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Miscellaneous - 40 PHEASANT BROOK ROAD 4/30/2018 (3)
yo Pheasant Brook f � I \ I 5 I I I ' I { R � Lot & Street Lor 16 � Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit Plan Approval: Date: L Approved b Designer: Plan Date: Conditions: -- - � ` �� � ✓•6 �- cps-1,/iii` Water Supply- Town __ Well.Well Permit: -..Driller: Well Tests: Chemical Date Approved Bacteria I Date-Approved Bacteria_U Date Approved Plumbing-Sign-Off. -Wiring Sign-Off- Comments: Form"U" Approval: Approval to-Issue: S) NO Date Issued Bv: Conditions: Final Approval: All Permits Paid? _ NO Well Construction Approval? NO Septic System Construction Approval? NO Certification? NO Other NO Any Variance Needed? YES NO� FINAL BOARD OF HEALTH APPROVAL: DATE: rte/ APPROVED / SEPTIC SYSTEM INSTALLATION Is the installer licensed? YES NO Type of Construction: REPAIR New Construction: - ._Certified Plot Plan Review NO -Floor Plan Review NO _— Conditions of Approval from Form U YES l O -Issuance ofDWC permit: - NO -DWC Permit Paid? — NO . ---DWC_Permit# fD _- Installer: - - Begin-Inspection:_ — YES NO -- .Excavation Inspection: Needed: - Passed: _.._ By: .__Construction Inspection: Needed: As-Built_Plan Satisfactory: YES: _-_ Approval of Backfill: Date: By: ---Final Grading Approval: Date: v By: Final Construction Approval: Date:�/-/ y By: Certificate of Compliance: Approval: e: { I - A 'C-*\ Commonwealth of Massachusetts City/Town of System Pumping Record y Form 4 w . 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 your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location:42Aight front of house, Left/Righthous Left/right side of house, Left/ Right side of building, Left!Right front of building, Left/Right rear of building, Under deck Address City/Town State rHEALT;HD1FPAP"rw- �fld`illy 2. System Owner: SJ �� Lk:,- , 0 Z01 Name RTH ANDD `J Address(if differentfrom location) Citylrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes a o If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of.. yste m: lclw t v 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location re contents were disposed: S. Lowell Waste Water SignAtufe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping-Record E® Form 4 MAY 11 2015 DEP has provided this form for use-by local Boards of Health. Other forms mjVuQjSw,btjttffl@VER information must be substantially the same as that provided here. Before using lt -idrfF6Wh"ith your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house/Right' a o hour , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Lt CAltYRown State Zip Code 2. System Owner. . � � �t �f-Zd> Name Address(if different from location) citylrown ' State i Code r' Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Typeof sYs.tem: ❑ Cesspool(s) G se�Ptic Tank Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas L Wo If yes,was it cleaned? ❑ Yes ❑ No: 5. Condition of System: 1 No VV\OL 6. System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L S'. Lowell Waste Water Lj� =C,�= Sign HauleluDam ` t5fomt4.doc•06/03 System Pumping Record•Page 1 of 1 I Commonwealth of Massachusetts1. r ;orms City/Town of System Pumping Record Form 4NTR DEP has provided this form for use=by local Boards of Hy be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house(�Righ rear Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Cityfrown State Zip Code 2. System Owner. Name Address(if different from location) City/Town Stat �1 Lf�i de t-mac Telephone Number %- B. Pumping Record 1. Date of Pumping pate 2. Quantity Pumped: Gallons' 3. Type of system- ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No, 5. Conditin qf System: ` v 6. System Pumped B m Y P Y Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company i In re contents were disposed: Lowell Waste Water ~ L3 Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: lllml6l SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) /66- DATE OF PUMPING: /� ``� QUANTITY PUMPED GALLONS CESSPOOL. NO C,--- YES SEPTIC TANK. NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: / GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: I COMMENTS: CONTENTS TRANSFERRED TO: 4 r0 2001 r' Commonwealth of Massachusetts RECEIVE City/Town of MAY 0 6 2009 System Pumping. Record TOWN Op NORTHANpOVER Form 4 HEALTH DEPARTMENT 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 your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left front eft ear, ft si ofhous . Right front, right rear, right side of house. forms on the computer,use only the tab key Address to move your. cursor-do not use the return City/Town State Zip Code key_ 2. System Owner: Ills Name ' Address(if different from location) CitylTown State\f.� Telephone Number B. Pumping Record 1. Date of Pumping anti Pumped: Gallons 3. Type of system: Cesspool(s) _ eptic Tank Tight Tank P Other(describe): 4. Effluent Tee Filter present? Yes.—Vv If yes,was it cleaned? Yes No 5. Condition of System: ��� �'?