HomeMy WebLinkAboutMiscellaneous - 350 FOREST STREET 4/30/2018Lot & Street ��0 �""D�% c�j Map/Parcel %C7� 2.
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES NO Permit# / %4
Plan Approval: Date:—A Approved by: MCS
i
Designer:b;2Q0&j jr J� Plan Date:
Conditions:
Water Supply
Well ermit:
Town ell
Driller:
Well Tests: Chemical -
Bacteria I
Bacteria II
Plumbing Sign -Off:
Comments:
Date Approved
Date -Approved
Date Approved
Wiring Sign -off:
Form "U" Approval: Approval to Issue: YES NO
Date Issued By:
Conditions:
Final Approval:
All Permits Paid?� NO
Well Construction Approval? YES NO
Septic System Construction Approval? NO
Certification? NO
Other? WYS NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Is the installer licensed?
ES
NO v T
Type of Construction:
New Construction:
Certified Plot Plan Review
NEW
YES
EPAI
NO
Floor Plan Review
YES
NO
Conditions of Approval from Form U
YES
NO
Issuance of DWC permit:
YES
NO
DWC Permit Paid?
YES
NO
DWC Permit # I A(QJ
Installer: ,M,k6
Begin Inspection:
YES
NO
Excavation Inspection:
Needed:
Passed: t�
By:
Construction Inspection:
Needed:
It Plan Satisfactory:
Approval of Backfill
Final Grading Approval
Date:
Date:
0
Final Construction Approval: Date:�SIO By: -
Certificate of Compliance: Approval: �/1/Li Date:
l
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
08/12/2002
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired ( X )
by
Mike Reilly
at
350 Forest Street
Telephone (978) 688-9540
Fax (978) 688-9542
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.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANKING 688-9535
i TOWN-'OFNORrfI-I ANDOVER
I-N-,STALLA-rioNCERTIFICATIOIN
The und-ershmed hereby cerafy that the Sewage Disposal System Const.-UCU;C1,
renaired:
by_ 1A
located at Cz e Q T -
was installed in C'Ordo-mance with the No-th Andover Boa -rd of Hezith a`provee plan.
Systern Design Permdt dated with an approved desion
flow of callons per day The mate!-:*a-s,ust----4 were In conformanc-, x -ii -h those
specified on the appro4ed- plan; the system was Installed in accordarct- -,,,ith the provisions
of 310 CMR 15.000, Title 5 and local res--ilaElAns, and the final suadip -2 agrees
substantially with the approved plan. Ail :Cork is accuratelY represented or: the As -built
which has been submitted to the Board cz- Health.
Bed inspection date: c z,16 2
Enp-inecr RI-orestrative
Final inspection dare: �7
0 -C,o To—
Enciretr Represen(a[:Ve
Lnstal!er: C. Date:
(>sis-m Engineer: Date:
---------------
C.-
TAN GARD ti
W
JUL 3 12002
AS -BUILT CHECKLIST
LOT NUMBER, STREET NAME
(� ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
1/
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
%
"
TIES,TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
/
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
V
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES,
CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
/
V
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
t�
NORTH ARROW
�� '
LOCATION & ELEVATIONS OF BENCHMARK USED
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: 4- /G - c.), CURRENT INSTALLER'S LICENSE#__/__!rQ0
LOCATION: �3S0 r_e1zF-,s /
LICENSED INSTALLER: f?moi �� P. %�� i �s�&'JSq 7'� C
SIGNATURE: t TELEPHONE# /,a 3
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
160.00 Fee Attached?
Project Manager Ob.
Foundation As -Built?
Floor Plans?
Administrative Use Only
Yes ✓ i`
Yes
_z���
Yes
Yes
9
Approval
No
Nolkz^--.
No
we
Date:
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
property at 'ISO F—rec,,4 ��- _ relative to the application
of - \ dated":)–%Q- for plans by d
%.,T
dated with revisions dated
I understand the fol owing obligations for management of this project:
1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior
to performing any work on a site. I must have the approved plans and the permit on site
when any work is being done.
2. As the installer I must 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 three shall be applicable.
3. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without
completion of the items in accordance with Tile 5 and the Board of Health Regulations may
result in a $50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With pump system all electrical
work must be ready and able to cause pump to work and alarm to function.
c) Final Grade = Installer must request inspection when all grading is complete. Does not have to be
on site.
4. As the installer I understand that only I may perform the work (other than simple excavation)
required 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 to operate in the Town of North Andover; significant fines to all
persons involved are also possible.
5. 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 or consultant.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
Persons shall absolve me of this obligation.
Undersigned Licensed Septic
Date: 5 \�
Disposal Works Construction Perm# 1,A6
NEW ENGLAND ENGINEERING SERVICES
lk INC
January 30, 2002
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: 350 Forest Street, North Andover, Septic system design
Dear Sandra:
Enclosed are five copies of revised plans for the above referenced property. The
following changes have been made.
1. The reserve area has been shifted to meet the required 100 foot offset to the drinking
water well.
2. General note # 5 has been revised.
3. Construction note #4 indicates that the old system shall be removed.
4. The grading has been revised to comply with the requirements.
5. The length of the line from the d -box to the septic tank has been revised.
6. The spot grades have been revised.
In addition, the owner requested a more gentle slope at the back of the system fill so the
grading lines have been pushed further away from the system than required.
