HomeMy WebLinkAboutMiscellaneous - 296 RALEIGH TAVERN LANE 4/30/20188,Z
IZ
Irn
(D
SUUMARY OF INVERTS
SEWER 0 FDTN.
153.29
SEPTIC TANK IN
152.94
SEPTlC TANK OUT
152.71
PUMP TANK IN
152.68
DIST. BOX IN
154.53
DIST. BOX OUT
154.36
INV. IN CHAMBER
154.30
BOTT. CHAMBER
154.02
JULNGH
Q
BUILDING TIES
BLDG. CORNER A B C D AaM THIS PLAN & CERTIFICATION IS NOT
SEP11C TANK OUT 33.5 14.5 A WARRANTY OF THE SUBSURFACE DISPOSAL
PUMP TANK OUT 24.1,17.0 SYSTEM * IT IS A RECORD OF THE LOCATION
DIST. BOX 25.11,31.7. AND ELEVATION OF THE EXISTING SYSTEM
COMPONENTS.
"I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS -BUILT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
APPROVED DESIGNS PLANS.
114014el
SIGNATURE OF DESIGNER 'D,4TE
WETLANDS FLAGS BY -
NORSE EWARONMENTAL
SERMCES 4-13-115
LEACH FIELD
W/96 INFILTRATOR
CHAMBERS
TA; TRN
AS BUILT PLAN
RECEIVED
JUL 2 3 2.015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN I -
NORTH ANDOVER, MASS. /296
AS PREPARED FOR
DAN MCQUAIDE
DATE: 6-22-15
SCALE: 1"=40'
RAIZIGH TAVERN LANE
TM: 106C
TL: 112
0 20 40 80
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
SUMMARY OF INVERTS BUILDING TIES
SEWER 0 FDTN. 153.29 BLDG. CORNER A B C D BjQM' THIS PLAN & CERTIFICATION IS NOT
SEP11C TANK IN 152.94 SEPTlC TANK OUT 33.5 14.5 - - A WARRANTY OF THE SUBSURFACE DISPOSAL
SEPTIC TANK OUT 152.71 PUMP TANK OUT 24.1 17.0 - - SYSTEM. IT IS A RECORD OF THE LOCATION
PUMP TANK IN 152.68 DIST. BOX 25.1131.7 - - AND ELEVATION OF THE EXISTING SYSTEM
DIST. BOX IN 154.53 COMPONENTS.
DIST. BOX OUT 154.36
INV. IN CHAMBER 154.30 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
BOTT. CHAMBER 154.02 EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS -BUILT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
APPROVED DESIGNS PLANS.
veklme e��&iAl4rz_ - 0 7, InlIZ,
SIGNATURE OF DESIGNER . DATE
31- .1d,
I?ALFJGH TA VERN LANE VLA I L
NEM cp
C-14
AS BUILT PLAN
TE
Ne R�p �,/ _S4 mll
,p
I xn/
I w-, - �: ONA L
0 F
SUBSURFACE DISPOSAL S viSTEM
LOCATED IN'
NORTH ANDOVER,
RECEIVED AS PREPARED FOR
DAN MCQUAIDE
JUL 2 0 2015 DATE: 6-22-15
TOWN OF NORTH ANDOVER SCALE: 1 =40'
HEALTH DEPARTMENT
MASS./296 RAIZIGH TAVERN LANE
TM: 106C
TL: 112
0 20 40 80
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
Q
:13
CH
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 7/15/15
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Construction of an
On -Site Sewage Disposal System
By: Todd Bateson
At:
296 Raleh!h Tavern Lane
Map 106.0 Lot 0112
"_Nqrth Andover, MA 01845
of thireu(ifiXe �hall not be construed as a guarantee that the system will function satisfactorily.