�-✓`��1, . —o 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location here contents were disposed: .L.S.D Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03' System Pumping Record•Page 1 of 1 Commonwealth of Massachuse s City/Town of System Pumping Record Form 4 a 'i ��� ' M TQWN O�NQR7H ANC�N� DEP has provided this form for use by local Boards be used, but the information must be substantially the same as that provided ere. Eletore using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health ovother approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, Right front of house, <Ieff rear-sigh ar of house. I,eft reMf building. Right rear of building. b Y� Ct ' Cb Address Cityrrown ` \J� State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping (� 2. Quantity Pumped: ��6 e\— pate Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ElYes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: U 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. aG.L.S-:D ion ere contents were disposed: Lowell Waste Water Signature of Habler — Date r t5form4.doc•06/03 System Pumping Record.Page 1 of 1 ��� ��. iM ...�r:.�.��. ,,.. � �s ., ,.•�... p .r 3TC+'•,�;t�tu^ �fi.� .t'r ;��, � J I ^f � � � 1 � �� �� � . .,��� ,� Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record Form 4 OCT - 2 2007 DEP has provided this form for use by local Boards of Health. II the,� the information must be substantially the same as that provided he�ore-tings form, eck with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use only the tab key Address to move your cursor-do not Cky�own State Code use the return key. 2. System Owner. f y [ UCLA/-,Name 1�1 Address(if different from location) City/Town Statr S l a / qp Code Telephone Number B. Pumping Record 2 n. Qua t 1 1. Date of Pumping Date tY Pumped:P Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee FilterP resent? ElYes No If yes,was it cleaned? ElYes ElNo 5. Condi ' n of System: 6. S st ,rn PtKnped� By: Name Vehicle License Number Company 7. Location ere Conten s we 'sposed: S' a e auler Date t5form4.doc•06t03 System Pumping Record•Page 1 of 1 Commonwealth.of Massachusetts REC IVED City/Town of System Pumping Record APR 2 4 2006 Form 4 TO`A N OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information .Important: When fining out 1. System Locati forms on the computer,use only the tab key Address ) to move your cursor-do not �vCJGs� City/Town Zip Code use there State key_ 2. System Owner Name 11 Address(if different from location) City/Town State Zip Cone Telephone Number .B. Pumping Record j 1. Date.of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight.Tank ❑ Other(describe)' 4. Effluent Tee Filter resent? Yes o P ❑ t If yes, was it clean ed. Y Y es N ❑ ❑ o 5. Condition of System: 6: System Pum ed By Name Vehicle License Number Company 7, Lo Pn where contents ere disposed: ig t e of Hauler Date h.ttp://wWw.mass.gov/dep/waterlapprovalt/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 OR� i 'own ® . 3gAndover No. � � dower, Mass. 19 Q as LAKE • - '9�:CO CHICHE W ICK r ,g d �7 QTED�P �4. BOARD OF HEALTH Food/Kitchen PEKMIT T D Septic System BUIL NG INSPECTOR THIS CERTIFIES THAT....... .......Q� �.. . ......... �........ !.. .......�.... .......... undation has permission to erect................l....................... �lldings o ... ..�..YV,.... .I 'v !..... ough 1 �— to be occupied as. .I. .. l.!�....� .�......... .1.....oa/1....�/N �cr .......JaI.... fL� Chimney �� 4 Ch' provided that the person aZ'�opting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPEC OR VIOLATION of the Zoning or Building Regulations Voids this Permit. ~� a ,2 �C PERMIT EXPIRES IN 6 MO S ELECTR INSPB' O i j UNLESS coNST�vc TI a AIT Doug 1 �✓ :� ; ............ Service 9 t�: -s _ ... % e UILDING INSPECTOR /f Occupancy Permit Required to Occupy Building GA INSPECT R Display in a Conspicuous Place on the Premises — Do Not Remove Rough 5 No Lathing or Dry Wall To Be Done FIR DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 1D TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 06/04/99 This is to certify that the individual subsurface disposal system constructed ( X) or repaired ( ) by Dave Maynard at Lot 1B Evergreen Estates 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 # 803 dated 10/19/98. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector I , TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; by /4-')Z located at Zt.-- Z ;.-e .. was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #� dated � with an approved design flow of!t!jQ gallons per day. The materials u ed were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on t As-built which has been submitted to the Board of Health. Bed inspection date: WERepresentative res ive Final inspection date: �i' � g�/ Installer:!' Lic.#: Date: Design Engine' ngine Date: x 3- py k; TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System em constructed; ( ) repaired; by located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #�G 3 , dated / , f,, with an approved design flow of gallons per day. The materials u ed were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work.is accurately represented on t As-built which has been submitted to the Board of Health. Bed inspection date: ngi res ive Final inspection date: �4 / 3 E Representative Installer: %' Lic.