If you have any questions regarding the information submitted, please do not hesitate to
contact this office.
Sincerely,
3 C
Benjam2C. Osgood,
President
T 04N OF TORTH Wl�
BOARD OF HEAJ14
.SAN 3 1 2002
60 BEECHWOOD DRIVE -NORTH ANDOVER, MA 01845 -(978) 686-1768 - (888) 359-7645 -FAX (978) 685-1099
Town of forth Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
February 20, 2002
Ben Osgood, Jr.
New England Engineering Services, Inc.
60 Beechwood Drive
No. Andover, MA 01845
Re: 350 Forest Street
Dear Ben:
Telephone (978) 688-9540
Fax(978)688-9542
This is to notify you that the revised plans dated 1/29/02 for 350 Forest Street have been
approved.
If you have any questions, please do not hesitate to call the Board of Health Office at
978-688-9540.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
cc: Logan
file
SS/smc
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
NOONAN & Mc DOWELL, INC.
25 Bridge Street, Suite 6, Billerica, MA 01821-1023
Voice (978) 667-9736 Fax (978) 671-9565
Email: nm netway.com
Date: January 14, 2002
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System
Plan Review, 1770/ 050A
350 Forest Street
Assessors Map 106A, Lot 192
Dear Members of the Board,
0 i,EAL1�H,
y
JAN 2 2 2002
Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated Dec. 3, 2001,
by New England Engineering Services Inc. It is our opinion that the proposed design will meet
the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is
addressed:
1) The drinking well is 96' + from reserve area. 100 ft. minimum.
2) Revise general note 5.
3) Add a note regarding removal of existing leaching trenches and stone. 354
4) Grading for line L1 and L2 does not comply to break-out.
5) Length of line from septic tank to D -Box is 17 feet.
6) Revise uphill spot grades (100.50) minimum should be 9 in. above top of trench
excluding top soil. 240 (9)
Respectfully,
John L. Noonan, P.L.S.-P.E.
Qoffice/forms/350 Forest.doc
Land Surveyors Civil Engineers Environmental Planners
SEPTIC PLAN SUBMITTAL FORM
LOCATION: T:�, 0-e-5 t
NEW PLANS: YES
REVISED PLANS: YES
SITE EVALUATION FORMS INCLUDED:
DATE: 113 D 2
$160.00/Plan
$ 60.00/Plan
YES NO
DESIGN ENGINEER: N L cr .�1 c , • �e2� -,
DATE TO CONSULTANT:
When the submission is all in place, route to the Health Secretary.
NEW ENGLAND ENGINEERING SERVICES
INC
December 10, 2001
Sandra Starr, Administrator
North Andover Health Department
Town Hall Annex
27 Charles Street
North Andover, MA 01845
Re: 350 Forest Street, North Andover, Septic system design
Dear Sandra:
Enclosed are the following documents in reference to the above referenced property.
1. 5 sets of septic system design plans.
2. Soil evaluator sheets.
3. Application for approval.
4. Check to cover the approval fee.
If you have any questions regarding the information submitted, please do not hesitate to
contact this office.
Sincerely,
Benjai. Osgoo , Jr., OT
President
60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099
SEPTIC PLAN SUBMITTAL FORM
LOCATION: 3,5-0 �� 2 Es i S� 2 e t i
NEW PLANS: YES $160.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES NO
DATE:
DESIGN ENGINEER: J n4(,, 1Q- e- a( .�
DATE TO CONSULTANT:
When the submission is all in place, route to the Health Secretary.
i Q 2001
C,moi, r �w2 ravr
FORM U - LOT RELEASE FORM - ot-
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLI ANTV�Nrlf\N� ST(e-,j� i l b� Go.
�Fa(C S1M t DU
LOCATION: Assessor's Map Number
SUBDIVISION
STREETS T_ S T.
PHONE_ 2�lob_ 6) ° L' g'
PARCEL O ( � 3
LOT (S) Z_
ST. NUMBER D
*****************************************OFFICIAL USE
ONLY***********************************
DATIONS
�)AI)
CONSERVATION
TOWN AGENTS:
TOR
DATE APPROVED
DATE REJECTED_
TOWN PLANNER
COMM
FOOD INSPECTOR -HEALTH
SEPTIC INSPE OR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED_
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED_
PUBLIC WORKS - SEWERMATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTO
Revised 9\97 jm
TE
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
September 12, 2001
Jim Logan
350 Forest Street
North Andover, MA 01845
Re: Application for a Deck, Bedroom and Garage Addition
Dear Mr. Logan:
Telephone (978) 688-9540
Fax(978)688-9542
Your application for an addition and deck at 350 Forest Street has been reviewed by the Health
Department. The application was denied on September 12, 2001 for the following reason:
1. The current septic system must be enlarged to comply with current Title V Regulations.
The Health Department also requests any drinking water wells within 150` be located and included on
any future submittal.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sinc
c
Brean j. LaGrasse, Health Inspector
Cc: Building Department
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
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.