Michele Grant
Public Health Agen
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
C
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System constructed; repaired;
By:
(Print Name) ' -
Located at:
(Installation Address)
RECEIVED
JUL 0 7 2015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
and last revised on
2--K; with a design flow of
440 —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 310. CNM 15.000, Title 5 and local
regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on
the As -built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: U - 1-7- 14,
DILL, [I-rA4_q,6
And - Print Name
Final Construction Inspection Date:
And - Print Name
(Signature)
Enginer:_V1k//Re OW4aA41Z Signature)
%00�
Engineer Repr gnature)
Engineer Representative (Signature)
Date:_�—j — /.S—
And - Print Name
Date: 71alllZel r
V141*11 N4,(XC1e4CWA1--
And - Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web http://www.townofnorthandover.com
Town of North Andover — Septic System - AS~BUILT CHECKLIST
1) All changes to the design plan have been reflected and noted on the as -built plan
2) __��__As-built plan has a suitable scale; U inch = 0 feet or fewer for plot plans)
1//
3) Street A/dress, Assessor's Map and Lot Number
4) Lot Lines and Location of Dwellings served by the system
5) Locations, Elevations and Dimensions of As~built system components, including reserve (if applicable)
6) __'�_Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure
v1 setback distances are shown on the as -built plan from system components to:
�41#Subsurface, interceptor & foundation drains
Catch basins
Property lines
V Dwellings or other structures
'I -Private water supply or irrigation wells
_/ Watercourses or wetlands
Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system
9) ---jocation of water, gas, electric lines, cable, control panel (if applicable)
10) _��_Location of Structures within 6 Inches of Finished Grade
11) Z Original Stamp & Signature
12) _��Location and holder of any easements which could impact the system
13) impervious Areas; Driveways, etc
14) _��North Arrow
15) "' Location & Elevation of Benchmark used
16) " STATEMENT ON PLAN (NA 5.3)
3. 1 certify the locations, ele vations, fies, cover matenal; exposed component covers etc.,
sho wr on this as -built substantially agree u4th the approvedplan andha ve deterinined that the
break out ele vadons, if applicable, ha ve been met. "
Signature of Designer
Date
b. - "If a STUCTUP,4L WALL IS PRESEAT (NA 4.9) a Letter or statement on the as -built inaica
the wall - was, or was not, constructed in accordance K*h the intended desio and an V
manufacturer's �s �Ificatjofls.11
Signature of Designer
Date
As of: Monday, July 20, 2015
North Andover Health Department
(ommunity and Economic Development Division
QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 296 Raleigh Tavern Lane MAP: 106C LOT: 112
INSTALLER: Todd Bateson
DESIGNER: Merrimack Engineering
PLAN DATE: 12/4/14
BOH APPROVAL DATE ON PLAN: 4/23/15
INSPECTIONS
TANK INSPECTION:
DATE OF BED BOTTOM
INSPECTION: 6/17/15
DATE OF FINAL CONSTRUCTION INSPECTIO
,�N: 6/24/15
DATE OF FINAL GRADE INSPECTION: 9 [1 �1 b
SITE CONDITIONS
Comments:
SEPTIC TANK
N/A Contractor reports any changes to-desigln plan
Z [E I n q-. -s e ------ ---k—
ptic tan 1p_!�qperly abandoned
Z Internal plumbing all to one building sewer
Z Topography not appreciably altered
Z Building sewer in continuous grade, on
compacted firm base
Z Cleanouts per plan
x Bottom of tank hole has 6" stone base
x Weep hole plugged
x 1500 gallon tank has been installed
H-10 loading
x Monolithic tank construction
Z Water tightness of tank has been achieved by
visual testing
x Inlet tee installed, centered under access port
1�1
EO
Comments:
Z
Outlet tee installed, centered under access port
(effluent filter)
Z
24" inch cover to within 6" of finish grade
installed over one access port
x
Neoprene boots around inlet & outlet
Comments: 74x26
PUMP CHAMBER
x
Bottom of tank hole has 6" stone base
Z
Weep hole plugged
x
1500 gallon Pump Chamber installed
x
H-10 loading
x
Monolithic tank construction
x
Inlet tee installed, centered under access port
Z
Pump(s) installed on stable base
Z
Alarm float working
Z
Pump On/Off floats working
Z
Separate on/off floats
Z
Drain hole in pressure line
Z
24" cover at final grade installed over pump
access port
Z