#: Date: 9 -,,2,;1 I Design En ine Date: l � r I TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION i The undersigned hereby certify that the Sewage Disposal System constructed; ( ) repaired; Z) located at � �- was installed in conformance with the North Andover Board of Health approved plan, System Design Permit #&-3 dated ; with an approved design flow of� gallons per day. The materials u ed were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on t As-built which has been submitted to the Board of Health. Bed inspection date: ngi res ive Final inspection date: I l E Representative Installer: Lic.#: Date: 9 Design Engine Date: AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER �...�`" LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE y. TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA i" LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION ✓� LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM LOCATION OF WATER,-'GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX l STAMP & SIGNATURE UAPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW �- FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED �'. LOCUS PLAN APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# /a LOCATION:- / rah-P r LICENSED INSTALLER: � ��,y��� SIGNATURE• 609:2: TELEPHONE# CHECK ONE: j REPAIR: NEW CONSTRUCTION: l/ IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes_6� No Foundation As-Built? Yes ✓ No Floor Plans? Yes '/ No Approval Date: I Town of North Andover, Massachusetts1 t MORTM BOARD OF HEALTH Form No.3 • C f 1ti 0 p L r 9 f 19 I 1 « _ CMUS I DISPOSAL WORKS CONSTRUCTION PERMIT . SS•� `�Et Applicant _ NAME 3 h au, 1 ADDRE Site Location Lv� / C TELEPHONE 4_ i Permission is hereby granted to Construct � Sewage Disposal System as shown on the Dejor Repair an Individual Soil Absorption sign Approval S.S. No. d CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No._/� � �ILL TolorlN ° tQ�pSeS 9 7. AA -,� .. ti PH J.. ;.J. + . .. ..� IGt-O � l �•�' � t T. 1 ' � , �t I i �, ' Imo' moo.; � + •• � 'C Lo � Kl � NY _ � Ci l-D• ' Kurz � �__�,;.-{� a'=rz � DRY - CLO I 1 - i `_•.r - - ---- -�-� _ ---___..... _.._.__. ..._ . _ _._iii-b.------ --- -_.. .-- --- .-- sltk 40 ANs, ,F FORM U — LOT RELEASE FORM ,a � INSTRUCTIONS: This form is used to verify that all necessary .. ,_ royals ermits from Boards and Departments having;� app /P P g jurisdiction have-been obtained. This does not relieve the applicant and/or aandowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills /out this section***************** APPLICANT: (z� �— Phone Cps IX2 CevLsT 6::9 S Zolo LOCATION: Assessor' s4Map Number Parcel subdivision �U��G � S!-i�iES - Lot(s) Street /'17L���S /P/T ��� �U St. Number **************'**********Official Use Only************************ RE ©IVENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments L Date Approved �qB Town Planner Date Rejected Comments Date *ved Food Inspector-Health Date Date Septic Inspector-Health >z` Date Comments . Public Works - sewer/water connections - driveway permit Fire Department12 - Received 2 -Received by Building Inspector Date Town of North Andover a NORTH OFFICE OFFICE OF 3�°�'"`o ° 64"0 COMMUNITY DEVELOPMENT AND SERVICES o A 27 Charles Street North Andover, Massachusetts 01845 �9SsgcHus���y WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 November 24, 1998 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 RE: Lot 1 B Pheasant Brook /Evergreen Estates Dear Phil: This letter is to inform you that the proposed septic plan for Lot 1 B Pheasant Brook Road has been approved for a house 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, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S George Farr File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North AndoverNORTH OFFICE OF ��Oy t e o "',�O L COMMUNITY DEVELOPMENT AND SERVICES O A 27 Charles Street .* : North Andover, Massachusetts 01845 �9ssACHus�t�y WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 November 24, 1998 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 RE: Lot 1 B Pheasant Brook/Evergreen Estates Dear Phil: This letter is to inform you that the proposed septic plan for Lot 1 B Pheasant Brook Road has been approved for a house 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, r Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S George Farr File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 SEPTIC PLAN SUBMITTAL FORM LOCATION: �� t1 e� �-�i � 6iF�SA�- �re�a► U` �� NEW PLANS: �Svfe, $125.00/Plan REVISED PLANS: YES i$6 0 lan4 ® L 3® 7 SITE EVALUATION FORMS INCLUDED: YES NO DATE: DESIGN ENGINEER: DATE TO CONSULTANT: i When the submission is all in place, route to the Health Secretary. I e. � I CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS The following is a.checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: Name of Designer: Plan Date: Revision Date: Date of Review: Property Address:.,,/-,QT I B L V e R6 Map: Q to Lot: _ BOH Reviewer: -3- S TO if K Type of Plan(new or upgrade): Number of Bedrooms in Assessor's Records:AIA gpd)Garbage Disposal Allowed: /l)6 General Information: N.A. =North Andover Septic Regulations Other numbers refer to Title 5 OK .Problem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) ✓ Maximum scale of 1 "=20'for profile and component details.