***************D****************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANTDVRWhAM _G_DNST(LVG"t� —�'O, �INL. PHONE�14�,A149' 0010 T
LOCATION: Assessor's Map Number —f o l'o —_— PARCEL 0 ( l 3
SUBDIVISION_ N AL _ —_—_ —_ —_—_ ---- LOT (S) —c_Z
STREET -35 -Pf Dru S 'f—s-T ------ ST. NUMBER 3 SD
********************************OFFICIAL USE ONLY*****************************
RECOM ENDATIONS OF TOWN AGENTS:
ATION ADMINOTRATOR
COMMENTS (t)e-4I0�1115 � /Ob
TOWN PLANNER
COMM
INbl'tG i UK -HEALTH
C INSPECTOR -HEALTH
COMMENTS
DATE APPROVED ��—__--
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED —__—
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR ----------------------------- DATE—__
Revised 9197 Jm
Town of North Andover, Massachusetts Form No. 2
NORTh BOARD OF HEALTH
O �
~ w
D
# #
E i #
DESIGN APPROVAL FOR
C""5``� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applican2adek 2 Test No.
Site Location
Reference Plans and Specs.!
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CHAIRMAN, BOARD OF HEAL
Fee
I
Site System Permit No. ////l
NOONAN & Mc DOWELL, INC.
25 Bridge Street, Suite 6, Billerica, MA. 01821-1023
Voice (978) 667-9736 Fax (978) 671-9565
Email: nm@netway.com
Date / a Z --
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System
Plan Review, 1770/ 0 5 (2A
5-c? V-c7o,-z &F -.5T S --
Assessors Map/pd A , Lot /y' Z
Dear Members of the Board,
Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated
by -
It is our opinion that the proposed design will meet the requirements of Title 5 and the North
Andover Board of Health `By -Laws" if the following is addressed:
-t/fGp 71C /,4) -ti ccs - L- G- /S 9 C 1= zC,
71
7_,Acrt fix. en T
g'
"� L- Z 1947 -EF .194 i env,--f�c_ /
S'e--� /C__ 7 s�
Respectfully,
a) /`f/ L i /�'Q T tic. 0 (
s `' O "o, 5-i / "
, ��
John L. Noonan, P.L.S.-P.E. k G91
G:office/forms/tonarev p '/
Land Surveyors Civil Engineers Environmental Planners
r
n
CHECKLIST FOR NORTH ANDOVER
SEPTIC SYSTEM PLANS
N & M Job 1770/ Q 5<7-+
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant:J.41y,�5 > AN -y-4 1,06.FA)Name of Designer: N G 3
Plan Date: Revision Date: — Date of Review: Xr/ e4"ze-z—
Property Address:D,Map: ed'A Lot:2—
BOH Reviewer: c"" Type of Plan (new or<�grade):_,-)
Number of Bedrooms in<Ptssessej'—s Records: 3 gpd) Garbage Disposal Allowed: oov �
General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5
OK P blem N/A
Street number and map/lot - 220(4)(u)
Maximum scale of 1 "=40' for plot plan - 220(4)
f
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 and dimensions of the system incl. reserve (new const.) - 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)
�-
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)
Location 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(1)
Original R.S./P.E. stamp, signature & date - 220(1) & (2)
r
If 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. Win 150' of system — NA 8.02r
Wetland disclaimer — NA 8.02s
-��
RLS plan reference & certification required (prop line setbacks) - 220(3)
la e�rEai s-desigrier-ee�s f1 tea`!ian°--sty -----
--®—
Use approvals / standards checked for I/A system - DEP docs.,
Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3)
Perc rate > 60 MPI - must use modified tight tank or IIA technology - 245(4)
Proposed system qualifies as "shared" system - 002 (definitions)
Flow is over 2,000 gpd - No R.S. allowed - 220(1)
�- Design flow was set in accordance with code - 203
Existing system location and note on proper abandonment - 354
Leaching facility at least 1' above Base Flood elevation - NA 9.05
piping All i m Sch 40 minimum - NA 10.01
—��
Basement floor minimum 1' above groundwater elevation - NA 5.04
2 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 peres shown, including aborted tests - NA 8.02n
r 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)
Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4)
—tom---- Deep hole testing conducted within two years - NA 7.05
Hole Identification Numbers:
ground elevation el.
acceptable soil el.
Leach facilitv invert el. c.
ground water el.
refusal el.
v
bottom of leach facility el.
thickness of acceptable soil
before & after soil R&R
separation to groundwater
separation to refusal r
soil class
perc rate
loading rate
septic tank below g.w. table d" (yes or no)
pump tank below g.w. table (yes or no)
l.f in fill -255(l)
Setback Distances (Given in feet) 15.21 1
YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02
OK Problem N/A
Septic Tank Leach Facility
Fl Property line 10 10
Cellar wall 10 20
1\
2
2
P
_Q
�—
Inground pool 10
20
Slab foundation 10
10
�^
Deck, on footings, etc. 5
10
Waterline 10
10
9 6P
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)
Trib. To Surface Water supply 325
325
Reservoirs 400
400
__-
Tributaries to reservoirs 200
200
Drains (wat. supply/trib.) 50
100
Drains (intercept g.w.) 25
50
Foundation drains 10
20
Drains (Other) 5
10
Drywells 20
25
Downhill slope 15' to 3:1 slope
w/o barrier
Building Sewer
OK Problem N/A
Grease trap required for certain uses (check 230 for details)
Pipe diameter listed (4" minimum) - 222(1)
_
Pipe schedule listed - 222(3)
�.