Watertightness of tank has been achieved by
Visual testing
Z
Neoprene boots around inlet & outlet
Comments:
CONTROLPANEL
Z
Alarm & Pump are on separate circuits
Z
Alarm sounds when float is tripped
Z
Location of control panel: basement
Z
Alarm signal located inside: basement
Comments:
DISTRIBUTION -BOX
Z
Installed on stable stone base
Z
H-20 D -Box
Z
Inlet tee (if pumped or >0.08'/foot)
Z
Hydraulic cement around inlet & outlets
Z
Observed even distribution
N/A
Speed levelers provided (not required)
0
Schedule 40 PVC Pipe
Comments:
SOIL ABSORPTION SYSTEM (General)
X Bottom of SAS excavated down to C soil layer,
as provided on plan
X Size of SAS excavated as per plan
X Title 5 sand installed, if specified on plan
40 Mil HDPE barrier installed
Laterals installed and ends connected to
header (and vented if impervious material
above)
Elevations of laterals and chambers installed as on
approved plan
Retaining wall (boulder / concrete / timber/ block)
F1 Final cover as per plan
Comments: 74'x26 w field
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
Brand and Model of Chamber: Standard Quick
4 Low Profile Infiltrator Chambers
Number of chambers per row: 16
Number of rows (trenches): 6
Comments: Total Chambers = 96
FINAL GRADE
Loamed
Seeded
Cover per plan
Comments:
DOCUMENTS NEEDED
a-11 Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
[D�As-Built Plan
BM = 154.50
HR = 4.76
HI = 159.26
SYSTEM ELEVATIONS
ROD
ELEVATION
AS -BLT INVERT
ELEV
DESIGN INVERT
ELEV
Benchmark
Building Sewer OUT
5.49
153.42
153.4
Septic Tank IN
5.98
152.93
153.00
Septic Tank OUT
6.20
152.71
152.75
Pump Chamber IN
6.24
152.67
152.70
(2") Pump Chamber OUT
6.70
152.39
-----
(2") Distribution Box IN
4.57
154.52
154.50
Distribution Box OUT
4.58
154.33
154.33
Lateral 1 TOP
4.60
Lateral 1 INVERT
154.31
154.28
Lateral 2 TOP
4.61
Lateral 2 INVERT
154.30
154.28
Lateral 3 TOP
4.62
Lateral 3 INVERT
154.29
154.28
Lateral 4 TOP
4.62
Lateral 4 INVERT
154.29
154.28
Lateral 5 TOP
4.61
Lateral 5 INVERT
154.30
154.28
Lateral 6 TOP
4.60
Lateral 6 INVERT
154.31
154.28
Top of Chamber
4.60
154.66
154.67
Boftom of Bed/Chamber
5.25
154.01
154.00
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
1 Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
Tank
SAS Sewer
Z
Property line
10
10
Z
Cellar wall
10
20
Z
Inground pool
10
20
Z
Slab foundation
10
10
Z
Deck, on footings, etc
5
10 --
Z
Waterline
10
10 101
Z
Private drinking well
75
1002 50
Z
Irrigation well
75
100
Z
Surface Water
25
50
Z
Bordering Vegetated Wetland
Salt Marsh, Inland / Coastal Bank 3
75
100
Z
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
Z
Trib. to surface water supply
325
325
Z
Public well
400
400
Z
Interim Wellhead Prot. Area
Z
Reservoirs
400
400
Z
Drains (wat. supply/trib.)
50
100
Z
Drains (intercept g.w.)
25
50
Z
Drains (Other) Foundation
10(5)
20(10)
Z
Drywells
20
25
1 Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
C
Commonwealth of Massachusetts
Map -Block -Lot
106.CO1 12
BOARD OF HEALTH
-----------
Permit No ------------
North Andover
BHP-2015-0160
-----------------------
FEE
$250.00
V4WV -----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Bateson -Ent ----------------------------------------------------------------------------------------------
to (Construct) an Individual Sewage Disposal System.
atNo - 296 RALEIGH -TAVERN-LANE ----------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. BBP-2015-016 Dated --- May - 05 - , - 20 - I - 5 --------
-------------------------
Issued On: May- 05-20 15 BOARD OF HEALTH
a
Important
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Application for Septic Disposal System
Construction Permit -TOWN OF
TODAY S DATE
$ 2501.00 — Full Repair
NORTH ANDOVER, MA 01845 $125.00: - Component
Application Is hereby made for a permit to:
[] Construct a new on-site sewage disposal system*
04e-;;ir* or replace an existing. on-site sewage disposal system*
[] Repair or replace an existing system component - What?
A. Facility Information
Cf(, R,.� �IAV_"w
Address or Lot # RECEIVED
Cityrrown
MAY 0 5 2015
2.- *WPE OF SEPTIC SYSTEW: TOWN OF NORTH ANDOVER
> 2,Pump M Gravity (choose one) HEALTH DEPARTMENT
�If pump system, attach copy of electrical permit to appficatidn�
> E] Conventional System (pipe and stone system)
> &3-Mfiltrator or Blodiffuser (Gravel -Less) (Attach a copy of your certificafton to install this type of system.)