-220(4) c✓ Legal boundaries of the facility being served-220(4xa) 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 9n 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) 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) a/ 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 Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) i/" Local upgrade approval request form submitted-403(1) c✓ Original R.S./P.E. stamp, signature&date-220(1)&(2) 1 w sfc. supplies(w/in 400'),pub. wells(w/in 250'),Pvt.wells(w/in 150@)-220(4x Location of watercourses,wetlands,wells, etc.w/in 150'of system-NA 8.02r Wetland disclaimer-NA 8.02s L-- Land surveyor plan reference required(property line setbacks)-220(3) Plan contains designer's certification statement 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) 1� Design flow was set in accordance with code-203 ✓ Existing system location and note on proper abandonment-600.3. 1 (f), 354 ✓ Leaching facility at least V above Base Flood elevation-NA 9.05 All piping Sch 40 minimum-NA 10.01 Basement floor minimum V above groundwater elevation-NA 5.04 On-site Soil and Groundwater Review OK ,Problem N/A Proper deep observation hole logs on plan-220(4)(h) Soil evaluation forms submitted within 60 days of field work-0 1 8(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) Hole Identification Numbers: /C ground elevation el. In7,'5 167 5 11A6 acceptable soil el. % o- U /6910 Leach facilitv invert el. to r ground water el. /0!9 refusal el. e.,J- bottom of leach facility el. 106 �a•6 thickness of acceptable soil /, /s-j before&after soil R&R separation to groundwater 4 l>, separation to refusal ,6 soil class Perc rate loading rate septic tank below g.w.table U (yes or no) pump tank below g.w.table (yes or no) 1.f in fill f- -255(l) 1 � �/ �� � ' � �� ��� /� �. - _� _ _-- Setback Distances(Given in feet) 15.21 1 O,K/Problem N/A V Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 / Septic Tank Leach Facility v Property line 10 10 ✓ Cellar wall 10 20 V Inground pool 10 20 Slab foundation 10 10 Deck,on footings,etc. 5 10 Waterline 10 10 ✓ 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 v 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 i 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)-2220) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 Watertight joints specified-222(3)&(4) Pipe laid on compact,fin base-222(5) 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: V``i Slope: ZXJ (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank O✓Problem N/A Tank is accessible-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) 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) _1 Outlet tee extends 14"below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compart) 228(2) 3-20"manholes-228(2) 1 childproof, 24"riser/manhole to final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) ✓ Soil compaction below tank specified(if soil is non-native)-221(2) �✓ 6"of<=3/4"stone beneath tank specified-221(2)&22 8(l) / If> 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. -223(1)(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) S� Top of tank<=36"below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible Tight Tank(Check here if not present: ✓ ) Distribution Box(Check here if not present: OK Problem N/A Inlet elevation: , Outlet elevation: /D , / �L 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) _L7 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 N/A Volume specified: 220(4)(r) Pump on elevation- 220(4)(r) Pump off elevation: 220(4)(r) Alarm on elevation: 220(4)(r) Number of cycles per day-220(4)(r)(also 254(1)(d)if gravity from d-box) Minimum 2" delivery line to d-box if gravity-254(1)(c) 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 pump(s)- gpm @ 'TDH-220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) Alarm equipment specified-231(2) Alarm is in building and powered on separate circuit from pump-2') 1(9) Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA-12.01 Check valve,bleeder hole-NA 12.01 1 childproof 24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr. specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), Chamber is watertight-221 (1) Top of chamber<=36"below grade-221(7) i 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) y/ No vehicle access or imperv. area above 11 unless unavoidable-240(7) 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) ✓ Reserve area provided(new construction)-248(1) Reserve 4' from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a)&(b) 4'(down to T with variance or I/A-upgrades only)of natural soil under U GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005-251(9) - Require 5'removal and replacement if in fill-255(5) s/ 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 U -240(1 1)&245(5) 3/8"-5/8" orifices specified(gravity system)-251(8) 9/ Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) (/ Impermeable barrier if<3:1 slope or< 15 feet to—3:1 slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 ✓ Retaining wall stamped by P.E. -255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) ✓ 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) Perc test(s)done inmost restrictive layer- 104(2) IT 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 capped,vented,or connected together-251(9) s� Pressure dosing guidance followed if pressure distribution-254(2xc), Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) Leaching Trenches h ✓ eac , g S(C eck here if not present: ) OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 rimes effective width or depth-251 (1)(d) In fill or reserve between trenches, 10' min. -NA 14.01& 14.03 Available leach area given(Min. 500 s.f.)