Pipe cast iron or Sch 40 PVC - NA 11.02
�C
Watertight joints specified - 222(3) & (4)
Pipe laid on compact, fin base - 222(5)
1
Pipe laid on continuous grade in straight line - 222(7)@
Cleanouts precede all changes in alignment and grade - 222(8)
Cleanout provided every 100 feet - 222(8)
Manhole at any 90 degree alignment change - 222(8)
Invert elevation at building:
Invert elevation at septic tank:
`—
Length of run:
Slope: (minimum of 0.01 - 0.02 desired) - 222(6)
10' offset to private well or suction line - 222(2)
3
3
4
Septic Tank
OK Problem N/A
Tank is accessible - 228(3)
1�
No structures above tank — (228(3)
Tank can accommodate both primary & reserve — NA 9.04
200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a)
2-3" drop from inlet to outlet - 227(5)
Minimum of 4' liquid depth - 223(2)
-0
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(1)
Tees extend 6" above flow line - 227(1)
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(2j
1 childproof, 24" riser/manhole Win 6" of final grade if <1000gpd- 228(2)
.l
Inlet and outlet tees on center line - 227(1)
Soil compaction below tank specified (if soil is non-native) - 221(2)
T
6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1)
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(1)
H- 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
�s
Tank is set to keep old system in service during install if possible
c-, Distribution Box (Check here if not present: )
OK Problem N/A
Inlet elevation:
Outlet elevation:
0.17' drop from inlet 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 10.01
Number of outlets: Number of laterals:
Size of outlets:
Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a),
Soil compaction below distribution box specified (if soil is non-native) - 221(2)
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 Chamber (Check here if not present: )
OK Problem
Volume specified: 220(4)(r)
Pump on elevation- 220(4)(r)
Pum off e r
A arm on elevation: 220(4)(r)
Number of cycles per day - 220(4)(r) (also 254(1)(d) if gravity from d -box)
Minimum 2" delivery line to d -box if gravity - 254(1)( c)
i
Pressure dosed l.f. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a)
Cycles per day is consistent with chamber volume - 23 1
Volume calculations include flowback volume - 2') 1(2)
24 hour storage capacity above pump on elevation - 231(2)
Number of pumps: 2 if system serves >2 dwelling units - 231(6)
Capacity of pumps) - gpm @ ' TDH - 220(4)(r)
Pump can pass 1 solids (minimum) - 231(7)
Pump contr specified - 220(4)(r)
Al uipment specified - 231(2)
is in building and powered on separate circuit from pump - 2') 1(9)
ump 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 gr 1(5),
Soil compaction beneath pump c er specified (if soil is non-native) - 221(2)
6"of <=3/4"stone benea r. specified - 221(2) & 228(1),
Buoyancy calcula ' if chamber is at or below water table - 221(8)@
9" of cover r chamber (minimum) - 228(1)
H- 1 ading (min.) - H-20 if traffic - 226(')),
amber is watertight - 221 (1)
Top of chamber <=36" below grade - 221(7)
Leaching Facility (general - complete for all designs)
OK Problem N/A
50% larger if garbage disposal - 240(4)
Trenches to be used whenever possible - 240(6)
No vehicle or imperv. area above 11. 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 - 241(1)(d)
`�.
9" cover over peastone - 240(9) 0 -?c c -v a I-V..C- Y -v 0:5
Reserve area provided (new construction) - 248(1)
Reserve 4' from primary leach area - NA 9.04
r-___
4'(5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b)
4' (down to 2' with variance or UA - upgrades only) of natural soil under 11.
-�
GW separation is adjusted to highest existing grade if facility cuts into a hillside
Pipe slope minimum of 0.005 - 251(9)
J
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(10)
Surface & subsurface drainage away from l.f. - 240(1 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-3:1slope - 255(2)
Impermeable barrier/retaining wall poured concrete - NA 9.02
"1
Retaining wall stamped by P.E. - 255(2)(b)
Top of retaining wall >= top of peastone elevation - 255(2)(f)
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 10.01
}
Leach pipes minimum 4" diameter except for dosed system - NA 14.04
Leach lines cappe vente connected together - 251(9)
Pressure dosing guidance followed if pressure distribution - 254(2)(c ),
Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1)
Leaching Trenches (Check here if not present:
OK Problem N/A
v
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)
f
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 14.01& 14.03
�--�
Viable 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(1)
Leach Fields (Check here if not present:
OK Problem N/A
Number of fields: (need dosing chamber if> 1, 231 (1))
Length max.): - 252 (2)(b)
W'
T area: L x W = s. f.
Minimum 900 square feet - NA 9.01(1)
Distribution lines connected with solid pipe 15.01
Effective leach area given
Loading factor:
Effective area =
to a s.f x LTAR – da�
Effective area is > esign flow of facility being served
Minimum o o distribution lines - 252(2)(a)
6' line aration (max.) - 252(2)(d)
4' ximum separation from edge of feel ine - 252(2)(e)
0' minimum separation between a ent leach fields - 252(2)(f)
Between 6" and 12" of 3/4 - "stone beneath field - 252(2)(g) & 247(2),
2"of 1/8"-1/2" 2x washed peastone.- 247(2)
Final Grading
OK Problem N/A'
Slope over leach area minimum of 0.02 feet/foot – 240(10)
_ Grading shall divert drainage away from leach area – 240(l 1)
Grading slopes away from dwelling
5/24/01 f:/office/forms/tonackltr.doc
6
O
/J4
4 N & M Job number 1770/ 4:V.SQ15'
TOWN OF NORTH ANDOVER -
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Site: -3 5-12 7— 5 '�r—
Installer:!
