HomeMy WebLinkAboutMiscellaneous - 30 WINDKIST FARM ROAD 4/30/2018 (2)'r,
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MAP # LOT # "
PARCEL # STREET W 1 J" 7 �(X44ed;'
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE Z APP. BY
DESIGNER: PLAN DATE�Z_e
CONDITIONS
e
WATER SUPPLY:
WELL PERMIfi
WELL TESTS:
x
PLUMBING SIGNOFF b
COMMENTS:
W� WELL
_ DRILLER
CHEMICAL
BACTERIA I
BACTERIA I I `�.-�IA��`~IA
DATE APPROVED
DATE APPROVED
DATE APPROVED
WIRING SI
FORM U APPROVAL: APPROVAL TO ISSUENO
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DATE ISSUED6Y ;21
BY
/ f !
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL ��NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL C"Y NO
OTHER YES
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES
DATE: BY:
f
SEPTIC SYSTEM INSTALLATION
IS THE INSTALLER LICENSED?
TYPE OF CONSTRUCTION:
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW
CONDITIONS OF APPROVAL
(FROM FORM U)
tNEW
NO
REPAIR
YES NO
YES NO
ISSUANCE OF DWC PERMIT ES NO
DWC PERMIT PAID? YES NO
DWC PERMIT NO. /d/®� INSTALLER: Y � -
a�
BEGIN INSPECTION Y NO:
EXCAVATION INSPECTION: NEEDED:
PASSED/ o
S l BY
�- ✓ /
AS BUILT PLAN SATISFACTORY: / YES:
APPROVAL TO BACKFILL: DATE: G BY,/
G '
FINAL GRADING APPROVAL: DATE BY
i
FINAL CONSTRUCTION APPROVAL: DATE -BY
G
FORM U - LOT RELEASE FORM
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
APPLICANT bP, UU1f� � C� PHONE
l
LOCATION: Assessors Map Number C) FARCE L
SUEDIVISION LOT (S)
I�OGy,�
STREET 3l� W �'R sk �►'� �ST. NUMEE:R 30
Mo rir)V er. MA
OFFICIAL USE ONLY
-RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE.APPROVED
DATE REJECTED
SE?TIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
PUELIC WORKS-SEWER/WATER CONNECTIONS
GRIVENAY PERN11T
FIRE DEPARTMENT
RECEIVED EY EUILDING iAISPECTOR
nevized 419; im
DATA
Town of North Andover, Massachusetts Form No. 2
f 1101t71f BOARD OF HEALTH
19 q
0 ' L
f
DESIGN APPROVAL FOR
SACMUSEt�
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant. Test No.
Site Location �Jy i , (JU1 Klr k
Reference Plans and S
ENGINEER
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee ( o
CHAIRMAN, BOARD OF HEALTH
Site System Permit No.
bb/01/yy 11:52 5OW7746146 THE FRASER COMPANY PAGE 01
6-01 —1 ` 99 '12: 22Pt 1 FROM P. 2
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TOWN OF NORTH AADOVER
SEWAGE DIS"AL SYSTEM
INSTALLATION CEIt'i'iFiCAMN
'Ybe umdara ped hmby anti$ *at the Sw�W Vi pow System { f co ed; {
by - ---- - AH -k
loatrta� � 1.n"i" l? i..i ► ►s tit 5tT" ��� ,� I[.�y .,,...,.w.
watt batalied in aong�n wik tate Worth Andover Boat;d of Roalth vvoved PIQAI Sy*M
DWp Pamsit # chord Gi l , wttb an approval "p flow of, W
.fid 41Y 'i per ez oond$ �ued,:vete in aotttbMa w with those apeciW an the ap;oved
plso; tha syd= was, insatlled in accordance with da provisions of 310 Cm 15.000, Title 5 ad
loaf redttisat OA 49 the final tt af"= tat ftU iWY• with the Wined VW. All wont is
unteiy Mr*nMd ca the A"aih wlsich hae scdivanittad to tha Board of Ham.
