and Time
-CHAIRMAN, BOARD OF HEALTH
Fee— Test No. 145�
S.S. Permit No. Z= D.W.C. No._C.C. Date—Plbg. Permit No.
Town of North Andover, Massachusetts
"OR7#1 Form No. 2
Of ..... . BOARD OF HEALTH
0
DESIGN APPROVAL FOR
AC
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant
Test
Site Location
Reference Plans and Specs.
ENGINEER DESIGN DAT
in accordance with regulations of Board I
Permission is granted for an individual soil absorption sewage disposal system to be insta led
of Health.
CHAI AN, B ARD OF
Fee— Site System Permit No.
WELL DATA3ASE
ADDRESS:
AGE OF WEELL.-
WELL DRILLI-7R.-
W`El_r WELL LOCAT70N:
,WELL PER.N.ET DATE: DEPTH OF WEL.
-...'-TYPE OF WELL. a— DRMLED�� b. DTJG
CK:_
TYPE.0FWA=BEkRlNGRO
WA=.A,'L'�TAT_YSSDATF_--
EIGH MANGANESE:. Y
BIGHIRON- y CT= CONTANENLNTS: y
W= DATA -BASE
ADDRESS: 0 11-7
AGE OF WELL. WELL DRILLER -
"Y= rr.
PER, WELL LOCA77ON: N
WELL P EF-_`Lv9 T D A TE: DEPTH OF WELL.
TTPE OF V;`ELL: a.. DRILLED b, DUG c. U-MKNOWN
ME OF WATER BEAR2,TG ROCK:
Z
WATER A.NLALYSIS DATE: I I-HGHNLk_NL GAIESE Y
HIGH IRON: y N OTT= CONTAILY�A_NLTS: y IN