Date
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches, sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation, etc.
Comments: (Use back of sheet for diagrams.)
B. Retaining Wall
1. Wall height and width as specified
2. Waterproofed
3. Wall minimum 10' to leaching facility
4. Wall meets specifications of plan
Comments:
C. Building Sewer d
1. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Inlet to tank, cemented
4. Slope minimum 0.01 or 1/8" per foot minimum
5. Pipe properly set on compact firm base
6. Pipe laid on continuous grade in straight line
7. Cleanouts precede all change in alignment and grade
8. Manholes at any 909 change
9. 10' minimum offset to waterline
Comments:
Q
Septic Tank.
y3 0
1.
Level
2.
1,500 gal minimum
3.
Gas baffle present on outlet
4.
Manhole to w/in 6" of grade
y
5.
Manholes over center and each tee
6.-
3-20" manholes
7.
Outlet line cemented
8.
2" — 3" drop from inlet to outlet
eV�
9.
Pipe set
10.
Compact base with 6" of 3/" crushed stone under tank
11.
Tank is watertight
12.
Tees 12" off side of tank
Final Date:
Tel:1970 -- I/
Yes No Initials
cam'
4 N & M Job number 1770/ 0 '5 Q
Date
Comments:
Yes No Initials
E. Pump Chamber
1. If separate from tank, compact base wi of/a" stone underneath
2. Minimum 2" pipe to d -box if gravi stem
3. 20" access manhole
4. Tank Ievel
5. Watertight
6. Tank size agrees wi Ian specification A.
7. Manhole to grade
8. Check valve bleeder hole present
9. Alarm in b "ding on separate circuit
10. Alarm ions
11. Man operating switch
12. Pump delivers liquid to d -box
Comments:
1
F. Distribution Box
1. D -box level
2. Minimum 0.1 T' (2") drop from inlet to outlet
3. Minimum 6" sump'
4. Outlet pipes show equal distribution
5. Compact base with 6" of stone beneaih box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe
9. First 2' from box laid level
Comments:
G. Soil Absorption system Z-
1. All stone double -washed – 3/a" – 1 '/z"
- pea stone
Bucket test done? � 'Poe TX
2. Minimum 2" of pea stone above distribution lines y4��
3. Minimum 6" stone beneath pipe?' v
4. Distribution lines capped or connected together
5. Toe of slope stops minimum 5' from edge of property;y
5a. if not, then swale.
Comments:
___I- Tom E RIX 7-
.1'
I N & M Job number 1770/ 5
Date Yes No Initials
H. Leach Trenches p�
1. Minimum 2 trenches A---
2. Length of trenches agrees with plan. (Max.- length 1001)
3. Width of trenches agrees with plan Minimum 2'; maximum - 4'.
4. Vent present if>50 feet or specified .✓+�-��
5. Minimum distance between trenches 10
6. Pipe slope minimum -0.005 or 6" per 100'�G
7. Depth of trenches below outlet invert minimum of 6". :.
8. Pipes set on stable base. A.
Comments: >_
7-)
A!E��"T e:�2� P . 1jT7P1 c.
I. Leach Field
I . Maximum length of field 0'
2. Pipe slope minim 05 or 6" per 100'
3. Separation pipes 6' maximum _
4. Pipes co ed at end & vent sed
5. Separ 'on between adjac elds 10' minimum
6. P' s set on stable b
7. Maximum 4' s ation from edge 6f field to first 1'
8. Minimum two distribution lines
Comments:
J. Leaching Pits
1. Minimum inlet " e 4"
2. Pits of concr
3. Sidew tween 12" and 48" wide
4. Acc manholes on each pit
5. Pi es cemented with hydraulic ce
6.
Comments:
Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9" soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
6. Grading meets 3:1 slope
7. Minimum of 9" of fill graded over system
Project Request Record
Town of North Andover
Date: `5� 2_47
Client Id: ToNA Card Id: ToNA Client/Company Name: Board of Health
Card Type -Client
Contact -Name: Ms. Sandra.Starr
Titley Director
Address:. 27 Charles Street
Phone: 978-688-9540
Fax: 978-688-9542'
Email: sstarr@townofnorthandover:com
Notes:
Town: North. Andover
State: MA, Zip Code:. 01845
Other contacts_ if. applicable:; ie Engineer/ nstall
Name:. f7 /C / LL j� Phone:
Title: Fax:
Address: Email:
Notes:
Town:
State: Zip Coder
Proiect:
Project Id: 1770 Project Title: Town of North Andover, Board of Health
(JOB NO) (PROJECT NAME & STREET ADDRESS)
Manager: NOOJ Billing Group: 0 5— Q 8 Billing Cod : Fixed Fee,
Contract Info. ProjectDescription for each billing group
BG/ S4 Applicant
Assessors Man X?tf iA Lot l9 Z Street 2 Sn --5Qe-z- s 7` 517 --
Type of 'service X 5
Office/forms/jbrqutona
Town of North Andover, Massachusetts Form No. :3
f 14OR7p BOARD OF HEALTH
'6,
f -
�,,5,,,o•°{h DISPOSAL WORKS CONSTRUCTION PERMIT
3^CRUSE
Applicant /Y/K';- Y
NAME ADDRESS TELEPHONE
Site Location 0�6 + 7—
Permission is hereby granted to Construct ( ) or Repair (1/fan Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.— / �P
Fee X166
" CHAIRMAN, BOARD OF HEALTH
D. W.C. No. _ Zi!k
Per;,nit • #
BOARr "OV HEALTH
Town of Nu�-L1'1--%ndover,Mass.