Inaaller Lia. #: ,,, Dak 1119
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TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
05/07/99
This is to certify that
the individual subsurface disposal system
constructed ( X ) or repaired ( )
by
Raymond Fraser
at
30 Windkist Farm Road
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit # 950 dated 11/2/98.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
d.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:J4 (iA&* 66-1 S t 7C4 m /2G/
N D !,-C e
Owner's Name: /- Y
,o N
Owner's Address:
Date of Inspection: _ -0 1
Name of Inspector: (please print) Jo �,1 L U ty ruc,-e /V -L6
Company Name: T'el.tle ts 3 e jC
Mailing Address: rLILc v'( Si"
/-? / -a aof mcg .
Telephone Number: i'7$ ,�?
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs FuPher Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:„_
The system inspector shall Omit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of cothpleting this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
TOWN OF NORTH A`001V.
BOAR , OF
****This report only describes conditions at the time of inspection and under the i onditions of use at that
time. This inspection does not address how the system will perform in the future u idedLhj s�r2e §@@�iffeient
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
.. 4 Page 2 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: ,qG 1 / wi l2"►
O
Owner: /
Date of Ins ction:
Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D
A. :y�,temsses:
have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired: The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup -or break out or high static wAter level in the distribution l5o)CduJ to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if (with approval of the Board of Health):
ND explain:
broken pipe(s) are replaced
obstruction is removed
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 N /e ft /rl e
Owner: L
Date of Ins ection:.� = ' ',� - 01
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health, safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
su_rface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the=well:water analysis,, performed at a.DEP certified laboratory, --for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
I g Page 4 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:36 IV tl'V t K 15" T -A r, -K FC/
Owner: I vel N
Date of Insp ction: `O
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Yes No
_ acic�p of sewage,into facility, or system component dueto overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
logged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
/of times pumped
y portion of the SAS, cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
— /'water supply.
_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
+` Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
N (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either "yes" or "no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a napped
Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address• 4,j;m C/ 1 5 r rrr%. Rd
Owner:
Date of Ins ction: f5- L-9:
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Ye No Pumping informatiMi was provided by the owner, o&upd'nt, or'Board of Health s R'
V Were any of the system components pumped out in the previous two weeks ?
_ Has the system received normal flows in the previous two week period ?
b Have large volumes of water been introduced to the system recently or as part of this inspection ?
— Were as built plans of the system obtained and examined? (If they were not available note as N/A)
— Was the facility or dwelling inspected for signs of sewage back up?
— Was the site inspected for signs of break out ?
— Were all system components, excluding the SAS, located on site ?
Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ?
— Was the facility owner (and occupants if different from owner) provided with information on theroper
maintenance of subsurface sewage disposal systems
The size and location of the Soil Absorption System (SAS) on the `site has been determined based on:
Yew no ,
7f _ Existing information. For example, a plan at the Board of Health.
— Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b)]
` t 4. Page 6 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: go IU iv rif lC / T r
a N crert..
Owner:
Date of Inspection: O I
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms):
Number of current residents:
Does residence have a garbage grinder (yes or, no): A/,O
-, Is laundry on a sdparate sewage"system (yes or no): � [if yes separate inspection required] #
Laundry system inspected (yes or no): —
Seasonal use: (yes or no) --Am
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump (yes or no): Y-0
Last date of occupancy: e`r"'�" / G�
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow (based on 310 CMR 15.203): gpd
Basis of design flow (seats/persons/sqft,etc.):
Grease trap present (yes or no): _
Industrial waste holding tank present (yes or no):
Non -sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information: v4 < jYm Gt r G
Was system pumped as pa4 of the inspection (y or no) c
If yes, volume pumped/ :�,?& gallons --=How was quanfity pumped determined?
Reason for pumping: //V.S Q e G r 7 c ,
TYPE OF SYSTEM
ptic tank, distribution box, soil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system (yes or no) (if yes, attach previous inspection records, if any)
_ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
_ Tight tank _ Attach a copy of the DEP approval
_ Other (describe):
of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site (yes or no): &4
ob ,d Page 7 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �Q n/ t'
Owner:
Date of Inspection:
BUILDING SEWER (locate on site plan)
Depth below grade: --ZP,— //
Materials of construction: — cast iron _4,t40 PVC _other (explain):
Distance from private water supply well or suhtjon line:
_k- Comments (on condition of joints, venting, evidence of leakage, etc.): -
SEPTIC TANK: Lollocate on site plan)
Depth below grade:
Material of construction: grade:/2.-
_metal _fiberglass _polyethylene
—other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of
certificate)
Dimensions -5, 6--s-
Sludge
—SSludge depth: !" 3 �„
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: / If
Distancefrom top of scum to top of outlet tee or bathe: g ��
Distance from bottom of scum to botto f outlet tee or baffle:,`/
How were dimensions determined: 17P
Comments (on pumping recommendatiotinlet and outlet tee or baffle condition, structural integrity, liquid,levels
asrglated poutletS vert, evidence o� �(i age, etc.) if Aid 6 t f 1, c -rueLL 106 rt4C,�
GREASE `TRAP: _(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address A; G,r twx gd.