> Pressure Distribution S.A.S. (No D -Box)
> Pressure Dosed (D -Box Present) SJLS.
> 0 Does the system require an effluent filter? Yes No
If yes, does plan specffy make and model of filter? (jjjP (no further info. needed)
NO = (installer must specify brand of filter before DWC issuance)
What is the Make?
2. Owner Information
What is the modaP�
Name
Address (if different from above)
CityfTown State Zip Code
Telephone Number
3. Installer Information
Name Name of Company
Pd -
Address �j
.,44
Cityrrown State Zip Code
4. DesLaner Information
Name
Z,
Address /41 Alij,
Cityrrown
17 ?-' P- 7 4 -
Telephone Number (Cell Phone # if possible pleaSO)
Name of Company
State Zip Code
9%, 6-tv ,1- 6 ,,v, 6
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit - Page 1 of 2
A. �OAFT
Z
..TOWN
TODAYS DATE
$.250.66 �. Full Repair
$125.00.. Component
PAGE 2 OF 2
A. Fad'111tyInformati.on continued....
S. Type' of Buildin-g: 04�s�ldential Dwelling or E3Comm . ercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-dei&rlbed
on-s1te sewage disposal system In accordance with the provIslons of Title 5 of the
EnvIronmental Code, as well as the Local Subsurfjcq Disposal Regulations for the Town of
North Andover, and not to place the system Ih operation until a Certificate Of Compliance has
been Issued Py this Board of Health.
Name Date
I . A 'I ica o�n A. p d 8 o d-af ealth Representative)
"lic p
Nm Date
Application Dit;appr.oved.. for the following reasons:
For ofnc6 use Only:
I. - -Fee AttAchedp:
2.. ProjectAradgger
3, jkM P & ? If,
4 FouvdadoizAs-Budt,
(S"M S
Attach=yof TftCqjP_
egnii
'P, [an) .
S. FloorMwsp (new colistruction, o I
yes No
yis M
No
Page 2 of 2
�Ys tbt.h, ,6ft"Ct10fi Permit
SEP n.c*s.y - MR. -PRO
JECT MAMGWMNT'OJ31JGAnONS
As fl*Nqnh Andovar&=sed bjivaWr *4w.W114Mk*A fog -16 -septic qrtewforthevop"u-
(Ad4cm Ofseptle syst=) --Trot PUM by
Ate
Roative to djt,jppjjmd=,Of 440'5�,
(Dwstauees qmiq— AM doftd �A(_/ 4/
DiW [di
With �_vv�= dated
(TAst
I undcatand the fonowing Obngatio= f0t Mgnagement Of0b P
;Oject:
1. As , the insune411 'am obligated -to obtain, Aff Pe=its and Board -of-Health Plans MW
to
f tdOM149 anfwwk da I% Rite. glut
Wad= -
2. As f6hwftj
1001trPmm not *940ckted with my empiq *18-dulm M 1nsPfdC#= and tha sptcin is not rejd� &in
item 6ftesuLbo. sTpub".
As
t4 lu�- Vamii4*ad W lmvv,�6 A_ettMt� w—e*' leow-Pliotto thespplkabjeiu�ictioo'
'3p
_VPW CobA but 4Q .:dGt to bo pa
T, pea
Ai_6&i I* 6&idon for rjCvA1iow,..tk4
b. t"*a'k
.2mRQ.V Mq#banddu=RM)Y&3M thee
-be tahittful od% -anim
for "'.filspeed qttft.4-4- aecfticd,�Mmf be res4j ond abk to
C.
&Ve to ke, 6&dtr- -
4. ed
ngton of the
6.
LNOrM,AnQ=L fQ"1== �ftj tR a
ezrp�ce �qf thi! foRowing Cani"COM
&
Pcdi�*& afthe�wdwdstavfoU used
Q
d. laqb& dou oruj* "aj�py
p4g, 0=4* vwt.. P =,P chamber. rewAbw waff wd mh'...
Infiltrator Chamber I/A technology Certification
I
I hereby certify that I have been given a copy of the Title 5 I/A technology
approval letter, and the Owner's Manual for the above technology and I
agree to comply with all terms and conditions.
I further certify that I am aware that this design does not allow use of a
garbage grinder in the dwelling and that I understand my requirement to
repair, replace or modify or take any other action required by the
Department or the LAA if the Department or the LAA determines the
system to be failing to protect public health and safety and the environment.
signature:
J
fi7c4un Lj�
certified by: (please print)
date
4
April 23, 2015
Dan McQuaide
296 Raleigh Tavern Lane
North Andover, MA 0 184 5
I .