-NA 9.01(2) i \ 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-2470) Leaching Pits(Check here if not present: ) OK Problem N/A #of pits/pit systems: (dosing chamber if>1, 231 (1)) Dimensions of each pit or system:L 6 W /L c.5 . D Depth of pits(max eff. 2'): -253(1)(a) G-1 Available leach area given q Y Bottom=L x W 12, .-5 x#of systems= D �� S s.f. Sidewall=L D 2 x#of systems=-t-34�3/0 s.f. Total area=bottom /2,3- +sidewall�/ Z2. s.f. Effective leach area given Loading factor: Q� Effective area=total area //z I., s.f x LTAR g/day Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X16'-NA 9.01(3) Distribution for galleries/chmbrs. in trench config. -pipe every 20'-253(6) Distribution for galleries/chmbrs. in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2"2x washed peastone.-247(2) J� 3/4"to 1 1/2"double washed stone-247(1) Each pit has at least one 20"access cover. 24"CI to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary, extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: ) OK Problem N/A Number of fields: (need dosing chamber if> 1, 231 (1)) Length(100'max.): -252(2)(b) Width: Total area:L x W s. f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe-NA 15.01 Effective leach area given Loading factor: Effective area=total area s.f x LTAR = g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) 6'line separation(max.)-252(2)(d) 4'maximum separation from edge of field to line-252(2)(e) 10'minimum separation between adjacent leach fields-252(2)(f) { Between 6 and 12 of 3/4- 1 112 stone beneath field-252(2)(g)&247(2) � 2"of 1/8"-1/2" 2x washed peastone.-247(2) '�-�_� - ..v � a I /�- I 1 1 The ( ) bottom of bed; ( ) septic system located at has been inspected and approved on by Board of Health personnel, and the Health Department has no objection to a construction permit being'issued for this lot. Inspector Date 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �� / //✓ U�(/ ��C- Phone :5&1 -2145, LOCATION: Assessor' s Map Number Parcel Subdivision ,Lot(s) Street. '�f��'/�SArZ/T ��a� �1J St. Number ************************Official Use RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved, Town Planner Date Rejected Comments I Date Approved Food Inspector-H © Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works- sewer/water connections - driveway permit Fire Department Received by Building Inspector Date �,� �j CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508)373-0310 FAX: (508)372-3960 T0: Ms . Sandra Starr Board of Health North Andover RE: Septic System Design Plans Date: T Attached are plans for This design is a new submittal a revision with the following changes r CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508)373-0310 FAX: (508)372-3960 April 8, 1996 Ms . Sandra Starr Tom � ,�'©F ,ri' r` North Andover Board of Health 146 Main Street i No. Andover, MA 01845 y � RE : Lot 1, Evergreen Estates - e Dear Sandy: In response to your letter of April 3 , 1996 ; I offer the following information 1; A gas baffle has been added. 2, Mr. Giles is not a soil evaluator, as you point out, however, we used the mottling water table you established. Regarding soil types, the soil logs for the entire site show a sandy loam which is why that type was chosen. We can do additional testing in the northern end of the system at your convenience this spring. jVe my y :�zr , Ph' ip G. Christiansen PGC; lc Town of North Andover kORTN -1OFFICE OF Z Of t"'10 '°',41 COMMUNITY DEVELOPMENT AND SERVICES ° - ..... ... . MEMEERCEIM % 146 Main Street } 9 e x North Andover, Massachusetts 01845 SACHU April 3, 1996 Mr. Phil Christiansen 160 Summer Street Haverhill, MA 01830 Re: Lot #1 Pheasant Brook Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Gas baffle needed on outlet of tank; 2. Since Mr. Giles is not a certified site/soil evaluator, the most restrictive loading rate must be used to determine leach area size. 3. All passing soil tests are in one quarter of the leaching area. Three quarters (roughly 75 feet) of the leaching area has no soil testing at all except for the one aborted percolation test. Additional soils tests, unfortunately, must be done. In addition, lots #3A, 7, 10, & 11 Pheasant Brook and lot #20 Beaver Brook have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f - _t FORM C —APPLICATION FOR APPROVAL OF DEFINITIVE PL��OEowe c�_ ` a.C:_R'�< x NORTH ANuOVER January 17 ^ j 19 95 I To the Planning Board of the Town of North Andover: The undersigned, being the applicant as defined under Chapter 41, Section 81—L, for approval of a proposed subdivision shown on a plan entitled Definitive Subdivision Plan "Evergreen Estates" located in North-Andover by Christiansen & Sergi , Inc . dated December 28 . 