r
Owner: N
Date of Insp ction:
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete ;* metal fiberglass—�poly�ethylene �' other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present (yes or no):
Alarm level: Alarm in working order (yes or no):
Date of last pumping:
Comments (condition of alarm and float switches, etc.):
DISTRIBUTION BOX: ''lir present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out jbo etc/jI O sn S Gi / y �i d U -e✓- r&a c4 L 6151—
PUMP
15i"
PUMP CHAMBER: (locate on site plan)
Pumps in working order (yep or no):
Alarms in working order (yes of no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
A , , Page 9 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:r i �. 1Pal
/V O dJ [./�P
Owner: D
Date of Ins ection:
SOIL ABSORPTION SYSTEM (SAS): ✓(locate on site plan, excavation not required)
If SAS not located explain why:
Type
leaching pits, number: _
leaching chambers, number:
leaching galleries, number:
(/leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth — top of liquid to inlet invert: ,
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool: f
Materials of construction:
Indication of groundwater iAflow (yes or n'b.): ` t
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
e , Page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATION (continued)
Property Address: I rAd ( r ", {fid
il/ �v v-er
Owner• D'�C/
Date of Insp ction: — 'Q
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within, 100 feet. Locate where public water supply enters the building.
. s.
ti rr '
9
10
1
1
._
34
r = -
Page 11 of 11 %
OFFICIAL INSPECTION FORM — NOT FOR VOLUATARY ASSESSMENTS
t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
r. Property Address,? ren /Z
Owner: �L. N
Date of Inspection: , 5r- 2,0
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate (check) all methods used to determine the high ground water elevation:
ltibtained from system design plans on record - If checked, date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health -explain:
Checked.with local excavators, installers- (attach documentation)
Accessed USGS database -explain:
Youust desc -be how you es li hed the high ground water elevation:
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4
Form No. 3
Town of North Andover, Massachusetts
BOARD OF HEALTH q p
HORTN 19�--
p! St�.D ,• Mo
0
O p
F
x • DISPOSAL WORKS CONSTRUCTION PERMIT
�J +DR�T�D ��•<y�
t
,SSACHUSE
L
ApplicantADDRES
NAME
Site Location
idual Soil Absorption
n—;—;nn Ir, herebv zranted to Construct (X) or Repair ( ) an Indiv
r'
CHRISTIANSEN & SERGI, INC.
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 (978) 373-0310 FAX: (978) 372-3960
October 27 1998
' TQC/N of r,o:�l'N A+".DQ`!ER/
RQ� D D "-ALT�: �
Ms. Sandra Starr
North Andover Board of HealthOCT 2 g 1998
27 Charles Street,
North Andover, MA 01845
Re: Subsurface Disposal System Design, Lot 17 Windkist Farm Road
Dear Ms. Starr:
We have received the October 22, 1998 Title V review prepared by Port
Engineering for the above referenced lot and have made the appropriate revisions to the
plans. The following is a list of Port Engineering's comments (in italics) followed by our
response to each of the comments.
No deed references are shown on the plan.
The appropriate deed reference has been added to the plan.
Plan does not contain designers certification statement.
The Soil Evaluators certification was included with the soil evaluation forms
submitted for the lot. My Registered Professional Engineer's stamp and signature
serve as a certification of the design plans and specifications.
Offset from leaching bed to property lines not shown.
The appropriate offsets between the leaching trenches and the property lines have
been added to the plan.
Offset from leaching bed to catch basin not shown.
The 40 foot offset between the end of leaching trench 1 and the catch basin has
been added to the plan. Since the catch basin and street drain do not intercept the
groundwater, this offset distance is sufficient.
Three 20" manholes are not shown over the septic tank.
The three 20 inch minimum access port covers are clearly indicated on the septic
tank detail.