Date 8726-87
ATION FOR WELL & PUMP PERMIT
19
APPLIC
Application.is hereby made for permit to drill a well (xx). Application is
made to install ( ) a pump system'.
Location: Address 350 Forest Street, North Andover, Mass. Lot #. •••---
Owner James•& Anna Logan Address 104 Cardinal Lane, TyngsboroTel.
MA. 01879
Well Contractor les M. Rollins Co., Inc. Addressl29 Depot Rd.,Boxford ,MA.01921 Tel -887-2-320
Pump Contractor Address Tel.
WELL CONTRACTOR (To be completed at time of purnp test)
Type of Well
Diameter of Well
Depth of Bed Rock
Drilled Well used for Domestic
6"
16'
Was Seal Tested? Yes (.) No ( )
De pth --o-f W-;-1 i
605'__
Size of. C'asi-ng 6"
r
Depth casing into Bed Rock 37'
Date.of Testin
Well Ended in W.ha-t.Material Rock
Depth to Water 51 Delivers 42 Gals.Per Min. for 4 hours
Drawdown feet after pumping __hours -at GPM
Date of Completion I `
Signature Wel Contra% or
.� ✓r k X .,. _� v •�• :::::: �:: -�::: ;': ;: -:: ;'::; :; .�..�_ v. ;: ...., ..:, n :.:. ,...:. ,. „ .......... .... ...: is ;, :... ,...., n n n ;, „ n :. ;..: n x ;, n n n .0 -& n * rk * �
n n .� ;♦ n hid./. ��
PUMP INSTALLER (To be-•f-i.11ed in- before installation) r
Size & Name Pump _ _ _ Pump Type Used
Water Pump Delivers GPM Size of.Tank
Pipe Material Used in Well: Cast Iron (_) GnI.,vnni.zed (_) Plastic (_I
Well Pit ( ) or Pitless.Adapter
Was sleeve used to protect pipe? Yes (_) NO(—) Type or Name Well Seal
Date
�r�'r►1r�1r�M�1r�t�F4r�lr�'r�ri4ti'r���4�a�Y�4�rrtiM�k�'r�r�rti'ttilr�t►4�r�'t�4t�r�4�'r�4�'r►4ti4�4�r►'t�'r544'r,'r Q;il,`�c-;irU Gi J� 2w-.iVWW , F d�dfdVdMt�tdYlk
Date Water analysi.•s repor-t submitted to Board of }ieal•th
Date release given to owner of record & Bldg. Insp
Health Inspector
�
�
�
CC�.�
CC
�
��
_�60
��
s®.0
��
_�E
�C
�
����
_�
�
1'
�
�
���
�s
���
���
a
•
�
��
i,
RCH ASSOCIATES, Inc.
ENVIRONMENTAL CONSULTING, ANALYSIS, PLANNING & ENGINEERING
James & Anna Logan Date 8/27/87
Water report for: MainePost & Bean
Invoice number 1.445
P.O. Box 2598
So. Hamilton, Ma. 01982
Water classification: This sample for the parameters tested
❑ Not Applicable ❑ Meets or exceeds criteria for drinking ❑ Meets or exceeds criteria for recreation
❑ Is not considered to be drinkable ❑ Does not meet criteria for recreation
sample taken by ACharlesRollins time _ date 8/25/87
type of sample: ❑ Well -Faucet ❑ Municipal ❑ Swimming Pool
❑ Well -Dug ❑ Raw Surface IN Other NEW Well
site: ❑ Same as above
350 Forest St.
North Andover, Ma.
bacterial results:
aliquot (ml) I total coliform (#/100 ml) I fecal coliform (#/100 ml) I fecal streptococcus (#/100 ml)
bacterial method: Membrane Filter ❑ MPN ❑
chemical results: (unless otherwise specified — results are mg/1)
pH 7.14 manganese 0.3
chloride 45 nitrate(N) <0.1
hardness 120 sodium 16.1
iron 0.884
Any questions, please call after 5 PM
Mass. Certification #25451
26 FENNO DR., ROWLEY, MASSACHUSETTS 01969 • 948-2449
STEVENS ANALYTICAL LABORATORIES, INC.
38 Montvale Avenue, Stoneham, MA 02180, (617) 438-6114
FAX (617) 438-0173
LABORATORY NUMBER: 172385 SAMPLE SAMPLE: 12/28/89
SUBMITTED BY: JAMES LOGAN
104 CARDINAL LANE
TYNSBORO, MA 02180
SAMPLE SOURCE: NEW ARTESIAN WELL/COLLECTED DIRECT
350 FOREST STREET, NO. ANDOVER
ANALYSIS: According to Standard Methods of Water and Wastewater
Analysis, 16th Ed.