1994 being land bounded as follows:Northerly bt Com of MA , land of Steer and Fried ; ' easterly by land of Fried , eadder, Rough , Green , Galeassi , Yourre , Mateja , Farr and Com of MA ; westerly by Com of MA.. hereby submits said plan as a DEFINITIVE plan in accordance with the Rules and Regulations of the North Andover Planning Board and makes application to -the Board for approval of said plan. 1087 314 Title Reference: North Essex Deeds, Book 2901 Page 13 ; or Certificate of Title No. , Registration Book , page ; or Other: Said plan has( x) has not( ) evolved from a preliminary plan submitted to the Board of Aug 24 19 ,94 and approved (with modifications) ( ) disapproved (g on Oct 4 _ _, 19 q4 The undersigned hereby applies for the approval of said DEFINITIVE plan by the Board, and in furtherance thereof hereby agrees to abide by the Board's :Rules and Regulations. The undersigned hereby further covenants and agrees with the Town of North Andover, upon approval of said DEFINITIVE plan by the Board: 1. To install utilities in accordance with the rules and regulations of the Planning Board, the Public Works Department, the Highway Surveyor, the Board of Health, and all. general as well as zoning by—laws of said Town, as are applicable to the installation of utilities within the limits of ways and streets; 2. To complete and construct the streets or ways and other improvements shown thereon in accordance with Sections Iv and V of the Rules and Regulations of the Planner Board and the approved DEFINITIVE plan, profiles and cross sections of the same. Said plan, profiles, cross sections and construction specifications are specifically, by .reference, incorporated herein and made a part of this application. This appljcation and the covenants and agree— ments herein shall be binding upon all heirs, executors, administrators, successors, grantees of the whole or part of said land, and assigns of the undersigned; and 3. To complete the aforesaid installations and construction within two (2) years from the date hereof. . c• Received by Town Clerk: i%_Mn-4 n -11 - Date: Signature of Applicant Messina Development Corp . , 805 Winter St . Time: Uorth Andover , MA 01845 Signature: Address Notice to AP?J IU N /j V CLERK and Certification of A .on or rlanzLing Board t on Definitive Subdiviblon Plan entitled: Evergreen Estates By: Christiansen & Sergi dated �P�Ptni,P �u_ , 19 94 The North Andover Planning Board has voted to APPROVE said plan, subject to the following conditions: 1. That the record owners of the subject land forthwith execute and record a "covenant running with the land", or otherwise provide security for the con— struction of ways and the installation of municipal services within said sub— division, all as provided by G.L. c. 41, S. 81—U. 2. That all such construction and installations shall in all respects conform to the governing rules and regulations of this Board. 3. That, as required by the North Andover Board of Health in its report to this Board, no building or other structure shall be built or placed upon Lots No. as shown on said Plan without the prior consent of said Board of Health. 4. •Other .conditions: -z .o 77� P--4� See attached .700c)=o r+g rr rn CS p ,_ ct L.r In the event that no appeal shall have been taken from said o ddaP��fo=,,thwial �th twenty days from this date, the North Andover arming thereafter endorse its formal approval upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: NORTH ANDOVER PLANNING BOARD r Date: August 15, 1995 By: / Josepi, v. Ylanoney, Chaliman r a. A complete set of signed plans, a copy of the Planning , Board decision, and a copy of the Conservation Commission _ Order of Condition must be on file at the Division of Public Works prior to issuance of permits for connections to utilities. The subdivision construction and installation shall in all respects conform to the rules and regulations and specifications of the Division of Public Works. b. All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must .be in place. The Town Planning Staff. shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. C. The applicant must submit a lot release FORM J to the Planning Board for signature. d. A Performance Security (Roadway Bond) in an amount to be determined by the Planning Board, upon the recommendation of the Department of Public Works, shall be posted to ensure completion of the work in accordance with the Plans approved as part of this conditional approval. The bond must be in the form of a check made out to the Town of North Andover. This check will then be placed in an interest bearing escrow account held by the Town. Items covered by the Bond may include, but shall not be limited to: i. as-built drawings ii. . sewers and utilities iii. roadway construction and maintenance iv. lot and site erosion control V. site screening and street trees vi. drainage facilities vii. site restoration viii. final site cleanup e. Three (3) complete copies of the endorsed and recorded plans and two (2) certified copies of the recorded subdivision approval, Covenant (FORM I) , Right of Way easements, and FORM M must be submitted to the Town Planner as proof of filing. 