Septic tank does not show a 6 -inch stone base.
The required 6 inch crushed stone base has been added to the septic tank detail and
the profile of the system.
Distribution box does not show a 6 -inch stone base.
The required 6 inch crushed stone base has been added to the profile of the
system.
Leaching trenches are over 50' long and therefore must be vented, which is not
shown.
Vents were specified on both the longitudinal section detail and the system profile.
We have revised the plan to indicate the vents on the site plan as well.
A statement should be added about why the design will prevent effluent from the
higher trench f Zowing into the lower trench.
We are unaware of any requirement to provide such a statement on the plan,
especially when the configuration of the system does not include any connection
between the two trenches. The system as designed meets all Title V and local
design requirements. If the system is installed according to the plan, effluent flow
will be split equally by the distribution box and will flow by gravity through the
distribution lines to the leaching trenches. No connection is proposed between the
ends of the distribution lines in the leaching trenches. Effluent flow from the
higher trench could not flow to the lower trench unless a total failure of the upper
trench caused a backup through the distribution line to the distribution box.
The design profile on Sheet I of 2 is for Trench #2 only. Inverts for Trench #1
should be added to the profile, or anew profile for Trench #1 should be included.
The profile on the plan is for Trench #1, the higher of the two trenches. The invert
elevations at the beginning and end of Trench #2 have been added to the profile.
The plans should speck that the distribution lines connecting the distribution box
with the soil absorption lines shall unperforated with water tight connections.
(This is especially important for trench #2).
Although we have added the notation to the system profile on the plan, we do not
understand the need for it. We cannot believe that without the notation on the
plan an installer would put perforated pipe before the leaching trenches.
The length of lines and elevations of Trench #2 have the following concerns:
1. The design profile (of Trench #2) does not correctly show the length of line
from the D -box to the leaching trench. The length of this line should be specified
(it scales to about 40 feet long).
The profile on the plan is for Trench #1, the higher of the two trenches. This is
apparent from the labeling on the plan view and on Cross Section A -A. The
length of the pipe between the distribution box and Trench #1 is accurately
depicted on the profile. Notation specifying the length of the two distribution lines
has been added to the profile.
2. The invert of the beginning of the pipe at the beginning of Trench #2 should be
shown.
The invert elevations at the beginning of the leaching trenches have been added to
the profile.
3. The elevation difference between the d -box outlet and the end of the leaching
trench is shown on the plans as 0. 33feet. This elevation difference should beat
least 0. 49feet. (Trench is 58 feet long, line from D -box to trench is about 40 feet
long. If we assume that line from the D -box to the trench is supposed to have a
slope of 0.005, then the total elevation difference is 0.49 feet. If this line (from d -
box to trench) should instead be 1/8 inch per foot, then the elevation difference
would be 0.71 feet.)
This assertion by the reviewer is wrong. The slopes of the outlet distribution lines
after the two foot level section from the distribution box are as follows:
Trench #l: Elevation drop of 0.04 feet divided by Length of 7 feet = 0.0057 ft/ft
Trench #2: Elevation drop of 2.04 feet divided by Length of 33 feet = 0.0618 ft/ft
Enclosed are three copies of the revised plans. I trust that the revisions we have
made satisfy all of the reviewer's comments. Please contact me if you have any questions
regarding this matter.
LOCATION:
NEW PLANS: S
REVISED PLANS: YES
DATE: (%
DESIGN ENGINEER:
SEPTIC PLAN SUBMITTALS
0r- A 6. /
$60.00/Plan
$25.00/Plan
When the submission is all in place, route to the Health Secretary
z
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
EWA)
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Y Repair ( ) Upgrade ( ) Abandon ( ) - ❑ Complete System ❑ Individual Components
.urs//L ti
ma el#
Installer's Name
Address
Telephone #
Type of Building: JA
Dwelling — No. of Bedrooms
Other — Type of Building _
Other fixtures
,CQt�(�in l & nV4l,14a ey
b
Address
�a� CMZ - Z3z 2
Telephone # D4
/ it �iL"//"Ly/.��rL
. De igner's Na�p�jl �
1t�0 L�5(ld�J/721�0' cs'--.