"�Opy
North Andover Health Department
(ommunity Development Division
Re: Subsurface Sewage Disposal System Plan for 296 Raleigh Tavern Lane
(Map 106C, Lot 112)
Dear Mr. McQuaide:
The proposed wastewater system design plan for the above site dated December 4, 2014 with a
final revision date of April 13, 2015 and received on April 21, 2015 has been approved.
The design has been approved for use in the construction of a replacement onsite septic system
for a 4 -bedroom (max 9 -room) home utilizing an Infiltrator Chamber system. This plan is
generally good for 3 -years from the date of approval however, as this is for a repair system, this
is reduced to 2- years.
During this time, a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover. In the event an imminent health problem, such as sewage backup into the dwelling is
occurring, the North Andover Board of Health may reduce the time period for which this plan is
valid.
This approval is also subject to the following conditions:
1 If site conditions are found in the field to be different from those indicated on the
design plan and/or soil evaluation, the originally issued Disposal System Construction
Permit is void, installation shall stop, and the applicant shall reapply for a new
Disposal Systems Construction Permit (3 10 CMR 15.020(l)).
Page I of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035
North Andover, MA 0 1845 Phone: 978.688.9540 Fax: 978.688.8476
,`�296 -9aleigh Tavern Lane April 13, 2015
2. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and
municipal requirements are met. These may include review by the Conservation
Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit
shall not construe and/or imply compliance with any of the aforementioned
requirements.
3. A cleanout is required in the building sewer pipe at the proposed connection to
the existing building sewer pipe. Alternatively, if there is a cleanout in the
building sewer pipe inside the building/cellar this would be acceptable. The
cleanout inside the building shall be in close proximity to the building sewer pipe
location in the foundation wall.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
S1 cdrely,
ichele Grant
Health Inspector
Encl. Installers list
cc: Vladimir Nemchenok
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
NoithAndover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
P�
January 29, 2015
North Andover Health Department
(ommunity Development Division
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover, MA 0 1810
Re: Subsurface Sewage Disposal System Plan for 296 Raleigh Tavern Road, Map 106C, Lot
112
Dear Mr.Nemchenok:
The proposed wastewater system design plan for the above site dated December 4, 2014 and
received on January 5, 2015 has been reviewed. Unfortunately, the plan cannot be approved
until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or
N)rth Andover regulation that is not met by this design follows each item where applicable.
1 . The proposed contour elevations are incorrect on the southern side of the leach field.
2. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system
the "Standard Conditions for Alternative Soil Absorption Systems with General Use
Certification and/or Approved for Remedial Use" will apply. Please provide the
following as required by the approval conditions
Section 11(7):
e) The record drawings, approved by the LAA, must clearly indicate an areafor
the bestfeasible replacement system that could be installed in the event that the
proposed Alternative Soil Absorption Systemjails or it is determined that it is not
capable ofproviding equivalent environmental protection;
Section 11CM:
a) proof that the Designer has satisfactorily completed any required training by
'j the Companyfor the design and installation of the Technology;
c) a certification, signed by the 01wner of recordfor the property to be served by
the Technology, stating that the property Owner:
Page I of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
1. has been provided a copy of the Title 5 11A technology Approval,
the Owner's Manual, and the Operation and Maintenance Manual,
and the Owner ggrees to comply with all terms and conditions;
2. for Systems installed under a Remedial Use Approval, the owner
agrees toju,�,ill his responsibilities to provide written notification
of the Approval to any new Owner, as required by 310 CMR
15.287(5);
3. if the design does not provide for the use ofgarbage grinders, the
restriction is understood and accepted; and
4. whether or not covered by a warranty, the System Owner
understands the requirement to repair, replace, modify or take any
other action as required by the Department or the LAA, if the
Department or the LAA determines the System to befailing to
protectpublic health and safety and the environment, as defined in
310 CMR 15.303.
Please feel free to contact the 6ffice with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
incerely,
Michele Grant
Health Inspector
9 V4�'
!L4
cc: Dan McQuaide
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
1P 1 MERRIMACK ENGINEERING SERVICES, INC,
PROFESSIONAL ENGINEERS - LAND SURVEYORS - PLANNERS
66 PARK STREET - ANDOVER, MA 01810 - (978) 475-3555, 373-5721 - FAX (978) 475-1448 - E-MAIL Info@merrimackengineering.com
Michelle Grant
Health Inspector
1600 Osgood Street
Suite 2035
North Andover, MA 0 1845
RE: 296 Raleigh Tavem Lane
Dear Michelle,
We are in receipt of your review letter dated 1-29-15 for the above referenced site.