4 . Prior to a FORM U verification for an individual lot, the following information is required by the Planning Department: a. All lots must be approved by the Board of Health. The Board of Health has determined that Lots 6, 9, 12 , 13 , and 21 cannot be used for building sites without injury 4 i W to the public health without further testing. No building or structure shall be placed upon these lots without consent by the Board of Health. b. Due to the large amount of rock on the site which may interfere with the amount of parent material available for leaching, the Board of Health will require that the leaching area for each lot be completely excavated to insure that there is the requisite four feet of parent material present throughout the entire location proposed for the leaching area. C. The applicant must submit to the Town Planner proof that the FORM J referred to in Condition 3 (c) above, was filed with the Registry of Deeds office. d. A plot plan for the lot in question must be submitted, which includes all of the following: i. location of the structure, ii. location of the driveways, iii. location of the septic systems if applicable, iv. location of all water and sewer lines, V. location of wetlands and any site improvements required under a NACC order of condition, vi. any grading called for on the lot, vii. all required zoning setbacks, viii. location of any drainage, utility and other easements. e. All appropriate erosion control measures for the lot shall be in place. Final determination of appropriate measures shall be made by the Planning Board or Staff. f. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. g. The lot in question shall be staked in the field. The location of any major departures from the plan must be shown. The Town Planner shall verify this information. h. Lot numbers, visible from the roadways must be posted on all lots. 5 . Prior to a Certificate of occupancy being requested for an individual lot, the following shall be required: a. A stop sign must be placed at end of Pheasant Brook Road where it intersects with Salem Street. b. A driveway easement across Lot 22 must be granted to Ian 5 4 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508)373-0310 FAX: (508)372-3 60 January 22, 1996 PNpO Ms. Sandra Starr �01gop,R qo� North Andover Board of Health 146 Main Street No. Andover, MA 01845 RE: Lot 1, Evergreen Estates - Beaver Brook Road Dear Sandy: Thank you for your letter of January 10, 1996 regarding the above plan. I have changed the design to a field. Comments 1-4 have been addressed in the revisions. I do not know what a gas baffle is as mentioned in your comment 5. Please fax to me a copy of a gas baffle. I believe the soil class is correct. Perc test elevations have been added. I don't think the aborted perc is a problem. With the system being 1650 sq. ft in size, designed for 25 min/in it is unlikely it will ever fail. Thank you for your review. ytrulyo s, p G. Christiansen PGC;lc NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: Ao PERMIT # �G-� DATE RECEIVED f < < As- APPLICANT ---BOlj /V655/X/,9 MAP PARCEL ADDRESS LOT # C�U 12G,���iU Z S7 6 ENG._ ,e157-1/9V S�V q- 541-061 STREET`—j�'W�645i9/UT -Z5,eO6.0 ADDRESS 160 '50"016-e 57- PLAN PLAN DATE REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: D&-5 /G A,) — ` E2c: — a3 M Al - 3Y5TCM ti&n Uti ad NI 2�e U6- l J Iq A�6 / -0A) © A k)L r 1 . 4) 6 7-- r C �� S 7- Aj 2/2 VF 7 z- 11':9-6 v ' T i PLAN REVIEW CHECKLIST ADDRESS ZOTi —OR61eC ENGINEER C�".�/5T�5'/�5�45 7.c) GENERAL 3 COPIES L/� STAMP `� LOCUS NORTH ARROW SCALE vi CONTOURS PROFILE �� SECTION �� BENCHMARK �� SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?_A DRIVEWAY l./ (Eley) ATER LINE FDN DRAIN SCH40_jZ TESTS CURRENT? SOIL EVAL SEPTIC TANK I AM MIN 150OG v . 17 INVERT DROP �--'� GARB. GRINDER(+200% EDF)tjb-(85�06D '25 ' TO CELLAR �ANHOLEX ELEV GW #� COMPS. 5' D-BOX SIZE # LINES-aL FIRST 2 ' LEVEL STATEMENT INLET - OUTLET (2" OR . 17 FT) TEE REQ'D?210 LEACHING MIN 660 GPD? /f / ESERVE AREA 4 ' FROM PRIMARY? 2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLS 4 ' TO S.H.GW (5 ' >2M/IN) 70(1tZS5 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP v 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVERt/ FILL? . (25 ' • if above natural elev; 10 ' if below) BREAKOUT MET? TRENCHES MIN 660 gpdZ SLOPE (min .005 or 6"/100 ' ) �SIDEWALL DIST. 3X EFF. W OR D (MIN 61 )✓� RESERVE BETW N TRENCHES? IN FILL? MUST BE 10 MIN. ' 411 PEA STONE?. VENT. (>3 COVER; LINES >501 ) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) �. D 15 rr/19-Ay�S CA) 5//Z4- Copyright © 1995 by S.L. Starr C ` � z,vc.o���-=cT � a�� ry�c- -- . . - .J PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W) xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W) xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? � 4" PEA STONE? l/� DIST LINE SLOPE . 005? >31COVER-VENT SCH 40 L--' MIN 12" COVER RATE LDG X 660 = X = TOTAL G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm TL W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1 ' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright 0 1995 by S.L.Starr 1 Evergreen Estates Lot 1 Pheasant Brook Disapproved revision dated 1/19/96 1 . Gas baffle shown on inlet of tank. 2. Since Mr. Giles is not a certified site/soil evaluator, the most restrictive loading rate must be used to determine leach area size. 3. All passing soil tests are in one third of the leaching area. Two thirds of the leaching area have no soil testing at all except for the one aborted percolation test. Additional soils tests must be done. Town of North Andover f NORTH 1 OFFICE OF 3a°�'"e D " . ° COMMUNITY DEVELOPMENT AND SERVICES ° F p 146 Main Street `A 7 ODqTID PPy�y North Andover, Massachusetts 01845 9SSAcHUS�S (508) 688-9533 January 10, 1996 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: Lot #1 (Evergreen Estates) Pheasant Brook Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Incorrect perc rate for design - perc lA - 23 minutes per inch - system designed on 20 minutes per inch. 2) No water line. 3) Please show distances between house and site plan. 4) Please show reserve area. 5) Tank missing gas baffle at outlet and needs manhole to grade. 