Address
�3 -031a
Telephone #
Lot Size 43&0 Sq. feet
der
Garbage Grin( )
o. of persons Showers ( ), Cafeteria
Design Flow (min.equired) // 0 gpd Calculated design flow gpd Design flow provided4� gpd
Plan: Date 4, izok7 Number of sheets =a_ Revision Date
Title cZP o / /_ .$ u IS/�t"1
Description of Soil(s) SQ/YI L DU/✓"1
Soil Evaluator Form No. /T► 17 Name of Soil Evaluator ratWRf Ofvbate of Evaluation Ste, c
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and era rees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date (D C
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
--——————— ---— --- — ——--------_.__-----------------------.__,..____--------..-----
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. dated . Approved Design Flow (gpd)
Installer
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
OARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at as described
in the application for Disposal System Construction Permit No.
dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Date
FORM 2 - DSCP
FORM 1255 (REV 5/96)
Board of Health
DEP APPROVED FORM 5/96
H&W HOBBSB WARREN TM PUBLISHERS - BOSTON
DATE: A --7 /1 � 7
LOCATION: Lt V IlL (�i /,11, l /-�R w S Lo 1 1 7
,
ENGINEER: _ P -H L t, GN fL I (�T Ad d S
BOH WITNESS: Y t� zy/ /d hl 10
PERCOLATION TEST # S
BOTTOM DEPTH OF PERC TEST: 1 / / 8
TIME OF SOAK: Lb 7 &t p; �L'Z- (At least 15 minutes long)
r
TIME AT 12"
TIME AT 9"
TIME AT 6" 1 1, b
OVERNIGHT SOAK
TIME STARTED
NEXT DAY SOAK:.
TIME AT 12"
TIME AT 9"
TIME AT 6"
(At least 15 minutes)
DATE: "1 -- u — � 7
LOCATION: (/� G -�c I(�Qwti 0 f7
ENGINEER: (1•,,
BOH WITNESS:
E'
PERCOLATION TEST # 314 -�? �
BOTTOM DEPTH OF PERC TEST: Z/
�7
TIME OF SOAK: �� % `1 % (At least 15 minutes long)
TIME AT 12" ) (3 7
TIME AT 9" 11 1 %,59
TIME AT 6"
OVERNIGHT SOAK
TIME STARTED
NEXT DAY SOAK:
TIME AT 12"
TIME AT 9"
TIME AT 6"
(At least 15 minutes)
w
No.
FORM 11 - SOIL EVALUATO age FORM
Date: �/-)
Commonwealth of Massachusetts
jVor j�� , Massachusetts
a cwvzment for On-site Sewa a Di
�a
Date:-
Performed By. ... ,�� � ............ ........
Witnessed By: xG'l
uwnci s —.— Lr V& V /
Address • - •- • _ -
Location Ads a aY
W1,17A45-t +te-,ns Ate_. _n Id �lV 9 rhf'
Loc , aost J , Telephone�lo irrd/�u, o
owconstruction S Repair ❑
Office Reviev►
Published Soil Survey Available: No ❑
Yes �p� Pd L
1�
/ ......... Publication Scale / � �S't�.�0 Soil Map Unit
YearPublished /.................................... .............. ...................
r4"P f . Soil Limitations
Drainage Class Iti'e�� � � �
• Surficial Geologic Report Available: No
Yes El
Publication Scale
...........................
YearPublished...................................................... .
Unit)..........................................................
Geologic Material (Map -
Landform .............YG�YV1i 1�..................................................................
...........................................................
Flood Insurance Rate Map:
❑Yes
Above 500 vear flood boundary No ]Y ❑
Within 500 year flood boundary No Yes
Within 100 year flood boundary No es ❑
Wetland Area:.........................................................................
..............
Ma ma unit) ............
National Wetland Inventory p (Map ...................................................................
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal []Normal ❑Bel``v Normal ❑
Other References Reviewed:
DEp APPROVED FORM • 12/07195
^� FORM 11 - SOIL FVALUATOR FORM
=� Page -'of 3
Location Address or Lot iJoI� 14C�i�IS FGi/ �UU
On-site Review
��L f/Time:
Date:
Weather
Deep Hole Number
Location (identify on site plan)
Land Use .. Slope (%) Surface
Stones
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from:
feet
Open Water Body feet Drainage way
Possible Wet Area feet Property Line
feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE 'OG�
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface (inches) (USDA) (Munsell) Mottling
Other
(Structure, Stones.Boulders, Consistency,
Grave°io
10vn;4lz .
foo ,ayle
fes; Q�
�51T
/Via SS `
S.L•
M(tssfw -
F-ia��� �\r�
MINIMUM Lit- .4 t t t
I_ t
Material •(geologic) l� rum 1��2. _---
DeptMo6edrock:
Parent
Death to Groundwater: Standing Water in the Hole: • n
Weeping from Pit Face:
s,
Estimated Seasonal High Ground Water:
DEP APPROVED FORM - 12107/95
FORM 11 - SOIL PURIM
Y Pa(.,c 3 of 3
Location Address or Lot No.