We have revised the plans with regard to all items I through 2 of your letter.
Enclosed herewith are 3 copies of the revised plans.
We feel we have adequately addressed you concerns.
On behalf of the owner, we respectfully request the plans be approved for construction as
re -submitted.
Yours truly,
RECEIVED
William Dufresne, Project Manager
MERRIMACK ENGINEERING SERVICES APR 2 12015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
-dran?, Michele
From: Gaffney, Heidi
Sent: Wednesday, February 25, 2015 3:01 PM
To: Grant, Michele
Subject: FW: 296 Raleigh Tavern Lane - Septic
From: wrdufresne(cbcomcast. net [maiIto:wrdufresne0)comcast. net]
Sent: Tuesday, February 24, 2015 4:04 PIVI
To: Gaffney, Heidi
Subject: Re: 296 Raleigh Tavern Lane - Septic
Yes, everything I am working on is in holding pattern due to this dam snow.
It's killing me!
From: "Heidi Gaffney" <HGaffney(cb-townofnorthandover.com>
To: "wrd ufresne(a)-comcast. net" <wrd ufresne(@-comcast. net>
Cc: "Michele Grant" <mqrant(cD-townofnorthandover.com>, "Jennifer Hughes"
<'hughes(-a)-townofnorthandover.com>
Sent: Tuesday, February 24, 2015 2:32:25 PM
Subject: RE: 296 Raleigh Tavern Lane.- Septic.
Hi Bill, I'm glad she was able to delineate 1353 Salem before all the snow (I haven't seen the flags yet, but was out there
when the test pit app came in). I haven't been to 296 Raleigh Tavern and with the snow of course I won't be getting
there for a bit, but it will likely need to be delineated when the weather allows.
Heidi Gaffney
Conservation Field Inspector
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
Phone 978-688-9530
Fax 978-688-9542
Email hgaff nev@townof northa nclover.com
Web www.Townof NorthAnclover.co m
From: wrclufresneOXomcast. net [mailto:wrclufresne(�Dcomcast. net]
Sent: Tuesday, February 24, 2015 3:01 PIVI
To: Gaffney, Heidi
Subject: Re: 296 Raleigh Tavern Lane - Septic
1
Heidi
- - 'I
I had Leah Basbanes check out this site the same time she did 1353 Salem Street.
See attached GIS overlay.
I asked her to confirm the presence of wetlands within 150 feet of the westerly property line where I
intended to do the test pits.
I have the review from the BOH that requires revisions, I will look at the GIS overlay and confirm with
her and show any wetlands or buffer zones on the revised drawings.
Thanks
M
From: "Heidi Gaffney" <HGaffney(cD-townofnorthandover.com>
To: "wrdufresne(cD-comcast. net" <wrd ufresne(cD, com cast. net>
Cc: "Michele Grant" <mqrant(cD-townofnorthandover.com>, "Jennifer Hughes"
<0 hug hes(cDtownofnorthandover.com>
Sent: Tuesday, February 24, 2015 1:20:28 PM
Subject: 296 Raleigh Tavern Lane - Septic
Hi Bill, The septic plan for 296 Raleigh Tavern Lane does not have any wetlands shown on it and Note #15
states "no wetlands exist within 150ft. of the proposed system." Please see the image below showing the GIS
wetlands layer and a measurement I did on the GIS system. Did a wetland scientist check this area out and
determine that it isn't wetland?
2
.NORTH
-4 Z"
p",
Planning Com 51 714(
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N 0
q[q[q&, �
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P. 9 .
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it
Blackburn, Lisa
From: BlackburnJisa
Sent Monday, January 05, 2015 2:08 PM
To: Dan Ottenheimer, Isaac Rowe; Pam Lally
Subject: 296 Raleigh Tavern Lane
Happy New Year,
I'm mailing out plans and paperwork for 296 Raleigh Tavern Lane today.