Total Coliform .................. 0 per 100 ml
Chlorides....................... 47 mg/1
pH.............................. 6.64
Hardness ........................ 158 mg/l
Manganese ....................... 0.04 mg/1
Sodium......................... 15 mg/l
Iron........................... 0.38 mg/l
Nitrate ........................ 0.92 mg/l
Nitrite...............less than 0.10 mg/L
COMMENT: The results of these analyses meet the federal and
state standards for drinking water. However the
iron concentrations exceed the recommended
standards.
Although iron is not harmful to your health,
it can affect the taste, color and odor of
your water. If desired, iron can be removed with
filters sold by water treatment specialists.
-------------------------------
Chemist/Microbiologist
Town .of North Andover, Massachusetts Fdrm No.1
NoiTN BOARD OF HEALTH
OA
10 APPLICATION FOR SITE TESTING/INSPECTION
Applicant
� NAME (f ADDRESS TELEPHONE
Site Location
Engineer_�e! g) ""0'—gAL-'pd �
NAME ADDRESS TELEPHONE
Test/l nspection Date and Time
Fee -CHAIRMAN,-BOARD OF HEALTH
Test No. /OAJ_
S.S.. Permit No. N.o,.-C.C. Date Plbg. Permit No..
OCT 2 2 n9i
BOARD OF HEALTH
�- NORTH ANDOVER, MA 01845
978-688-9540
f`, Y
APPLICATION FOR SOIL TESTS
DATE: 911C C MAP & PARCEL: j q
LOCATION OF SOIL TESTS:
eeaz
e t t
,,t/-
Qa
OWNER: ;J1'Vi
TEL. NO.:
7C
ADDRESS: 1:;�:ae-&
-ENGINEER: A);k,,�, ErLny kv'�,
eeaz
TEL. NO:
q7✓- f& -j
Qa
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This:
Repair Testing: rx
Undeveloped lot testing:
In the Lake. Cochichewick Watershed? Yes
No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM UU! L. 20(x;
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. 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 $200.00 per lot for repairs or
upgrades. (If time is not critical, fee for repairs is $75.00)
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the
BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board
of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval: S a o
Date Received: Check Amount: r e r Check Date:
EXHIBIT "A"
i
�� /SQ fT. FRONT ON
10.00,3
J
i
_ - Ln� tie�ivvc VK JVVHY YAHUEL "A" PnR PAT7rL-r ii— io /
BOARD OF HEALTH
NORTH ANDOVER, MA 01845=' �=°
978-688-9540
2001
APPLICATION FOR SOIL TESTS n
t
DATE: i MAP & PARCEL: p J q.
LOCATION OF SOIL TESTS: ,3i O fL (Luh i St (Z e e`7' AJ, {in po,, -e-p
OWNER: J-1 /A N ✓t & ko(,-A.v TEL. NO.: q-76- �, v'G t F y
ADDRESS: 3t5 -c% /i/
ENGINEER:
ecl ta,' e.G
TEL. NO.:
q7 —1760
CERTIFIED SOIL EVALUATOR:
t�7e`�eCarr;. ('
dsy��
c
(Z; �,✓L,�
C
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, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. 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 $200.00 per lot for repairs' or
upgrades. (If time is not critical, fee for repairs is $75.00)
GENERAL INFORMATION
OCT 2 2 ?nni
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.
epresentative:5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board
of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval:
�o i fs—
Date Received: //7/W/Check Amount: 0 0. Check Date:
EXHIBIT "A"
FRoNr. ON FpRCST. STREET
Br. ti. •. 140
{
r
130
r
H
31
Y C
4o OG
1
a
z
T 'p,/^/SIJ✓"/A/
OPTION TO EXCHANGE OR SG7APPARCEL "A" FOR PAPCEL "B"
L�
10.8�
I
FORM 11 - SOIL EVALUATOR FORMM
Page 1 of 3
No. Date: 4/
Commonwealth of Massachusetts
A/o. Massachusetts
Soil Suitability Assessment ,fr On-site Sewage Disposal
i c/f,¢�2D C ��TzD Date:
PerformedBy: .......-........................................................................ .... ........
Witnessed By:
....... ®.... x.¢ ................ _
Localion Address or �SD Owtzr's Name,
��{ ,�5 f%��✓y�� L+. C'�` ��' 7
ress, and
Loi M
/VC �NO��Ft� /Y Teleptarc I ' 7%F ✓/
ew construction ❑ Repair [7 978 GAG—/84�
Review
_Office
Published Soil Survey Available: No ❑ Yes
Year Published �.. . . . Publication Scale
Soil Mai Unit
Drainage Class oO�, .4 ............. Soil Limitations
Surficial Geologic Report Available: No ® Yes ❑
Year Published _ _ Publication Scale
Geologic Material (Map Unit)............................................................................................................
Landform................................................................ .........................................................................................
.
....... .
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑ Yes
Within 500 year flood boundary No ❑ Yes ❑
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month o
Range :Above Normal ❑Normal ❑Below Normal
Other References Reviewed:
DEP APPROVED FORM • 12/07/95
FORM 11 - SOIL EVALUATOR F0101
Page 2 of 3
Location Address or Lot leo. Jos:%/ ��' �/D•i�vo�
On-site Review
Deep Hole Number / Date:.��/!%% Time: /4.4" Weather�Q S�
Location (identify on site plan)
�.:.... ope (%)
Land Use Sl
Surface Stones
Vegetation
Landform ..