P. (7-1
Determination for Seasonal High Water Table
Method Used:
Depth observed standing in observation hole
inches
�J Depth weeping from side of observation hole
inches
Depth to soil mottles c> ") inches
Ground water. adjustment . 7=,feet
Reading Date Index well level
Index Well Number ............ g .. .
Adjusted around water level
Adjustment factor 1
Death o` Naturally Occurrino pervious Material
Does at least four feet of naturally
ooccurring
sedforthe s'exist
oil abso ptionsystem?m ..all. �eas
observed throughout the area p f
If not, what is the depth of naturally occurring pervious material?
^_reification
examinatio
I certify that on �� %`f ` (date) I have EnvironmentalProtection aassed the �a' thatil the above analysis
approved by the Department o. �nviroFA g, expertise and exaerienc
was performed by me consistent with she required training,
described in 310 CMR 5.017.
Signature /� Date --r
9
DEP &PPROVED FORA - 12/07/95
FORIM 11 - SOIL EVALUATOR FORM
Page 2'of 3
Location Address or Lot IJo 7A /✓1C�K IS�/ rGi/1'►� PUG
On-site Review
Deep Hole NumberV17-d Date:'/q7 Time: Weather
Location (identify on site plan)
Land Use .. Slope (%) Surface Stones
Vegetation -
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet
Possible Wet Area feet
Drinking Water Well feet
Drainage way feet
Property Line feet
Other
DEEP OBSERVATION HOLE _OG*
Depth from Soil Horizon Soil Texture Soil Color Soil
Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, BouldGraveers, Consistency. °/a
Y
t t i t t ROPOSED Disi AREA
Parent Material- (geologic) 0rwwl
'r 4 DepthtoBedrock:
Death to Groundwater: Standing Water in the Hole:
• Weeping from Pit Face:
h
Estimated Seasonal High Ground Water:
DEP APPROVED FORM • 12107/95
Location Address or Lot No
TP l7 -,2,
t
Method Used:
FORM 11 - SOIL L�ALL:�.1UK rU101
Page 3 of 3
ion
onal Hi
Depth observed standing in observation hole
I—i Depth weeping from side of observation hole
!Depth to soil mottles v?�u inches
Ground water adjustment feet -
Water Tadl
inches
inches
Reading Date Index well level
index Well Number ......._..... .. ;
Adjusted ground water level
Adjustment tactor 1
Deoth o` Naturally Occurring Pervious Material
t of naturally
dVfor occurring
soil absorptionrial system? m allaJreas
Does at least four fee
observed throughout the area pro
If not, what is the depth of naturally occurring pervious material?
�_rtification
1 certify that on %f (date) I have pPsotect on and thatd the soil lthe above an lysis
approved by the Department o 'Environmental
was performed by me consistent with the required training, expertise and experienc:
described in 310 CMR x.017.
Signature' Date
DEP APPROVED FORM - 1:/07195
Location Address or Lot No. /7
FORINT 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
IVL90N fiAI /30 l%&7LrAassachusetts
Percolation Test`
Date: ..,!5//J -1-v7 Time:. /07 ..::...
Observation Hole #
Depth of Perc
37
Start Pre-soak
End Pre-soak
//:-37
Time at 12"
11.'37
Time at 9"
Time at 6"
Time (9"-6")
m�Yj
Rate Min./Inch
* Minimum of 1 percolation test must bo perfor� � iad in both the primary area AND
reserve area.