Lisa Blackburn
Health Department
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
Phone 978-688-9540
Fax 978-688-8476
Email Iblackburn@townofnorthandover.com
Web www.TownofNorthAndover.com
L * A
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 – Phone
Susan Y. Sawyer, REHS/RS 978.688.8476– FAX
Public Health Director E-MAIL: healthdept@townofnorthandover.com
WEBSITE: hftp://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM
Date of Submission:— I -f
SiteLocation: TAuI3141
Engineer: VJFa&jkjAfAC�� EK)61j)1�06
New Plans? Yes $225/Plan Check # "0�5 (includes I't submission and one re-
review only)
Revised Plans?Yes $75/Plan Check # F
Site Evaluation Forms Included? Yes No JAN 2015
TOI,v,, _-*gpm
Local Upgrade Forrn Included? /,,.)A.. Yes N o
LT01 il
de,�M 2M�- �5; 5 14- lel
Telephone ax #: &I w) 1
11 pjigjiii��
Homeowner
Name:— RA Q tj,-. Q LjA 0 6
OFFICE USE ONLY
'When the s b * sion is complete (including check):
U7 Date stamp plans and letter
Complete and attach Receipt
Copy File; Forward to Consultant
Enter on Log Sheet and Database
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01__�
VS"
Commonwealth of Massachusetts
City/Town of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
A. Site Information
[2A 0 H e. -
Owner Name
201 & V-�164 7VAV U4.
Street Address oTLot #
OM14 AVQ4Vf1L- I W45
Cityrrown State Zip Code
)
Contact Person (if different from Owner) 'relephone Number
B. Test Results
Observation Hole #
Depth of Perc
Start Pre -Soak
End Pre -Soak.
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate (Min./inch)
ll -z5-1+ IIA1.4
Date Time
f �- I
A41,
Test Passed:
Test Failed: El
uate i ime
Test Passed: El
Test Failed: F1
IN.L- [2i_tftoiV
Test Performed 8y: - -
fP �" A- io
Witnessed Ely:'
Comments:
t5form 1 2.doc- 06/03 Perc Test - Page 1 of 1
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 0 1845
Susan Y. Sawyer, RENS, RS
Public Health Director
978.688.9540 - Phone
978.688.8476 - FAX
www.townofilorthandover
APPLICATION FOR SOIL TESTS OCT Z , 9�. 2014
Torow OF r4bl*lti AN50VER
1EA1 DEPARTMENT
DATE: 1,9, ,77 - I MAP & PARCEL:
LOCATION OF SOIL TESTS: 9AL,61AW -T-10n1F1,lZ,14) A 10,-/-
A
*WNER:-QAh0 CA UL- - kc IQ QAJ0 Contact#: -'Iml M = Wo
APPLICANT: Contact #:
f
ADDRESS:
ENGINEER: H�M LAC� FQ(ai'kE'rZA&)� Contact#: 670) y-,
2--0
CERTIFIED SOIL EVALUATOR: VUrhe4TJ6 A 70 r2V 7, - �z Z1061
Intended Use of I Land: Residenti . al Subdivision �mgle �Fy Home Commercial
Is This: Repair Testing: Undeveloped Lot Testing:_ Upgrade for Addition:_
In the Lake Cochichewick Watershed? Yes
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
No
> Proof of land ownership (Tax bill, or letter from owner permitting test)
> 8.5"x .1-l"Plot Plan& Location of Testinva (please indicate test Pit sites on the Plan
> Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for remirs or uvarades.
GENERAL INFORMATION
> Only Certified Soil Evaluators may perform deep hole inspections.
> Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
> At least two deep holes and two percolation tests are required for each septic: system disposal,'area.
> Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
> Full payment will be required for all additional tests within two weeks of testing.
> Within 45 days of testing, a scaled plan (no smaller than I "-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
> Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date:.
Signature of Conservation
Date back to Health Department: (stamp in):
4�
2 - .2 2
X/V
kg/Lv,
o_Y, I.A
z r
. .... ..........
I
0!q j��
s 7-
Z2
4�14 SS
-tA IVA -
�_ya,-3 7
1.2— 22- - ��2
m m
Cc)
0� Y!c
Ncrth
APPRCVED DATE
ZA
nnic snTY-1i
JKI,MJILkTION GM�CK LIT
Reag=st
1. Distance Tot
a. Wetlands
b. Drains
c. Well
LOT,
F
Ek,Xr,AVA OK �AIL
or 2. Water Line Location
3- No PYrC PiPs
%1A ilk
Valz
Septic' Tank Clean Oat Covers
.a. .-Tees v,. -Length & To
b. Cement Pipe to Tank- On Both Sides of Tank
5. Distribiitiozi Box
a. Covers & Box - No Cracks
b. - All Lines Flowing Fqual Amounts
c. No Back Flow
6.- Leach"Field or Trench
a.