Gid/. /i? O?L rV•
Position on landscape (sketch on the back)
Distances from:
Open Water Body/1104a feet Drainage way. feet
Possible Wet Area./2f%. feet Property Line ..5 d... feet
Drinking Water Well _I/O feet Other . _:....:.:...
DEEP OBSERVATION HOLE LOG*
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravetea.
Depth from
Surface (Inches)
��—+��i!!��— / ' L L - apthtoBedrock:
Parent Material (geologic)
Depth to Groundwater:
Standing Water in the Hole: Weeping from Pit Face:
High Ground Water: -
Estimated Seasonal
---
DEP APPROVED FORM • 12/07/95
FORM 11 - SOIL EVALUATOR F0101
Page 2 of 3
Location Address or Lot No.
On-site Review
%9Time: /01 �1.�,� Weather /Rl �`f4
Deep Hole Number Date:..... -
Location (identify on site plan)
Land Use s - Slope (%) -°3 Surface Stones
Vegetation:. _.
Landform
Position on landscape (sketch on the back)
Distances from:
� feet Drainage way feet
Open Water Body/?l
Possible Wet Area %2? - feet Property Line :572 feet
Drinking Water Well //<4V . feet Other .........:....
Depth from Soil Horizon
Surface (inches)
DEEP OBSERVATION HOLE LOG -
Soil TextureSoil Color Soil Other
(USDA) (Munsell) Mottling (Structure, Stones, Go Boulders, Consistency, %
N
vG
rJI�G
ANY
n� ra
IL I
Pt
Parent Material (geologici �Fx� G �G L- )epthtoBedrock: _
r— from Pit Face:
Deoth to Groundwater: Standing Water in the Hole: Weep—
Estimated Seasonal High Ground Water:
a-
llEP APPROVED FORM - 12/07/95
NORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. � Al4 y,,, c P
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole......... inches
,❑ Depth weeping from side of observation hole ........... _. inches
tJ Depth to soil mottles ...:..' inches 7Z
❑ Ground water adjustment ................... feetZ— 68
Index Well Number .................. Reading Date ................... Index well level .....
Adjustment factor ................... Adjusted ground water level ...`. .......... __ ....
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in a I areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 1�(date) I have passed the soil evaluator examination
approved by the apartment of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. �—
Signature Date /02-//
DEP APPROVED FORM • 12/07/95
FOR%1 11 -SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot 14o. `?C' i�
On-site Review _
Deep Hole Number — Date:J0�..)I/ Time: Weather
Location (identify on site pian)
Land Use Slope M "l- Surface Stones
Vegetation
Landform
Position on landscape (sketch on the back)
4
Distances fromC
Open Water Body ` feet Drainage way feet l ti
Possible Wet Area — {eet Property Line fees f - if !;
Drinking Water Well f, feet Other
DEEP OBSERVATION HOLE LOG*
�c;-
Depth from
Surface (inches)
Soil Horizon
Sol Texture
!USDA)
Soil color
(!Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Graven
Parent Material (geologic) F'%' ^ '�Y , f OapQnofiedrodc: Joe
Death to Groundwater: Stand) Water in the Hole-_ '00V ,
Standing Weeping from Pit Face:r
Estimated Seasonal High Ground Water: �% T
DET APPROVIM roam - 12m7195
" SFT 2 2 2001
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot Ido. F ' > `
l roe
On-site Review _
Deep Hole Number _ Date: ®. ��f Time: `� J SF Weather _
Location (identify on site plan) r
Land Use t"')`e°
Slope i%) Surface Stones
Vegetation 1
Landform
Position on landscape (sketch on the back) ..::...
Distances from:
Open Water Body )E'o 0
feet Drainage way ` � f,f lest
Possible Wet Area "2 L'('" feet Property Line ____. feet
Drinking Water Well 9S --w' -,feet Other
oo
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (Inches)
Soil Horizon
Sol Texture
(USDA)
Sol Color
(Munsell)
Soil
Mottling
pts
(Structure, Stones, Boulders, Consistency, Ifo
Graven
^1
(1
tib'
� �-:,
rf�
���`,�''
r"..
,¢��. � � � i,�'�`• � � , � r 1.,,_^
'-
Ilk
Parent Material (geologic)
o•�teoe.d< >
Death to Groundwater. Standing Water in the Hole: - Weeping from Pat face;
Estimated Seasonal High Grow Water: 011
DET APPROVED FORM - 12/07AS
FORM 12 - PERCOLATION TEST
0
Location Address or Lot No. 3'5O r-L7,fC 1-7—,
COMMONWEALTH OF MASSACHUSETTS
/V 1 6 -OV t9 ®t; 1 w; -C-- - , Massachusetts
Percolation Test`
Date: /.a//, 1 Time:,
Observation Hole. # F_ I
Depth of Perc
ell
Start Pre-soak
:LJ
End Pre-soak
-------------
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
�� "..'
Min./Inch I ?
L
/cam 7
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed 59"'a.Site Failed El
............................
Per -formed By: 1 "6070 0 r_.) X,z t e
Witnessed By:
Commentq-
DEP APPROVED PORjM. 12/07195
OCT 2
:LJ
DEP APPROVED PORjM. 12/07195
OCT 2