Site Passed D-- Site Failed ❑
Performed By:
Witnessed By:
Comments:
WeMIMMA
DEP APPROVED FORM - 12/07/95
S
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VD
PLAN REVIEW CHECKLIST
Y
ADDRESS A /7 l,U ��(1 d�'15 T ENGINEER `1'- S
GENERAL
3 COPIES// STAMPy LOCUSy NORTH ARROW L/ SCALE
CONTOURS PROFILE e�-,(Sc) SECTION L---" BENCHMARK L/ SOIL &
PERCS ELEVATIONS WETS. DISCLAIMER L% WELLS & WETS t/
WATERSHED? -,6 DRIVEWAY ✓ WATER LINE L�-' FDN DRAIN I--' M&P
SCH40 L/ TESTS CURRENT? ti'' SOIL EVAL tet/, 0
SEPTIC TANK
MIN 150OG v/ .17 INVERT DROP GARB. GRINDER�/C) (2 comps +200)
10' TO FDN MANHOLE ELEV c,� GW I ## COMPS. ( GB
D -BOX
SIZE ## LINES `-� FIRST 2' LEVEL STATEMENT
INLET 12 - OUTLET •q',3 = (2" OR .17 FT) TEE REQ'D?A
M s
LEACHING
MIN 440 GPD?
100' TO WETLANDS
RESERVE AREA
100' TO WELLS
20' TO FND & INTRCPTR DRAINS
4' PERM. SOIL BELOW FACILITY
BREAKOUT MET?
TRENCHES
4' FROM PRIMARY?
4' TO S.H.GW
20 SLOPE
400' TO SURFACE H2O SUPP
(5'>2M/IN)
MIN 12" COVER FILL? (15')
MIN 440 gpd SLOPE (min .005 or 611/100') L*�SIDEWALL DIST. 3X EFF.
W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST
BE 10' MIN. 4" PEA STONE?L--'� VENT? (/" (>3' COVER; LINES >501)
BOT + SIDE = X LDNG = TOT
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
WILLIAM J. SCOTT
Director
(978)688-9531
November 2, 1998
Christiansen & Sergi
160 Summer Street
Haverhill, MA 01830
RE: Lot 17 Windkist
Dear Mr. Christiansen:
27 Charles Street
North Andover, Massachusetts 01845
This letter is to inform you that the proposed septic plan for Lot 17
Windkist Farm Road has been approved for a dwelling with a maximum of nine
rooms.
If you have any questions, please do not hesitate to call the Board of
Health office at the number below.
Sincerely,
_,-,K )4 14�Y6
Sandra Starr, R.S.
Health Administrator
cc: Colonial Village Dev.
File
Fax(978)688-9542
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
r'vov-ZU—yts U1 : .::s4N North Andover Com. Dev. . 508 688 9542
P.O1
x!01:0 AN"00 l' `
OF HEALT14 �
APPLICATION FOR DISPUSA1, WORKS CONSTRUCTION PEt211IFF
,�dtr �z 0 �g
DATE:_ c'D _ CURRENT INSTALLER'S LICENSE:#__4-
LOCATION:— -�1 /�l.��l��k lS�"_� 7 • !T- Z_
LICENSED (INSTALLER: J?p>/iU/)A/) -7–
S I GN A TU RE:
–
SIGNATURE: u _ C�-TF�LEI'HONE�# t8 %'A__ L4
CHECK ONE: J
REPAIR: NEW CONSTRUCTION: Z�
II+ NEW CONSTUCTION, PLEASE. ATTACH FOUNDATION AS-BU11:1.-.
DRIoPPE D oFF BX h)lll-L I I9(Vl902P =� IV201V
Administrative Use Onl)
575.00 Fee :attached'' Yes 11� No
Foundation As -Built'? Yes_ C/ voi
Floor Plans`' Yes �No
Approval_
_"j—-�;LLu' __ ___, .T Date:_
FORM U - VERIFICATION FORM
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 local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: _�iU�iSI �,�C�/J ZZ G Phone �Z -.,25
LOCATION: Assessor's Map Number Parcel
Subdivision ��/:s'-7' Lot (s) /%
Street�117 St. Number -30
************************Official Use Only************************
RECO DAT ON OF WN AGENTS:
Date Approved 01�7
Conservation Administrator Data Rejected
Comments
c Date Approved
Town Planner Date Rejected
Comments '
Food 4ILnsector-Health
e spector-Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway permit
Fire Departmentl��'�Li'd(�[ (11'aW4y t�dzWILL
�✓�-sir
de—o i7et Jct j'
Received by Building Inspector ate
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