Dimensions
b.,
Stone Depth
c*
Capped 'Ends
Clean Double -Washed Stone
7. Leach Pit
Leach Pit
ae
ions
b
b.
e%Depth
ce
ash Pads
Xess
d.
e
Cament Pipe to Pit Both Sides
I
.
lean Double Washed Stone
C Cl a
:
8.
No
Garbage DisPosal
9.
Final Grading Inspection,
10.
Barricacling Covered S�,stem
3.1.
As
Built Subn dtted
a.
Lot Location
b.
Dimmsions of System
c.
Location with Regar&to Perc Test
d.
Elevations
e.'
Water Table
S> Be
tflvll��r V-*UA59>
16 I -f 70-)
r-�,ard of
T'&Ith
SUBM-RFACE DIMS41 DMIGN CHWK LIST
LOT 7
APPROVED DATE DISA ' PPRUVM DATE
Provided: Reasons: #�-
Title V
Reg 2.5 e submitted plan mst show as a Unirm.mt
.e lot to be aerved-area.,dimensions lot # ab-atters
cation and log de4ep obaervation holes-disstmee to ties
or-ation and results percolation tests-distamce to ties
design calculations & calculations chowing requirei leaching area
e ocation and dimensions of syute-m-inDluding reBeme area
eAsting and proposed contours
g) location any vat areas ultMn 10-0 1 of semga disposal system or
disclair.3r-check vmtlands mapping
6.00 h) varface =d subsurfaco drains vithin 1001 of so-w2go disposal
systrwm or disclaimer
i- location wW drainage ease-mnzits vithin 1001 of se��'-a dit-posal
system or disclaiz--r-Pl=ning Board files
(j) k -no= sources of water supVlyr with3n 2001 of sowage di--Por�9-1
Of system or disclaimer
(.)C-) ation of my. Proposed well. to serve lot -1001 from leacbing facility
lo ation of water )-ines on proporty-101 fizom leaclAng facility
location of benchmark
drivetrdys
garbage diaposals
6000" no PVC to be ussd in conutruction
.00.4 q) profile of of basem.snt., plumb pipe.
.9 , sc-p twnk,
6istribution box 5DIets and outlets, eistribution field piping and
Utter elv'rations
00 to,
n.-iziaum groiaid water elevation in cxea sew�age dispo�il Sys tem
—2(s) plan raast be prapared by a r-rofessional. Fag--Inoor or other
p��ofessionaal nmthorized by Iaw to prepare su--h p1mas
Rog 6 80�,'ptic Tzmks
(a) of flow,. water table, teeSp &CjDth Of tOC-S.,
000, access., puzping
o0000 kb ) clemout,
w4l'M) 101 from cellar t,*11 or iWoLmd m4rmdng pool
---'7(d) 251 from gubmwface &z-Jms
Reg 10.2
Reg 10.4
Distrib-ation rkoxes
Ti—opegreater tb,-n 0.08
MOP
Sab-mirfac'e �hack LLst P,-� q e 2
FAIL I OT,
Reg 11.2
11.4
11.10
11.3-1
Reg 15.1
15.4
15.8
3.7
Reg 1,4,1
14.3
14.4
14 .7
10
Reg 9. 1
9.6
Leaching, Pith
Leaching ts are preferred where the installation is possible
a) calcula, ons of leaching area-minimm 500 eq ft
b) spac
c swu"r , e, drainage 2%
d.� cov rinaterial
e lizo
fjA 140 splash pad
tee at elbow
g) no bc-ads in pipe from d -box to pipe
P
A) no gre-a-ter an 20 ninutes/inch.
'b) area� 900 aq ft
I
,c) constra on of field
'd auiIa drainage 2 %
:0) �201 m cellar v -All or inground suim-Ang pool
Leaching TreAches
% MY bin
;d) CZ -1 -Flay. ons 'oeac g area-rdn 500 ijq ft
>Y spacing -4 ft idn 6 ft with reserve betueen
dim maions
dd) constria,ation
0)� stone
surface drainage 2%
Do-vmhill S,160pe
a) -sTq—pe'-y7---F be
b) ylx X 1�0 (to be-shom)
PTPS J
ff
a) agpr#al
b) staaU-by power