6) Incorrect soil class possible. 7) Elevations of perc tests missing. 8) Aborted perc in middle of system (P-2A) . If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Pamn0 D.Robert Nicetta Mchael Howard Sandra Starr Katheen Bradley Colwell No........................ .............................. THE COMMONWEALTH OF MASSACHUSETTS —7— p BOARD vO�-yFy HEALTH /..0a)t`�. ............. OF..N ...l.L.......... �nll(l .................... Appliratiolt for 11h;1logal Worltg T0111itrurtililt j1prittit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ` / Qs y L ! K)41.d COt I^l!l°Gelf>---e--^ ,,n ocation-Address or Lot o. -:'►ltC'--�(_Imi.....Delle, rlct?/2?e!.vts 061.13 ,��',�t�m ���� ri W Oner Address ••••.. -••••-••-••••..............••-•--..........._............... Installer Address Type of Building Size Lot.... �.,s.3 U Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a1-� Other—Type of Building ---------------------------- No. of psons Showers ( ) — Cafeteria ( ) dOther fixtures ......--•--------------------- ------ W Design Flow............................................gallons per person per day. Total daily 4640................ f� Septic Tank—Liquid capacit ,! ,..gallons Length_fC6."'.. Width.k�.y.**_. Diameter................ De pth.f f Disposal Trench--No. ......... .... Width_.............. Total Length.�.�Q �.. Total leaching area....l Z.BO...sq. ft. 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq, ft. Z Other Distribution box ( w) Dosing tank ( ) , ~' Percolation Test Results Performed by........��e1.17`'--__at1C.S'.............. . Date..l�/ZL/y� f Jv_ .4 j t,---------------TestPit No. I...!?-A...__.nnutes per inch Depth of Test .Pit._...10.e._ . Depth to ground water-R'ON. 66 " tz, Test Pit No. 2....Ar.....minutes per inch. Depth of Test,Pit.-- ------------- Depth to ground water 04 ---------------------------------•- ---....._...---------..._.....----......._...-----••-•--•-•-•-•• ........................................................ D Description of Soil--------.F/AIE.......5— r --------- -----------------------i x TOWN OF NORTH ANDOVER/ U ••-••-•••••-•-•••••.....................•-•... ••----------------......-•--------•---•-••..--•- -BOARD-Of•H ALTIC--------.. W U Nature of Repairs or Alterations—Answer when applicable.--.-.................................... ....... ...... ._._.. .._.... ............... ....... -------•----------------------------•---.....-------•----------....---------.........--•--------....----•-•••---------. ...... - - ..f- 1995 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis oral System 1n accor , 1 Witt the provisions of TITLE 5 of the State Sanitary Code — The undersigned further es=n:ot_ he s stem i operation until a Certificate of Compliance has been issued by the board of health. Signed.........................•--••----•-•-•------••----._._:..._-----•........_.........-- ................................ Date Application Approved By............................ Date Application Disapproved for the following reasons-------------------------------•---------•-----...-----------------------------•-----•-•••-•......---••••••...... ---••-•----------------•-----••-------•-----------.....------..... -•-------------------••---------------..._......•--••----••---------- -•-----•••--------•----••------••••--••---...................•- Date PermitNo......................................................... Issued..............................................• ....... Date THE COMMONWEALTH OF ivIASSACH—USETTS '— BOARD OF HEALTH ..........................................OF Cnprtifirate of Toutpliattre . THIS IS TO CERTIFY, That the Lxllvldual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------•.-._.-.------------------------------------------------------------------------------. Installer at...................•....... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................._............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Ihspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF..........................._...................................... i9hipatial Worlto Tomitrortiott j1prlttit Permissionis hereby granted............. ....•,:---....--;--.._._....... r........................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo..............................................................................................•..----•..._. - Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ----•-•----------••-••------•-------•• ............................................................... Board of Health DATE.................................................................... -•••••••••- FORM 1255 M0813S.& WARREN. INC.. PUBLISHERS TOWN OF SYSTEM PUMPING RECORD----,--- DATE: ECORD--- , �DATE: 5 , SYSTEM OWNER&ADDRESS SYSTEM LOCATION Ue (example:left front of house) C� I DATE OF PUMPING:C—�� QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: r CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste