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Miscellaneous - 42 FOSTER STREET 4/30/2018
4 - 5-rl�<,g, i � I Fier Use-Cotle:��� Tax Class: T -- - TotFinArea: 1453 Sal yTe pe�.�_ Tot Land Area: 1.03 Sale Valid: A Owner#1: DANTONIO, PHILIP,T. Owner#2: Grantor: WILLARD Address#1: 42 FOSTER STREET Inspect Date: 3/21/2017 Road Type: T Exempt-B/L%: 0/0 J Address#2: Meas Date: 3/21/2017 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: CE Water: Indust-B/L%: 0/0 Inspect Reas: C Sewer: Open Sp-B/L%: 0/0 RESIDENCE#1 INFORMATION LAND INFORMATION Style: RR Tot Rooms: 8 Main Fn Area: 1453 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 1 Bedrooms: 4 Up Fn Area: Bsmt Area: 1457 Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 546 1 P 101 S 43560 1 N 206910 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 101 A 0.03 100/ 228 Masonry Trim: Ext Bath Fix: Tot Fin Area: 1453 Foundation: CN Bath Qual: T RCNLD: 233034 Kitch Qual: T EffYr Built: 1972 MktAdj: Heat Type: HW Ext Kitch: Year Built: 1962 Sound Value: Fuel Type: O Grade: AG Cost Bldg: 233000 Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Vail: DETACHED STRUCTURE INFORMATION Central AC: N Bsmt Gar SF: 520 Pct Complete: Aft Str Va12: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class Aft Gar SF: %Good P/F/E/R: /100/100/76 SE S 96 2002 A A ///92 1600 Porch Type Porch Area Porch Grade Factor SE S 80 1988 A A ///83 200 V 188 PT S 300 2002 A A ///92 2000 E 108 W 256 VALUATION INFORMATION SKETCH Current Total: 443900 Bldg: 236800 Land: 207100 MktLnd: 207100 Prior Tot: 443900 Bldg: 236800 Land: 207100 MktLnd: 207100 7 8 13 2 13 171 18 7 Sq.F FSgF t. AlFM/B PHOTO E 9. 117 Sq.Ft. 9 6 108 Sq.Ft. 6 18 7 47 .8 13 16 W FM/B 256 Sq.Ft. 1175 Sq.Ft. 16 16 p 25 25 16 1 g7 47 Sq.Ft. 1 r ` - FM 4 4 �. 42 FOSTER STREET l D � O PUBLIC HEALTH DEPARTMENT Town of North Andover ''�� Community and Economic Development Division CERTIFICATE OF COMPLIANCE As of: October 30, 2017 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Repair of the On-Site Sewage Disposal System By: Todd Bateson — Bateson Enterprises, Inc. At: 42 Foster Street Map 104.D Lot 0051 N rt lover, MA 01845 7T, f this ce i e h n t e construed as a guarantee that the system will function satisfactorily. Mi bele E. Grant Public Health Inspector 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov Town of North Andover — Septic System - AS-BUILT CHECKLIST 1) All changes to the design plan have been reflected and noted on the as-built plan 2) As-built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans) 3) ✓ Street Address,Assessor's Map and Lot Number Lines and Location of Dwellings served b the 4) Lot L g y system 5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 7 6) fies to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins '7 Property lines Dwellings or other structures Private water supply or irrigation wells ✓ Watercourses an s 8) Locations of W s,Dra' ,Wetland Resource Areas wi in 150 feet of system 9) Location o w r, as,electric lines,cable,control panel (if applicable) 10) I—Location of Structures within 6 Inches of Finished Grade 11) Original Stamp&Signature 12) 1 Location and holder of any easements which could impact the system 13) " Impervious Areas;Driveways,etc 14) North Arrow 15) V/ Location&Elevation of Benchmark used 16) _�tSTATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties,cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,if applicable,have been met." Signature of Designer Date b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was,or was not constructed in accordance 34th the intended des1 and any manufacturer's S jfjcgt4ons." Signature of Designer Date As of:Tuesday,March 17,2015 . . P C,® North Andover Health Department [ommunity and Economic Development Division August 8, 2017 Philip D'Antonio 42 Foster Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 42 Foster Street (Map 104D, Parcel 51) To Whom It May Concern: The proposed wastewater system design plan for the above site dated May 19, 2017 with a final revision date of July 21, 2017 and received on July 28, 2017 has been approved. The design has been approved for use in the construction of a new on-site septic system for a 3-bedroom house with a maximum of 7 total rooms, utilizing a pump chamber and Presby Enviro-Septic system. the followingvariances: Thea royal includes h pp 1. Setback reduction between the leaching area and wetlands from 100' to 65' 2. Setback reduction from the septic tank and wetland area from 75' to 62.7'; 3. Setback reduction from the septic tank and the deck from 5' to 2'; 4. Setback reduction from the pump chamber and the deck from 5' to 3.8'; 5. Setback reduction from the deck and the leaching field from 10' to 6.6'. The approval includes the following Local Upgrade Approvals 1. Separation reduction from the septic tank and pump chamber inverts to groundwater; r 2. Allow more then 3' of cover over the pump chamber This design plan approval is valid until August 8, 2020. Page 1 of 2 North Andover Health Department,Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 1 42 Foster Street August 8, 2017 4During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover: This approval is also su sect to the following conditions: 1. Prior to the issuance of the Disposal Works Construction Permit, the applicant must submit a foundation as-built at the same scale as the approved plan 2. Prior to the issuance of the Disposal Works Construction Permit, the applicant must submit the floor plans of the proposed dwelling showing no greater than 4 bedrooms or a total of 9 rooms. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere y, a rian . aGrasse, CEHT Director of Public Health Encl. Installers list rcc: Christiansen& Sergi, Inc., 160 Summer Street, Haverhill MA 01830 File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 r .I" - D •:S1u CPO : , Commonwealth of Massachusetts Map-Block-Lot BOARD OF HEALTH ------- -------------- Permit No North Andover BHP-2017-0549 P.I. ----------------------- FEE F.I. $350.00 DISPOSAL WORKS CONSTRUCTIONS -I�IiT Permission is hereby granted Bateson Ent � � to(Construct)an Individual Sewage Disposal System. at No 42 FOSTER STREET as shown on the application for Disposal Works Construction Permit No. BHP-2017-05 ated S017 IssuedOn: Sep-12-2017 — --------- -- __V -------------- -------------------------------------------------------- BO OF HEALTH 1� I Application for So System - /7 Construction;Pett, it -TOWN OF TODAY'S DATE NORTH ANDOVER $2301.00—Full Repair , MA 01845 $125.00-Component ------------ A__pnlication is hereby made for a permit to: 0.Construct a new on-Rite sewage disposal system* [Repair.or replace an existing on-Rite sewage disposal'system* ❑Repair or.replace an existing system component—What? A. Facility Information �`� N 0-f Address or Lot# IMW Cityfrown 2.-*TYPE OF SEPTIC SYSTEM*: ➢ a ump ❑Gravity(choose one '**If PUMP system attach copy of electrical permit to application*** ➢ ❑Conventional System (pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certificaffon to install_this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info.needed) 'NO=(installer must specify brand of frlter before DWC issuance) Whatis the Make? �'a`-'� �^ [Whatis tficModeP 2. Owner Information f Name Fe's - - Address(if different froomXabove) �_ o _ Cityrrown State G �y Zip Code Telephone Number 3. Installer Information Name Name of Corr�a�n� �A7EvON ENTERPRISES,INC AddressDOVER,MA 01810 AN Cityfrown, State Zip Code `/7K F1/5--OIL 703 Telephone Number(Cell Phone#if possible please) 4. Desioner lnfOrrnation C/kf r,s4,-,yy / �L �L�rq� ��1� L�J:s�•iri+�S.C�/ Name T— Name of Compan Address Cityfrown State Zip Code TAV 3 73 - 0:3 /© Telephone Number(Best#to Reach) Application for Disposal System Construction Permit.Page 1 oft Applica�ion.•for.Septic. Disposal aSVsaern TODAYS:DATE ' C©ns#ruction Pa. rrttit -TO'CT O:R-1.[Z D V Y mit 1y11i 01,845x:250 00 Fult Repair e�� + $125.0p-Component ....PAGE 2 OF 2 A. Facility. Information continued.... S. —Ta-e.•o_f Building: RdSlentlai.Dwellin9. or ElCommercial B. Agreement The underslgned agrees to ensure the constructlon and maintenance of the afore.descr/bed on-site sewage disposal ikstemin accordance with the provisions of ride.5 of the EnvlronMental Code,as well as fhb Local Subsurface Dlsposal Regulations for the Town of North Andover,and not to /ace.ahe s• stem fn o enation P Y p until a Certlflcate of Compliance has been Issued by this Board of Health. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved.for the following reasons: For off,ice Use Inly: ; 1. PeeAttachcd? Yes 7 NO 2.• Project"AdVer Obligation Form Attached. Yes 3.: hin System? • Ifso) Yr'es V . , No 4. FoundadouAs-BuftI (hew oonstrucdon•ronly): Yes No (Same scale as approvedpLw) 5. F1oorPlsnsp'Mew construction-only): Y . No_ �+lppO,i i tidn*for.pisppsat.OystbM'--DonMrucfloh permg:Raae 2 rir 2 i f • SEP'�`IC'S.'Y31�F •iN�A�, •�tR0,�8aC°,['iV ►��r!#�Y�1'�`�BLiGA�'I�l�fS As f$c•N9s&Andover.lic= all e:t jr ie iatzuc�3gtrf the�eptic fatthe prQj e�tysc {Adst M ofsepde sq�teia} + �•. --P`oz pim by R*eM to d*,spplmdmcf-r Aid daoedL thea —I l i '7 wft itvidom dgW L (Ian zcvFsed date) ' I uaderatand the following obligations fat g==t ofthis Prgr-Ctr i. As the fosbN4 I alis.obl*ted io cbttt6 sopemita mdBoa d c nth appsovcd phmpdmOD +pig any:wwkdam sitme . 3. At flte' -.I meta aaIl ttatd • M . >1Z$f1A Of AYZ o;haptuaon riot stied wA ttay:�ompsny�va tnd the is � ' y fpm �� system aatttady,thcia 3." Adsitq�icd�o Ize�y to tht And PER a#W,'F=d04 bM 4CCc&jiothate to be p mibnt: - .6. _ • • � "-_�nemfratft�� fiiap for��� � .. a 've>bart OIC'(or emt ttxegthe etfgiaees must be faidit 6cd•to Xhc Bc=d ofHeattl;,tit: for is inspect .ptne.`ice itiu t heptestiat f it tl> ,fnaftba :44Aoqd(iRlkat bepeso$ad able to' aroM pd op•to s>¢d id . c. ,— ts�ttifit�s roque#t aapcetioa Nlteiltdtt� s rn ?pltte: Iffier does snot 4. As a have to be Witte.' t msmlfer'I uad that a 'b?iasy p ate �tt 'tr ),itd 1 qui rewired to comps thg >�tfOa Of the spsEd ict#iitip ed niatsl�tion - un foi deiaiz]of th[s ayae�m aaad96A AftRl lez �nb •5.. .�tb`ainat�tes;Y ntdesttaa� �tt�a�e��e��3 th � *r � . t per cz•af tR&Rming coast nem. � ��: Deatlamithat.�pr�perrJeHr'd�aaftbeeJeaa�trl�•,bc,�sr�cbea't � - k Iaspo&dw a ttkcosw dnada ieYfa lse heat c 'Piasl per oarxbyAmwf4vae b 04ff"con;aft dta'a afnralc,l]-. o�g p , troll PMP abet&ftniIt►sad'other . 6. As the intt��� MA#U t t s s�! hm%lc' am Inx . •bla�f ��;A1h7T�t1A!�.1S� rp-�t�F l�1ws +• � .. Uad �d'l veuudSeptic.Ii�tialbet" '' . (-Od �/ o i � & 8007 Of NOR 7M,f4 o z Town of North Andover HEALTH DEPARTMENT ,SSAtMUSE� CHECK#: 5J�7 DATE: LOCATION: !.Z, H/O NAME: ,OXi X IJ b -,414 n;'c CONTRACTOR NAME: /'3"..50 a �� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ f. ❑ Recreational Camp $ ` ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: F `r ❑ Septic-Soil Testing $ t<; ❑ Septic-Design Approval $ t Septic Disposal Works Construction(DWC) $ 35d Septic Disposal Works Installers(DWI) $ t � ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Hea ent Initials White-Applicant Yellow-Health Pink-Treasurer i . �ttXXI RECEIVED OCT 2 5 2017 '(OWN OF NORTH ANDOVER }{EALTH DEPARTMENT PUBLIC HEALTH DEPARTMENT Cammunity&Economic Development TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION 0 �I The undersigned hereby certify that the Sewage Disposal System constructed; repaired; r By:Todd Bateson (Print Name) I Located at:42 Foster Street (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 5/19/17 and last revised on 7/21/17 ,with a design flow of 330 gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: 10/10/17 .n ineer Representative(Signature) James Melvin, P.E. And—Print Name Final Construction Inspection Date: 10/17/17 I /gineer Representative(Signature) James Melvin, P.E. And—Print Name Installer: Q (Signature) Date: �����/7 And—Print Name Engineer / nature) Date: %G I Phil Christiansen, P.E. And—Print Name 120 Main Street, North Andover,Massachusetts 01845 I Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov I • 54,`�K��icya � �(� ��:.�. ��• Cep\�_`�\ North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 42 Foster Street MAP: 104.D LOT: 0051 INSTALLER: Bateson Ent. DESIGNER: Christiansen & Sergi, Inc. PLAN DATE: May 19, 2017 final Revision 7/21/2017, Received on 7/28/2017 BOH APPROVAL DATE ON PLAN: August 8, 2017 INSPECTIONS TANK INSPECTION: 10/03/2017 DATE OF BED BOTTOM INSPECTION: 10/11/2017 DATE OF FINAL CONSTRUCTION INSPECTION: 10/19/2017 DATE OF FINAL GRADE INSPECTION:10/25/2017 SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned; ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments.- SEPTIC omments:SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port Outlet tee installed, centered under access port (gas baffle/effluent filter) 20" inch cover to within 6" of finish grade installed over one access port ❑ Neoprene boots around inlet & outlet Comments: PUMP CHAMBER ® Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" cover at final grade installed over pump access port ® Watertightness of tank has been achieved by Visual testing ® Neoprene boots around inlet & outlet Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: basement ® Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution N/A Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: Installer will cut a V notch in the D-box baffle wall to prevent siphoning of the water back to the pump chamber. 1 r� SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 19.50 x 50 remove rocks SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ® Loamed ® Seeded ® Cover per plan Comments: I DOCUMENTS NEEDED ® Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer i ® As-Built Plan BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 95.35 Septic Tank IN 10.32 94.95 94.99 Septic Tank OUT 10.56 94.71 94.74 Pump Chamber IN 10.66 94.61 94.59 2" Pump Chamber OUT 94.36 94.34 2" Distribution Box IN 5.16 100.29 100.05 Distribution Box OUT 5.37 99.90 99.88 Lateral 1 TOP 5.57 Lateral 1 INVERT 99.90 99.88 Lateral 2 TOP 5.88 Lateral 2 INVERT 99.39 99.38 Lateral 3 TOP 6.15 Lateral 3 INVERT 99.12 99.08 Lateral 4 TOP 6.46 Lateral 4 INVERT 98.81 98.78 Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN f CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 (Variances Granted) 10 (Variances Granted) ® Waterline 10 10 10' ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank' 75 (Variances Granted)100(Variance Granted) ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 0 co North Andover Health Department Community and Economic Development Division June 29, 2017 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 42 Foster Street(Map 104D,Lot 51) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated May 19, 2017 and received on June 5, 2017 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. The Assessor's field card has the house assessed for 4 bedrooms and 8 total rooms. However, the design plan indicates 3 bedrooms and 7 total rooms. The design plan or the Assessor's records need to be revised accordingly. 2. The names of the abutters from the most recent tax map were not depicted on the design plan(NA 3.2). 3. The full legal boundaries of the facility were not depicted on the design plan(3 10 CMR 15.220(4)(d)). 4. On sheet 1 of 2,the property lines should be depicted on the site plan view to confirm compliance with the setback requirements in 310 CMR 15.211. 5. The lot area and dimensions were not depicted on the design plan(NA 3.2). 6. The water line was not depicted on the design plan(3 10 CMR 15.220(4)(m)). 7. The existing septic system to be abandoned was not depicted on the design plan(NA 3.2). Page 1 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 8. On sheet 1 of 2,the Local Upgrade Approval request is considered an Alternative Design Standard as stated on page 3 of the DEP Remedial Use approval letter for the Presby system. The Form 9A should be revised accordingly. 9. On sheet 1 of 2,the profile view does not appear to accurately depict the existing and proposed grading above the pump chamber based on the site plan view. However, if this finish grading is correct then please request a Local Upgrade Approval to increase the cover material beyond the maximum allowable depth and modify the finish grading on the site plan view. 10. A Local.Upgrade Approval is required for the reduced setback from the pump chamber to the cellar wall(3 10 CMR 15.405(1)(b). 11. A Local Upgrade Approval is required for the reduced separation between the inlet and outlet of the pump chamber to the ESHWT(3 10 CMR 15.405(1)0). 12. Buoyancy calculations are required for the septic tank and pump chamber(3 10 CMR 15.221(8)). 13. An effluent filter is required prior to or within the pump chamber(3 10 CMR 15.23 1(10)). 14. On sheet 2 of 2, the pump curve for the Barnes BP314 model does match the pump curve on the specification sheet for this pump. Please revise the pump curve and confirm the proposed pump can provide the flow needed for the calculated total dynamic head. 15. On sheet 2 of 2, the pump model in the pump chamber detail and the pump curve are not the same. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Brian I LaGrasse, CEHT Director of Public Health cc: Philip D'Antonio File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 z FILE North Andover Health Department Community and Economic Development Division August 8, 2017 Philip D'Antonio 42 Foster Street North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 42 Foster Street (Map 104D,Parcel 51 ) To Whom It May Concern: The proposed wastewater system design plan for the above site dated May 19, 2017 with a final revision date of July 21, 2017 and received on July 28, 2017 has been approved. The design has been approved for use in the construction of a new on-site septic system for a 3-bedroom house with a maximum of 7 total rooms, utilizing a pump chamber and Presby Enviro-Septic system. The approval includes the following variances: 1. Setback reduction between the leaching area and wetlands from 100' to 65'; 2. Setback reduction from the septic tank and wetland area from 75' to 62.7'; 3. Setback reduction from the septic tank and the deck from 5' to 2'; 4. Setback reduction from the pump chamber and the deck from 5' to 3.8'; 5. Setback reduction from the deck and the leaching field from 10' to 6.6'. The approval includes the following Local Upgrade Approvals 1. Separation reduction from the septic tank and pump chamber inverts to groundwater; 2. Allow more then 3' of cover over the pump chamber This design plan approval is valid until August 8, 2020. Page 1 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 42 Foster Street August 8, 2017 During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certifrcate,of Compliance be endorsed by the installer, designer and the Town of North Andover,?— This approval4ealso subject to the following conditions: 1. Prior to the issuance of the Disposal Works Construction Permit, the applicant must submit a foundation as-built at the same scale as the approved plan 2. Prior to the issuance of the Disposal Works Construction Permit,the applicant must submit the floor plans of the proposed dwelling showing no greater than 4 bedrooms or a total of 9 rooms. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Since , rl w. rian J. aGrasse, CEHT Director of Public Health Encl. Installers list cc: Christiansen& Sergi, Inc., 160 Summer Street, Haverhill MA 01830 File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 » � I RECEIVED JUN L -. 9 20,E TOWN OF NORTH ANDOVER HEALTH DEPARTMENT North Andover Health Department Community and Economic Development Division June 29, 2017 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 42 Foster Street(Map 104D,Lot 51) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated May 19, 2017 and received on June 5, 2017 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. The Assessor's field card has the house assessed for 4 bedrooms and 8 total rooms. However,the design plan indicates 3 bedrooms and 7 total rooms. The design plan or the Assessor's records need to be revised accordingly. 2. The names of the abutters from the most recent tax map were not depicted on the design plan(NA 3.2). 3. The full legal boundaries of the facility were not depicted on the design plan(3 10 CMR 15.220(4)(d)). 4. On sheet 1 of 2, the property lines should be depicted on the site plan view to confirm compliance with the setback requirements in 310 CMR 15.211. 5. The lot area and dimensions were not depicted on the design plan(NA 3.2). 6. The water line was not depicted on the design plan(3 10 CMR 15.220(4)(m)). 7. The existing septic system to be abandoned was not depicted on the design plan(NA 3.2). Page 1 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 I j 1,4 8. On sheet 1 of 2,the Local Upgrade Approval request is considered an Alternative Design Standard as stated on page 3 of the DEP Remedial Use approval letter for the Presby system. The Form 9A should be revised accordingly. 9. On sheet 1 of 2,the profile view does not appear to accurately depict the existing and proposed grading above the pump chamber based on the site plan view. However, if this finish grading is correct then please request a Local Upgrade Approval to increase the cover material beyond the maximum allowable depth and modify the finish grading on the site plan view. 10. A Local Upgrade Approval is required for the reduced setback from the pump chamber to the cellar wall (3 10 CMR 15.405(1)(b). 11. A Local Upgrade Approval is required for the reduced separation between the inlet and outlet of the pump chamber to the ESHWT (3 10 CMR 15.405(1)0). 12. Buoyancy calculations are required for the septic tank and pump chamber(3 10 CMR 15.221(8)). 13. An effluent filter is required prior to or within the pump chamber(3 10 CMR 15.23 1(10)). 14. On sheet 2 of 2,the pump curve for the Barnes BP314 model does match the pump curve on the specification sheet for this pump. Please revise the pump curve and confirm the proposed pump can provide the flow needed for the calculated total dynamic head. 15. On sheet 2 of 2, the pump model in the pump chamber detail and the pump curve are not the same. Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. i i Sincerely, Brian J. LaGrasse, CEHT Director of Public Health cc:- Philip D'Antonio File i Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Main Street { NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.688.9542—FAX E-MAIL:healthdept@northandoverma.gov WEBSITE:http://www.northandoverma.gov SEPTIC PLAN SUBMITTAL FORM RECEIVE® Date of Submission: JUL 2 8 2011 Site Location: �( S 1,00 OF NORTH ANDOVER LTH DEPARTMENT Engineer: C 1't R 7S T 3 ANSF/v New Plans? Yes $275/Plan Check# (includes 1St submission and one re- review only) Revised Plans?Yes $125IPlan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yesy No Telephone#: 7� 37,-3 c31 a, Fax#: E-mail:—'7.7 C S? — N 2 Cc Homeowner I �� T - Name: �� (r � Ntvl-d OFFICE USE ONLY When the submission is complete(including check): ➢ 1/ Date stamp plans and letter ➢ V Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database I� Residential Property Record Card#1 of 1 Parcel Year:2018 � PARCEL 'ID: 210/104.D-0051-0000.0 MAP 104.D BLOCK 0051 LOT 0000.0 PARCEL ADDRESSr-:42 F05TER.STREE71� as of:7/28/2017 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 14868 Tax Class: T Sale Date: 11/8/2016 Page: 0288 Tot Fin Area: 1453 Sale Type: P Cert/Doc: Tot Land Area: 1.03 Sale Valid: A Owner#1: DANTONIO, PHILIP,T. Grantor: WILLARD Owner#2: Address#1: 42 FOSTER STREET Inspect Date: 3/21/2017 Road Type: T Exempt-B/L%: 0/0 Address#2: Meas Date: 3/21/2017 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: CE Water: Indust-B/L%: 0/0 Inspect Reas: C Sewer: Open Sp-B/L%: 0/0 RESIDENCE# 1 INFORMATION LAND INFORMATION Style: RR Tot Rooms: 7 Main Fn Area: 1453 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R1 y _ Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 1 (Bedrooms: 3fUp Fn Area: Bsmt Area: 1457 Roof: G Full'Baths.- - —2-' Add Fn Area: Fn Bsmt Area: 546 1 P 101 S 43560 1 N 206910 Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: A 2 R 101 A 0.03 100/ 228 Masonry Trim: Ext Bath Fix: Tot Fin Area: 1453 Foundation: CN Bath Qual: T RCNLD: 233034 Kitch Qual: T Eff Yr Built: 1972 MktAdj: Heat Type: HW Ext Kitch: Year Built: 1962 Sound Value: Fuel Type: O Grade: AG Cost Bldg: 233000 Fireplace: 1 Bsmt Gar Cap: 2 Condition: A Att Str Val 1: DETACHED STRUCTURE INFORMATION Central AC: N Bsmt Gar SF: Pct Complete: Att Str Va12: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class Att Gar SF: %Good P/F/E/R: /100/100/76 SE S 96 2002 A A ///92 1600 Porch Type Porch Area Porch Grade Factor SE S 80 1988 A A ///83 200 P 28 PT S 300 2002 A A ///92 2000 E 108 D 160 W 256 VALUATION INFORMATION SKETCH Current Total: 443900 Bldg: 236800 Land: 207100 MktLnd: 207100 Prior Tot: 443900 Bldg: 236800 Land: 207100 MktLnd: 207100 7 8 13 2 13 171 18 7 Sq.F FSgF t. , FM/B PHOTO E 91 117 Sq.Ft. 9 6 108 S .Ft. 6 18 7 47 8 13 16 W Wv FM/B 256 Sq.Ft. 1175 Sq.Ft. 16 16 25 25 i 16 FM 4 60 A7 4 47 Sq.Fb20 4 —9a — i 42 FOSTER STREET CHRISTIANSEN & SERGI, INC. CS0' PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 July 27, 2017 CED Mr. Brian LaGrasse REEIV Director of Public Health North Andover Health Dept. TOWN OF typr�TH Pamo A 1600 Osgood Street, Suite 2035 H -J� j DF, --Tuf North Andover, MA 01845 Re: Septic System Design Plan for 42 Foster Street (Map 104D,Parcel 51) Dear Mr. LaGrasse: We have received your June 29, 2017 comments on the above referenced plan, and we offer the following response. 1. The house has 3 bedrooms and 7 total rooms. 2. The names of the abutters have been added to the plan. 3. The full legal boundaries of the roe have been shown on Sheet 1 of 2. 9 property rtY 4. The property lines have been shown on the design plan on Sheet 1 of 2. 5. The lot area and dimensions of the property line have been added to the design plan. 6. The water line has been added to the plan. 7. The approximate location of the existing septic system has been added to the plan. 8. The request for a Local Upgrade Approval for a reduction in the offset to groundwater from the bottom of the leaching field has been removed as it is considered an Alternative Design Standard as allowed in the MA DEP Remedial Use Approval for Presby systems. 9. A Local Upgrade Approval has been requested to allow for more than three feet of cover over the pump chamber. 10. The pump chamber has been moved to provide a ten foot separation to the foundation. A Local Upgrade Approval will not be required. 11. A Local Upgrade Approval has been requested to reduce the separation of the outlet of the pump chamber to the ESHWT, a„ 12. Buoyancy calculations have been provided on sheet 2 of 2. 13. An effluent filter has been proposed within the outlet tee of the septic tank. 14. The pump curve has been changed to represent the operating curve for a Myers SRM4 pump. 15. The pump model on the pump detail and pump curve have been revised to require a Myers SRM4 pump. I trust that these responses fully address all of your comments. Please contact me if you have any questions. Very truly yours, Christiansen&Sergi, Inc. Philip G. Christiansen i • Page 2 . r. �tECE,vEp Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrades` 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. i Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance,as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405,or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. f=acility Name and Address: forms on the computer,use only the tab key Name to move your cursor-do not Street Address key the return Ar (V 1 Do V t � City/Town State Zip Code 2. Owner Name and Address(if different from above): P k7-i_T P WA.rft�N.Tp 92 FcS T IF-R- 31' Name q Street Address E.l�� AtV0G:/'r R_ A Cityrrown State nNISfLf5' q 4d7 7!�Q,5 Zip Coe Telephone Number 3. Type of Facility(check all that apply): residential ❑ Institutional ❑ Commercial ❑ School I 4. Describe Facility: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) [�Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits,etc): �FACPi t5form9a.doc•rev.7/06 Application for Local Upgrade Approval,Page 1 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: gpd 330 Design flow of proposed upgraded system gpd Design flow of facility: �3 gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ❑ Voluntary ❑ Required by order, letter,etc. (attach copy) Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Cx�M YL('-rf 5`S TC-\ R eA ACe n NT 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: i ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction [_J_Red.uctio.n_in-separation_between_the-SAS-and-hig h-g r-oundwate.r_- Separation reduction ft Percolation rate minAnch Depth to groundwater ft t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 I Commonwealth of Massachusetts City/Town of 1 Y - Form 9A - Application for Local Upgrade Approval 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. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well(explain): i i [(Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test [,/Other requirements of 310 CMR 15.000 that cannot be met--describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an�Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluatormust be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: -THE FI-EVAT Tcy t>r- l t-I G P(//NP G 1-f n M(3 h 2 ICAIVJYt;7 (31z, R/01- ' d) 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: ,4tV t5form9a.doc•rev.7106 Application for Local Upgrade Approval,Page 3 of 4 i Commonwealth of Massachusetts City/Town of u = Form 9A - Application for Local Upgrade Approval a a• 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. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following(check the appropriate boxes): Application for Disposal System Construction Permit [ Complete plans and specifications Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property fines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ .Other(List): D. Certification 1,the facility owner, certify under penalty of law that this document and all attachments,to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information,including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner's Signature Dafe Print Name Cis RTS'170 NS t4 A ry 11 S 157 R tr1 -7124/17 Name of Preparer Date Preparer's address City/Town CO�f 3'73 c=-�5 f o State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 r Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval r 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd,where full compliance,as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405,or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy,or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When titling out 1. Facility Name and Address: forms on the computer,use only the tab key Name to move your !± s.f� cursor-do not Street Address use the return p /� n key. f�n� KC -t K A (opoy 6A 0� Ll City/Town State Zip Code 2. Owner Name and Address(if different from above): Pk7-GxP [PAMcNIO TPQ, S r nev Name Street Address c� •r K Arlocy- M A. z State aIfr qn 4d7 71- 5 j ZI Cp d e Telephone Number 3. Type of Facility(check all that apply): residential ❑ institutional ❑ Commercial ❑ School 4. Describe Facility: STN QF- PLA/n7ty b Vt;GL-z a6t, 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) [�Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers,leach field, pits,etc): p t5form9a.doc•rev.7108 Application for Local Upgrade Approval,Page 1 of 4 4 4 Commonwealth of Massachusetts Cityrrown of kipForm 9A - Application for Local Upgrade Approval 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: gpd 33 Design flow of proposed upgraded system Ca gpd Design flow of facility: - gpd B. Proposed Upgrade of System 1. Proposed upgrade is(check one): ❑ Voluntary ❑ Required by order,letter,etc.(attach copy) Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: &M?LG7F SY-S FES gzefoce JneFm 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)-describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑_Red.uctio n_in_separatioa_between-the_SAS-and-high-groundwater Separation reduction Percolation rate minAnch Depth to groundwater ft t5form8a.doc•rev.7106 Application for Loral Upgrade Approval*Page 2 of 4 I acht1setts de Approval ,f rnonwealth of Mass • L°gal U Agra used,but the our Com n 0f Own for s maybe check with Y C'tor A . p`01C Dards of Health.I Befo e using this form, F°rm 9 for use by local 13 andthaprovided here• rovided this form for the same they use. as DEP has P st be substa the form information mu ealth determine tinued) to local Board of H U grade of System (ion B• prop°sed p Relocation of water supply well(exp ch separation between inlet and outlet tee�and ghgroundwater �Reduct►orn of 12 to proposed disposal area e deep hole in Prop erc test and specify sections of a Use of only one met_describe � a substitute for a p of be analysis as 00 that cannot 8� � 4 Use of a sieve R 15.0 G1tP� of310C CZ� Q�nR ®/other requirements ►5° fL�iJ Code: (y-�►.* K N of the$oil l+�1� between the bottom e r,,,lred se Soil Evaluator must determine the in the an pApprov The coif evaluator must be a reduction 1 h)(1) rade involves a ater elevation, e roposed up9 the high ground 310 CMR 15.405( )( If th P bon system and Pursuant to authority absorp water elevation p roving helIvegro r l agent of the focal app High groundwater evatuabon determined by' Date of evaluation Signature Evaluator's Name(ripe or print) Each section must be ,s notfeasible. - 15.404(1),' -- C Explanation 10 cMR Bance,as defined in 3 - _.. {u11 comp - - 0 is not feasible: Explain why _ _.— — CMp 15.00 in full compliance with 31 QES A Kt) - -- -- railed system �S Ivly - upgraded �tc � TZ.�KQS An uP9 r Q c N A M a F �sJ (F P notfeasible: i.EVpTT to 15.288 is CMR -[ N 15.283 PC I d Pursuant to 310 S C j stem aPProveP 2 An /a�ltemative s Y �A,�.��v� rade APProval•Page 3 of 4 Application for Local UP9 formga• •rev 7108 t5 doc 1 r f I I Civ o�nwealth of Al F wn of achusettS - � O i ©EP r 9-4 -- A pplic Information provided this f anon for Lo al lmation rnust °�for C local Board of 1-St belth substantially they I oca!g° Up,�9�rade o deter arts of approval mine the provid same as C` EX�ianation co form they that ed he�th�efore forms may be used.b 3 I1tInU� 1179 this for ut the A shared s m, check with YsteM is not Your feasible: 4. Connection to a public sewer is not feasible; 5• The Application bores)Local Upgrade Approval mus Application for Disposal t be accom �Co System Co panied by all of the Complete plans and Cons P following(check specifi Permit k the Site cations evaluation forms ❑ A list of abutters Provide proof that by red ❑ Other at affected abutteCed setbacks to (List): rs have been notified pursuansupply wells or t to 310 CMR 15 405(Prorty lines. �• Certification the facility Owner, knowledge and Certify under Consequences belief, penal imprisonment for subm are true,accurate and w that this doc nt for deliberaInt and te viola ionsfalse ."dation�ncluding,l bu no are thatall attachme t limited to, may pts, to the best of penalties a significant my aclilty—p�ners Sty or fine and/or re ►'Tint Name Nam o.,,,T P�1A E/V btu ��Parer re-S FfZ address State/Z1p C- C to /'1117 ' CrtY/To11vCn�`� zG(, p� � ' P t5forrn9a.doc.fey.7/06 Tete � e+J Application for Local UP9rade Approval.page 4 of 4 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.rsi-engr.com fax 978-372-3960 July 27, 2017 Mr. Brian LaGrasse Director of Public Health North Andover Health Dept. 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Re: Septic System Design Plan for 42 Foster Street (Map 104D, Parcel 51) Dear Mr. LaGrasse: We have received your June 29, 2017 comments on the above referenced plan, and we offer the following response. 1. The house has 3 bedrooms and 7 total rooms. 2. The names of the abutters have been added to the plan. 3. The full legal boundaries of the property have been shown on Sheet 1 of 2. 4. The property lines have been shown on the design plan on Sheet 1 of 2. 5. The lot area and dimensions of the property line have been added to the design plan. 6. The water line has been added to the plan. 7. The approximate location of the existing septic system has been added to the plan. 8. The request for a Local Upgrade Approval for a reduction in the offset to groundwater from the q P9 pp bottom of the leaching field has been removed as it is considered an Alternative Design Standard as allowed in the MA DEP Remedial Use Approval for Presby systems. 9. A Local Upgrade Approval has been requested to allow for more than three feet of cover over the pump chamber. 10. The pump chamber has been moved to provide a ten foot separation to the foundation. A Local Upgrade Approval will not be required. 11. A Local Upgrade Approval has been requested to reduce the separation of the outlet of the pump chamber to the ESHWT, 'v 12. Buoyancy calculations have been provided on sheet 2 of 2. 13. An effluent filter has been proposed within the outlet tee of the septic tank. 14. The pump curve has been changed to represent the operating curve for a Myers SRM4 pump. 15. The pump model on the pump detail and pump curve have been revised to require a Myers SRM4 pump. I trust that these responses fully address all of your comments. Please contact me if you have any questions. Very truly yours, Christiansen &Sergi, Inc. Philip G. Christiansen • Page 2 106 _ 106 GENERAL NOTES ,. ..GARBAGE aSROsusARE TO BE IN—.. 1D4 104 z _ p IG 104 104 ®a oN SIM"E.°f'T a"'�a�E�x°AE E EaMN'TA.Tn��E�HTANNE�Eu A, US ono t �.._ . • 1Dz NV®ao%"amET99. I.E EOF Acxor:�s"""ea'ass°,r°c,xE«sIeE.6�cAIVE ".`SEs.,uES`s°oE"°`°,`,sTEaPTETHAT THE MnTeauLMEfTs F LME 99. 102 102 HE E.—PRI SPEEFFnn ' ' + .. BEEN SED GRADE 1 z' A-E SIDE PARTICAL - t ]W .BE oY.x, ' 100 11 ROSEPn ETYP �,•,II t3 1 BAER —J00 u n,m • SITE wsFR To ., _ M,ya Tf ROPOSE y —0-1 OF SYSTEEI °°a FFVEFEEMEABEE6aY11ALL IRECED,G TIE . `` b;x . ' � r B OBER BB� a 9B 9B MMATERIAL A.EEnuATHEBED PEaR,ED IDEND,E=;°A=L^a=°a°n°�== ��E HFL 'THE CMSNAu eE 6TOCUPtfOAT TNEEDGE OF TRE ExcnvnnOU A,roFILLED N 98 sea u TM No LLS s•. 1PRIOR` oPY CEMENT o FILL, 6NALi aE-ARE,EO ANO NELA 11 D—E, N,LL NOT BE q • �; a ■ �� y ,sEe°uorEs z:No�au sHEEr z1 LZER DUR NC Rau OR SNow ETONME FTHEAArevTAeLE ELEvnnON SABovE ELavnnONa THE 96 Ari 96 96 \V 96 BOTTOM OE THE-ON,THE EVCAYATON SN/.u.eE DEwniEREO AS NECESSABY.T"E RP°0 5. PROS EM6 RYEARSEPnOTANNPUMPINGSIIIo LEISRELOMMENDEDTOA DLECl� ARE R' BAamER 9=® RRPLA SYITE TnE SEPnc iANN SNULBE scNEDULEwwc.vaN,s SHALL BEEu6roMfTRw LOCUS MAP 9.35E P 14 �• SEE B IW GRILBELLTYPE. TEL ASSEMBLY SHALL BE PERFORMED AS PER MANUFACTUREas SCALE:1'-300' ,C LF4 6 C.S=200 94 ARIUN 94�� SPECIEIunOu6. IuvasEPncrA w INV®DMPCHAA1BERo ET.94.s.• z. THEBULIIGSEvzFnsHAueE4scN.Owc�PEsuRRouuDEOBYAMNIMUMOEBGRAVEL LOCAL UPGRADE APPROVAL: w®SEPOC TA RET INv®UMPCNAMBERI ETE 9'9'^ '� a THEREARE up%uOwN wEuS wlTHlu zoo FEE,OF THE PROPOSED SYSTEM11 92 92 INVERTS D�THE SEPnc TAUN°WAUO RUM 92 92 B 1 Ll 5L .BRIG, -025 0100 ON26 0.50 ANUYSS S,AueE suBMRTEO TOTNE BOnR00F nEnLTR EOR nvPROvnL PRIOR TO nNYPULEMEM OF FILL CHAMBER TO OROUNDAATER IN ACCORDANCE MTTR 0,0 CMR,5. Rl NTP BE , THRE ILL 1L USED 11"11 PLACED 111-UI 9D 9D CROSS-SECTION -A' ,,. 741 LITDOESRNOTITA1wNANITROGENSENBITIVEAREADMPACTEouFTs. LMR155I05inORCONiRUINC�T`"N310c�Mauzz"vcc°oaonNBEwRn9,B causRI'D NE ARlLIE -D. $ VERncusCALE.,.z TO RAIEOCs $ SETINAnNAR11 -11TOANY CONSTRucnON. 2s 0.00 III. Oso Dws 1.OD 1.zs 1+sB ,4. ALLPIP—R,,LLBEAMINIMUMOF6LHEDDLE.oPVB. VARIANCE FROM NORTH ANDOVER .5. TwSMOTDOESNoruEAR,RINTHE IRS H N BOARD OF HEALTH REGULATIONS: PROFILE(LINE 1) ,E. OEZGH ENGINEER PRIL,PCHRISTANSEMSENVIRa1Pn CERERLAnoN�MBERIST„MAES. DAAETLANDREBOURLEAREA ,,. i,'ou�NAEaaoEesIS A°o'P"os°oaEA AN A. EPT gLill SSORA-LBELAID LEVEL TRENCH,DEP,cTED IN PROFILE coMvouANc'O"vu UCH..,AX01Nv ois"EEAneuce u,�iT.NEa.sNnu aEneaoRRT`"ED for E DESIGN ENGINEER FE AEARTERS u 0CLOc%Po_ PRION TO ANI Cau6TRUCTION FOR CONFIRMATION OF SEPTIC TAN%AND PUMP CHAMBER INVERTS. A REQUEST IS MADE FOR A iM'UM DROP FROM RVENT 1. fTAEENABEPnC)"IAN DALAE NDRESOU CEAPEAI,5 is INVERTAT"°LASES,LLBECouFIRMEDPRIORTOCONSTRULn°NSEE NOTE 17 i / SYSTEM SAND REQUIREMENTS RE°VIRED,6z.TISPROPOSEDL IIIAIE �. ryy y SYSTEM SAND: o PUMP CNAMesR.IS IS /tie you PORT BALRvcBLE w,vG .1 A6CURFER,ANDAR T AND ESANDa alEGUIRIA vEnoOPoEDes,s PENIA DEC'I'D SEPTICSED TD IF MADE FOR A EACnNG REs6 TO PUMP AREREQUIRED.AERK 6T1 LOT AREA F ' =5� �ua nvERTRESANOSRULMEEr �n,m,sREOUIREO.e.e,s I ho s6o)� —Ecn 45,2502 S.F. / / YSE Ee eI�ow 1.03 AC. OL% SKI INDIEFFETHREgTOTALkAND MAI BE GFIVEL SEPT cVLME9,)x MN'ROLA '(d 01 EDGEOFAERAND --- 2'— ypp sEE°Pi EUT�TION CONTROL°ARRIER COA EAN0 TOTAL SAND IS TO BE COARSE AND VERY SIDES%Enos OF PIPES ice,— SEE DETAIL) NUEs w3_BP u 40 P61 ERPUNE ' ' ELIU R R LAO GRAV OF EzSTIUG�cMu°o[°o AS •i%a �� �� ,1., - PNOrECno BARRER ,NRS RHTAH.DS 1'�,"EAMET R.IT MOST HOT PASS I.E. ,arr N C%TEM OF TITLES RAN SM IGH VENT A ', M't/' \/P ,/ ORVENnp3ALs TEM RSE SAND Dunutt RE6TRICnOus: /y p / OAR6E SAND IS SMALLER THAN 0.5Mw.CA'I" UNIT OF ' DAMETER.TIT MUST NOT PASS THROUGH A ADS SIEVE.) LEACHING AREA DETAIL Nao,6 -O /a" ` , Aod PROPERSED NOMW�EµT'H uaz,511a,a.AL SA NO MAY PAss SLAC., E !i) LowvENr SAND)MEETTS HE ABOVERREQUIRE ENTS. v�coucRETE — h I 1 I d mL SURROUNDING SAND: IIII CMR,s.00D Ro L,HE RE'THE'E'AUY coMPAuv DfsiGU GUIDANCE SEPT1. TRES % o, 1F) : j 8- �sE Eor A E" SURROURMIGGIN SHou)n BEEITHER—EMSAuo ON ENv3RasERRE STA ECCERr NO zssMAEs DATE THELE, H 1.PVC FILL,31Q CMR 15 255 MAVBE PLACED i31 ONLY SURROUNDING GIII Bm 50' sD• u3m"c 1 °'I ry S.B1EEA.MOV60 ZONS T.ORUARG MATTER HAVE ARrnuR DETOan T.O.F.=,m. w 1 swu.naouuO LEACHING FIELD u TH E1n PERIMETER SAND BED REQUIREMENTS: oEDRDLIN IILNN RESULT FROM Al AcruAL sumiEV MADE $I' ) I TO BERFMwEO SUTUNGD AREA TO nWMMNA OFQfOOTARouuo TlE SIGNATUNEOr DES,GNEN DATE - w E `p0'/'; : /• % - — f5EiuL)°% PERIMETER OF EENVIROSEPTIC®RPE %I PMPCHAM ,°_o SEPTIC SYSTEM DESIGN SHEET 1 OF 2 A � 00• BAS Le✓� •%' 4 PROPOSEO HIGH FOR PROFESSgNnt ENGOEER too' L' ASSESSORS REFERENCE: 42 FOSTER STREET IN ,PVc MAP 104.D,PARCEL 51 NORTH ANDOVER,MASS. AIP.—T- PHCH BACK PUMPCHAMBER DEED REFERENCE: ERAAPPL,LANrSON.E.R.D.BOOK 14868,PAGE 288 PHILIP ANRT1 ENTIRE LOT PLAN L1MROF100' O SITE PLANRON1.`M R.AN—B auFEEE...E --' zo' o zo' 4O'60 0 60 120 "_--_ EwsnuG N.P.E A RSFRMCE PROFESSIONAL ENGINEERS 8 LAND SURVEYORS DATE MAY,9 0B„ (APRA-) SCALE:1•=20' CHRISTIANSEN&SERGI,INC. REAseO,�ULYz,z0 SCALE:1'-80• ti RRised s1DpIDg,,10% TOP VIEW SIDE VIEW END VIEW _ LEVEL <'D PERFORATED INSPECTION PORT TO BOTTOM OF S rt1r m •od.�.w:: aro LOWVE LAST s Nc_ro ro BuO EX. B SYSTEM00EAWRAP PIPEIND AND�WRH PERMEABLEEADED CAP GEOTEXTILE (OR IINT Mu3FOLDIF PRESENn OPFNIUG OFFSET AvmTER FABRIC TO ELIMINATE BAND INFILTRATION. ENv1RgsEFmc PPE oRETHANI ENARosEP PLAri"w,Tem�L E NTOOFFEETAwPTER ncPIPE SYSTEM oa ovERFlUAREASS OFFSETMAPTER m,ilJ'v.. SOW - .... a.3'°uoNe'°x0..miY H y��,, .Y.N'",!+;•`.•C:.,.::'.i. (i2':::. �....i i3 RAISED CONNECTION DETAIL NOi TO scalE -'^'" AW ra,r>anA eaaola=r FlBER NAT - eYei"EM 6Ati�j J' BUOYANCY CALCULATIONS BUOYANCY CALCULATIONS E c DOWNWARD FORCES II�I DOWNWARD FORCES IIII INSPECTION PORT RPE ,,,O1U.4 —HTOFPUInP CXAMBER 1A,az5 Le2Y TYPICAL SECTION ,......,,.,..- ^;';;- ... wBCMOFsoaneovE A"K NOT To SCALE RAISED PRESBY ENVIRO-SEPTIC FIELD WITH SLOPE TO 10% '_"� F': ' TOTSLr%E.3eFr%L3FiX,roCUEAI Le/cU 2000B S n 3.p p`X3oFTX3.3AFTXaD LBrOU S NOT TO SCALE UPLIFTFORCE B�L UPUFT FORCE ud� FT FIELD DwMEDFTAI KBELOwwAEa D oF...... U ATBR PUMPC RVE PRESBY VENTS oPo,9 OFwATERe `B 35, p�NsnOFWATER 4ALB U K4:, — DESIGN PARAMETERS I.—TTOSCA` INCUFTXB:"=FY L3 q" Cl FT 112.1 U-1 FY=� LS � I NET FORCE NET FORCE Sb O3-„..:,_ 19.,S1LS({ M a35R.PUM�d DESIGN PARAMETERS AS OMS Y CALCULATIONS PRESBY ENVIRO-SEPTIC NOTES 3 S IEDI ''W 330 cn0/Om OPOSF sw sF 11 PROv1Nr0B9Gx Auv NsraLu SOIL EVALUATION RESULTS TABLET PUMP DEMAND CALCULATIONS iSN MAK No.of Roo , soLCLAss cuss LEACH NO ARE.AaEW aEO- SY .TSTB'--1 Ev xacronvuus"T” ll CNrAv DE9GU FLOW 330 GAwAY Lwquc RAre 0.B0 GPp5F wxuN nATE um LOcu REcuumxs lOx PRvgxr x3DRAvnox Da rxE nMm,uTE AtSlAl IS FFnc—US. 3MINnN Lucn"DAnEA REQU RED EED sr LEACH UD AaEA PRov DSD= «EARE3T DEALIRarrrAcrPaEsreY ENnRONMExtAL xc In DIA O Naaro, /cvM) v( / I ` cuss) FELO LExcTN ,a lr.xavn ESSE, vmTEIELD UNassM PROKE wiaazs3w+nv.PREs3YElmaOxlS.NfALcvN 2017 BOIL EVALUATION REBULTS (�� (� (m _. sgLcuss 4v Fr DATE OF TESTS:TP:6111/2017 -- — F SEPTIC TANK LAPACTV REQUIRED B a N�uuivcoaysE swBl LEssrrwaM NNGAI3m SOIL EVALUATOR:JAMES MELVIN -]v Ys,fMON ='R`ATE SC, GF05 FELD W,DTH 14 FT Mlry s reNMuu OFF LEACHING AREA REWIRED 550 SF LEACH AREA PROV DED 53vsF •330 cPDx 90ox-BeO GAuous 9EVF,REOJAED aCRCUMIERExCF OFENAROSEPnc RPEs.SEEVESGu L rte_ AS s _— SEvrFTANK usED _ 0 1..tro 911 oI 1.500 cAu0v IusE,s00 CAuoN TANK) ArmlxsrALurrou NAuuu lce cp3P.ErB Grm ANDFusPEQFlGnOxs.l WITNESS:IROWE 2 s 01 INSTAUERAIwISEDTO.C. I-SAIEPHORTUDS.Rust. Teat Pit 012,11 CALCULATIONS n ro KGRODNDOR—EYSTEM 10-REnFw snrreOeFJev.se.v -- i s= B r PNNORATE'_' MENTI—El EKiExOEDPERNDSOFnu1F" 60 : 5.r ! 01 s[cncu x.TABLE A. uAUD IusrALunvu MAuuAL, wuOGE Axn SON EOU.us YORE D 1i A 1vYR3/2 SL SECTIO N TABL AESIc sl 1]-51' C1 2.SY5/4 LS 1a-1o' MNMEwWfE:RECOAMEN0 v1.RPECMINOF SEPIICTAKK NDSUMEQEVERY FOR 36EDRooM1 A APBHCRATE OF 3MINRN,THE"EOUI"ED Two vs OF THE N DEPTH DF 50-BS' C2 10VRSI6 SL SEPTIC FE 1. L=TI TOR RFOwREorPF SPAGNCIsgis Ou CENTER,sP.THE v°'ol cN PLACES, a� PURwsEDDe9.1Ig mrnvx�5 GTMFFFfwFxi RSPDset rnoM rABLEO A LEANDUSt ovE 81 MAiIOx IRoMn3sDocwBxTFOR AN.or,OREM Ob"HASa water:- I ISFA ESMWT@64• REDO% Elev.83.5 11 PUMP CHAMBER ELEVATIONS FROM TABLE c. - - - --_—_�— _ n APRw.0 FOR REYEquusE•a Ub CM "REDInRFn AS PE focLm A"anR 1 1 Ionuwr;o:ccwFn T OF 3 MINAu Pert A _ 3`8• 01sny1D1 II II EC Depth Of Perc Tmt:66• I I FOR uxE3 vnrH A TOTAL UNE.w FOOTAGE,3a,rnE L __J wMPON"ARDION=61.G• REgn EO uuE LENGTn wiu BE 4aBn1E MINIMUM $IBrt Pre-»Bk 1050 SEE NOTE I, x 91A1 asoulaso uY wTDTN Is r.,s. 12• 11:06 TOP VIEW EDRLA FROM TABLED 9• 11:13 .ur OE xo;rtr sAuO D AR�Msyss MlN cuss v500.THE MIUIMUM R.H01 Pux vlEw w,AIR Pa A vET TNE as4oP TIT.9•-6•: 91RRR. T':`:r wvsvnrx EA 15.00 F n� F.I.rale:3 minutes per incl) 109,WHILM IS GREATER THAN THE ICO SF D AFEA FOR THE ABOVE SYSTEM D 1INLET%PEASSEAL ?� 's PusSEA MlMM" 2017 SOIL EVALUATION RESULTS OATEOFTESTS:TP:`W1112011 ED AREA OFs.,.N ADav 1111U Ill MIA. WITSOINESS' IR Oft:JAMES MELNN svSTEM_.LHAnga.w 14' WITNESS:1 ROWS 1-6• Teat Pit p3 M 5340 CP%200ON TA C,uLous As/� r A.• T(E)4•BtA IMLET Surface Elev.101.5 rySE Tevp GALLON TANK) SEFF IL (19 INLET O O 3 E T��" "FELE 1'-S' - PLASTIC PIPE SEAL 0-7• A IDYR312 SL ;a maA.o.wmc B 1p� 7-60• Ct 2.SV4/4 SAND SECTIONVIEW ELEVATIONS S 6v-fia• cz srs SL ..En33Aw �� EcnOH vlEw E mrR i rAPEp TOP VIEW 2}•� OISS—W.- - INN.OF PIPE OUT OF HOUSE W356 SNEA CONCRETE PRODUCTS 1000 SIDE VIEW ESHWT@sfi•REDOX EI-96.7 GALLON SIMPLEX PUMP PACKAGE SPECIFICATIONS: Nor ro scuE —11 PPE AT SEPTIC TANK OUT- OcePSI MINIMUM 5, DISTRIBUTION BOX OF PIPEAT PUMPI"LET AURFNFOacEMEur PER ASTM cizf-el AY USE SHEA CONCRETE PRODUCTS MP OUTLET IT o...E 3 cROQVE vOINTSEALEDvnin BUTYLE RESIN. 6-OUTLET 114D DISTRIBUTION BOX, ITEM NO.S-6DBH I-OF PIT AT AS 1500 GALLON SEPTIC TANK NOTES SEPTIC SYSTEM DESIGN SHEET 2 OF 2 USE SHEA CONCRETE PRODUCTS ,. D INV. AT LINE I PSE. ITEM NO.TKAHIOO STANDARD -.TT T.H_..MANUFACTUHE_sFEOFlKA—AND FIXt —FEG90W1 EIpBEER NOTES: wARRavTv sxAUBEOFRO"FOacEOcOucaETECONsraucn0u.w 42 FOSTER STREET 1. THE SEPTIC TANK IS TO BE MONOLITHIC C—RUC--INS SHALL BE 2 IS TO BE SETT LEVEL AND TRUE TO CRAVE ON A LEVEL STABLE N W'TRnGHTTHROUGHMAHUFACTURERBSPECIII-0N ANDwARNAN- BASE wHClH/B,SSSEEo1ECHANCAUYCOMPACTED.IFTHE XSTRSMlONBOX NORTH ANDOVER,MASS. IS PLACED Ix FILL.Pa AC GOK11 REQUIRED TO ENSURE STIBUITY Fvc PPIIS 5E3 2. 1LEVEL AND,TOPRE oeou.,TTUIG,NA—GROUND W,TH A 9x 1-H—NE BASE Is ERAAPPUuxr. % 11 Fl.PPE LINES THE omLETIxvERT MAV BE PVC AT WAS 4 ENSURE STAIII-TY AND TO FIR VENT PHILIP D'ANTONIO TNE ESITIC TANK IS P-ACES IN FILL.PROPER COMPACTION IS REDUIRED TOI �FOSTER STREET sETTLB1G.THE SEPT�c TANK SHALL HAVE A INHAPIEDFivuc oITNEINUET e"FFUE� NORTH AN esnANMUMCDYBROFNNE 1Ncnes B . DESIG"ED AND W,T 8UTQNBOXOHALLBEDESGUEDANDCONSTRUCTEDSOASTO m0 —AER— CONSTRUCTED ASE CONSTRUCTED SO AS TOWTHSTAND AAM"ANTgPATED MHMUME111 Low NG 'T^' " AO"G PROFESSIONAL ENGINEERS S LAND SURVEYORS "SEE NOTE 17 1 Sox IS TG HAVEc"aE.."MSFa°1F,s INCH.OF ED FrHE OIsrR BunoN �j CHRIST/ANSEN&SS—BLNGC.cOM S-e/o CHRI S TIANSEN & SERGI, INC PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 RECEIVED June 1, 2017 JUN 0 5 2017 TOWN LTH DEPARTMENOF N0RTH T Board of Health Town of North Andover 120 Main Street North Andover, MA 01845 Dear Members: On behalf of my client, Philip D'Antonio, I hereby request waivers for setbacks for the repair system design for his property at 42 Foster Street. The proposed system is 65' from the wetland line,rather than the 100' required. The proposed septic tank is 62.7' from the wetland, rather than the 75' required. The proposed septic tank is 2' from an existing deck, rather than the 5' required. The proposed pump chamber is 3.8 from an existing deck,rather than the 5 required. The proposed leaching field is 6.6' from an existing deck, rather than the 10'required. In addition I am enclosing an Application for Local Upgrade approval. The proposed system, PP with a 3 min/inch perc rate is designed to be 3' from estimated high groundwater level. Sinc e , ;h* G. Christiansen P.E. Owners Certification for 4 2 F o s t e r Street North Andover I, Philip D;Antonio the Owner of record of 42 Foster Street, hereby certify to the following: i 1 . 1 have been provided a copy of the Title 5 Innovative Alternative Technology Approval, the Owner's Manual, and the Operation and Maintenance Manual for the Presby Enviro-Septic Wastewater Treatment System, and I agree to comply with all terms and conditions 2. 1 agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); 3. The design does not provide for the use of garbage grinders. This restriction is understood and accepted; 4. Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the Local Approving Authority (LAA), if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Philip D'Antonio June 1 , 2017 �O�oF N�4�MENS Commonwealth of Massachusetts City/Town of - Form 9A — Application for Local Upgrade Approval 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. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use only the tab key Name move your c cursor-do not use the return Street Address key. Nk-R'j City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address N--Rih Aro,-vl R Al 14 City/Town State n 16115- �fZ;� J27 Zip Code Telephone Number 3. Type of Facilit check all that apply): Residential Institutional Commercial School 4. Describe Facility: 5. Type of Existing System: t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 5 Privy Cesspool(s) Conventional Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): L ACh IFTEt-o A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: gpd Design flow of proposed upgraded 33 O system gpd 3 Design flow of facility: gpd B. Proposed Upgrade of System I p p9 Y 1. Proposed upgrade is (check one): Voluntary Required by order, letter, etc. (attach copy) ✓Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: i I 3. Local Upgrade Approval is requested for (check all that apply): Reduction in setback(s) — describe reductions: Reduction in SAS area of up t0 25%: SAS size,sq.ft. %reduction ✓Reduction in separation between the SAS and high groundwater: FSF IJ v�a�C rJ Separation reduction ft. t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 5 i Percolation rate min./inch Depth to groundwater ft. B. Proposed Upgrade of System (continued) Relocation of water supply well (explain): i groundwater p Reduction of 12-inch separation between inlet and outlet tees and high Use of only one deep hole in proposed disposal area Use of a sieve analysis as a substitute for a perc test Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) igature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: DUE -Tu L---f TI-AN6S, S Jft P ` '. PE 5, M) 4>CT5t7-Nt - 15—, rZVCrvf W�v L 0 nfi l L31—:; 'CAS Z L N t5form9a.doc•rev.7/06 Application for Local Upgrade Approval' Page 3 of 5 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: Aro A-L-?E W A-TIIr(? 5`�5 i M '3S P�'��pu Se 0. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): Application for Disposal System Construction Permit Complete plans and specifications Site evaluation forms A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). Other (List): i D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowled a and belief, are true accurate and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." Facility Owner' Signature F DatAr Print Name LRfr,7S'Til,\rSfrr Anti) S R C�--T, 3N� /'L7 Name of Preparer Date Date' 10 5y PI N-R Di l4AV'6-r`k.TU— reparer's address CitylTown t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 5 M A- c( 3C �2� 3 72) L` 316) State/ZIP Code Telephone i I t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 5 of 5 a � a� � TOWN OF NORTH ANDOVER Community &Economic Development 1- HEALTH DEPARTMENT 120 Mainn Street NORTH ANDOVER,MASSACHUSETTS 01845 �OZC3 978.688.9540—Phone 978.688.9542—FAX healthdept@northandoverma.gov www.northandovenna.gov APPLICATION FOR SOIL TESTS DATE: 4/13/17 MAP&PARCEL: 104.D-0051 LOCATION OF SOIL TESTS: 42 Foster Street i OWNER: Phil D'Antonio Contact#: 978 427 7425 APPLICANT:Phil D'Antonio Contact#:978 427 7425 ADDRESS: 42 Foster Street North Andover, MA 01845 ENGINEER: Christiansen &Sergi, Inc. Contact#: 978 373 0310 CERTIFIED SOIL EVALUATOR: Phil Christiansen Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:YES Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) 8.51'x 11"Plot plan&Location of Testing(please indicate test nit sites on file plan) ➢ Fee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for repairs or upgrades. GENERAL INFORMATION Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department. (stamp in): I �• Town of North Andover, MA March 8, 2017 CT ,F'f•" j l _s& All k, 'r X/ � ': ``�d.,�,,'�'`-•a�;.....� p �s: ,fit �. - �: �C, `� El b r - � EZJ �\-< id, � .+� 1T�rm2c46eatft �4�� CL - Property Information R� Property 210/104.D-0051-0000,0 ` ID Location 42 FOSTER STREET Owner WILlARD, MELISSA MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied, concerning the validity or accuracy of the GIS data presented on this map. �of<NORr 78'15 ti �_ .- 2 Town of North Andover +' HEALTH DEPARTMENT CNUStt CHECK#: --DATE: LOCATION: H/O NAME: x � 14,qloq;o CONTRACTOR NAME: V -cr- Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Septic-Soil Testing $ yO ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ "Agent Initials White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER .� Community & Economic Development vdl; `,_'� HEALTH DEPARTMENT d0c.� 120 Mainn Street ,NORTH ANDOVER,MASSACHUSETTS 01845 '(Ot 978.688.9540—Phone 978.688.9542—FAX '0 � healthde t northandoverma. ov n�� w northandoverma.gov r7' APPLICATION FOR SOIL TESTS I I DATE: 4/13/17 MAP&PARCEL: 104.D-0051 LOCATION OF SOIL TESTS: 42 Foster Street . OWNER: Phil D'Antonio Contact#: 978 427 7425 APPLICANT:Phil D'Antonio Contact 978 427 7425 I ADDRESS: 42 Foster Street North Andover, MA 01845 ENGINEER: Christiansen &Sergi, Inc. Contact#: 978 373 0310 CERTIFIED SOIL EVALUATOR: Phil Christiansen Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:YES Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan) ➢ Fee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation COI1tJ1JISSl0" royal Date: Signature of Conservation Agest• G G2� Date back to Health Departmen • _tamp in): 7Y S Ttown of North Andover, MA March 8, 2017 4 _ 7 -f ,-- -"w Al EZ f F 4 � ,.. �• f � �`� °1. `~Z ,,ems � �\ r ` , j_ rd St _ C t 1! ti y S _ 1f tff } S yy le j .+�• �F ` �y �`` 1" = 246 ft -- t LJxJ L� 7}� _ s �� f ::�. Tarin r,} Ilea; Property Information Property 210/104.D-0051-0000.0 ID Location 42 FOSTER STREET Owner WILLARD, MELISSA MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied, conceming the validity or accuracy of the GIS data presented on this map. I Commonwealth of Massachusetts Map-Block-Lot L°t ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2017-0358 P.I. FEE F.I. $440.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted ______________ ------------------------------------------------------- ----- --- - to(Construct)an Individual Sewage Disposal System. at No _42-FOSTER-STREET as shown on the application for Disposal Works Construction Pe it No. B_ 17-0 5 Dated April_18, 017 ----------------- ------------------------------------ ---------- Issued On:Apr-18-2017 OARD OF HEALTH • °1Commonwealth of Ma sachusetts Map-Block-Lot S4. 104.D0051 BOARD OF HEAL H ----------------------- North Andover CERTIFI ATE OF COMPLIANC THIS IS TO CERTIFY That th Individual Sewage Disposal System (Con truct) by -------------------------------------------------------------------- ----------------------------------------------- - Installer at No 42 FOSTER STREET ------------------------------------------------------ --------------- ------------------ ------------- ----- ---- -------------------------------------- has been installed in accordance with the provisI of TITLE 5 of the Sta e Environ enta ode as described in the application for Disposad Works Cons ermi No. BHP-2017-035 Da it 18 2017 -------- --------- -- - ----- ------------------------------------------ --------- Printed On:Apr-18-201 BOARD OF HEALTH •.5 °'� Commonwealth of ZhusettsMap-Block-Lot �., `.• 104.130051 BOARD OF HPermltNO North AndoBHP-2017-0358 FEE $440.00 DISPOSAL WORKS CONIT Permission is herebygranted ---------------------- ------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 42 FOSTER STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2017-035 Dated April 18,2017 ----------------------- ----------------------------- ----------------------------------------------------------------- Issued On:Apr-18-2017 -------- - ------------- -- - -- ------------------ -- ------------- BOARD OF HEALTH . .- 4, Commonwealth of Massachusetts Map-Block-Lot y . 104.D0051 ----------------------- BOARD OF HEALTH Permit No North Andover BHP-2017-0358 --------------- -- P•l• FEE F.I. $440.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permissionis hereby granted ---------------------------------------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 42 FOSTER STREET as shown on the application for Disposal Works Construction Permit No. BHP-2017-035 Dated April 18,2017 ----------------------------------------------------------------- Issued On:Apr-18-2017 BOARD OF HEALTH : , Commonwealth of Massachusetts Map-Block-Lot 104.D0051 BOARD OF HEALTH ----------------------- North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Construct) by ---------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at No 42 FOSTER STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. -BHP-2017-035- -- -- -- ------Dated April-1&2017 --------- - - ---- ----------- ----------------------------------------------------------------- Printed On:Apr-18-2017 BOARD OF HEALTH •,Sw� D'�va , Commonwealth of Massachusetts Map-Block-Lot 104.D0051 BOARD OF HEALTH Penn,tNo • - --- North Andover BHP-2017-0-58-- FEE $440.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted ---------------------------------------------------------------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 42 FOSTER STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2017-035 Dated April 18,2017 ----------------------- ----------------------------- ----------------------------------------------------------------- Issued On:Apr-18-2017 BOARD OF HEALTH NINE INN INN 1-1 Ell Igo BEEN IN I Ell I 1 0 1 INN 11 all MEIN 11 NOMINEE 11010111 � n s : . III I MEN I INN Ile i Commonwealth of Massachusetts �p11,��1 �5 �R City/Town of THPN�Z ��NSR Form 11 - Soil Suitability Assessment for On-Site Sewage DisposakoN' �oEpP A. Facility Information P 11 TLZ p D' A N'Tc-,N+-o Owner Name L'lC)q. 1) P 4R CLL Street Address Map/Lot# /vim k—rh /11\&CVC r-' C, I S` City State Zip Code B. Site Information �/ 1. (Check one) El New Construction El Upgrade L;d Repair 2. Soil Survey Available? [ Yes ❑ No If yes: n✓RC5 a� Source Soil Map Unit k.T'm-ETLF kr ,Nl) SFtr!'.5..'C�-MS Name Soil Li�ni. 91Y)Y Avg (-WVR� 64Ar'r, t,� ���, 11 L -LLandform Geologic/Parent Material Landform 3. Surficial Geological Report Available? 9 Yes ❑ No If yes: ptk9s 7)0— Year )Year Published/Source Publication Scale Map Unit 4. Flood Rate Insurance Map Above the 500-year flood boundary? ❑ Yes ❑ No Within the 100-year flood boundary? [ Yes ❑ No If Yes,continue to#5. 5. Within a velocity zone? ❑ Yes 2fN0 6. Within a Mapped Wetland Area? ❑ Yes RrN0 MassGIS Wetland Data Layer: Wetland Type 7. Current Water Resource Conditions (USGS): `-tM Range: ❑ Above Normal K Normal ❑ Below Normal MonthNe r 8. Other references reviewed: t5forml 1.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal , C. On-Site Review (minimum of two holes required at every proposed primary and reserve/*d�isposal area) Deep Observation Hole Number: �_ L. f 7 o-_ n 'a`r` a �'Y ' Date Time Weather 1. Location Ground Elevation at Surface of Hole: � � Latitude/Longitude:. / feet Description of Location: j "f 1 r r-iN 5H Pb An16 2. Land Use L Q W t4 M.(ir (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) L-Ay Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body Drainage Way Wetlands �f- feet feet feet Property Line 1.0 _ Drinking Water Well Other feet feet feet/ 4. Parent Material: &Aq;'Cp'f 64cfCtC\�Iiurvi Unsuitable Materials Present: El Yes EJIvo If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes R No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 5 � x. � inches elevation t5form11.doc-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Redoximorphic Features Coarse Fragments Soil Depth m. Soil Horizon/Soil Matrix:Color- Soil Texture /�by Volume Soil Structure Consistence Other p ( ) Layer Moist(Munsell) (USDA) Cobbles (Moist) Depth Color Percent Gravel &Stones C1 a� it i-,--A, /V1 F Additional Notes: t5form11.doc•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 r Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal o C. On-Site Review (continued) Deep Observation Hole Number: � / ,(rl? �� O� P`r' ���� Date Time Weather 1. Location Ground Elevation at Surface of Hole: c6v� 'j Latitude/Longitude: / feet _ 2. Land Use 1' A1,fN J'f-' (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) t-P N H Vegetation Landform Position on Landscape(SU,SH,BS,FS, 3. Distances from: Open Water Body Drainage Way Wetlands feet feet feet Property Line 2 10 Drinking Water Well Other feet feet feet 4. Parent Material: SQN�YY�) frYlt,�.-( �� � Unsuitable Materials Present: F-1 Yes LJ No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes [ No If yes: GDepth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: %,Z inches elevation t5form11.doc-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: Coarse Fragments Soil Redoximorphic Features %by Volume Soil Horizon/Soil Matrix:Color- Soil Texture Soil Structure Consistence Other Depth(in.) Layer Moist(Munsell) (USDA) Cobbles (Moist) Depth Color Percent Gravel &Stones 0-7 A to i 31� SA PQM C, ��,it s 5 to Additional Notes: Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 t5form11.doc•rev.8/15 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation Obs. Hole# Obs. Hole# 1. Method Used: ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches [Depth to soil redoximorphic features (mottles) inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USGS methodology) inches inches Index Well Number Reading Date Sh= Sc—[Sr x(OWE—OWmax)/OWl Obs. Hole# S� Sr Owe Owmax OWr Sh Obs. Hole# Sc Sr Owe OWmax Ow, Sh E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? L] Yes ❑ No ��� �C, L I—CC-- b. If yes, at what depth was it observed? Upper boundary: Lower boundary: inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11.doc•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness 'RAT ft A N0Cva Name of Board of Health Witness Board of Health G. Soil Evaluator Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. ature of Soil Evaluator Date ��Q Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. t5form1l.doc-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 8 Commonwealth of Massachusetts City/Town of Y Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: 1 Y Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 t5form11.doc•rev.8/15 Commonwealth of Massachusetts City/Town of a Percolation Test Form 12 II Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage as provided this form for use by local Boards of Health. Other forms may be used kbw with h ch Disposal. DEP p his form o t Dis ore using Be f P here. 9 same as that at ro vid ed the Information must be substantially the s P the local Board of Health to determine the form they use. Important:When A. Site Information filling out forms �- on the computer, KV-7-P 6��rjTr N-}O' use only the tab Owner Name key to move your �� cursor-do not use the return Street Address or Lot# M C t key. /J� &'-TH ANL)GVGe Zip StateCode City/Town VQ �17�� Contact Person(if different from Owner) Telep oneh Number B. Test Results "—°moo — Time Date Time Date Observation Hole# Depth of Perc Start Pre-Soak , End Pre-Soak Time at 12" ! Time at 9" Time at 6" Time (9"-6") Rate(Min./Inch) Test Passed: Test Passed: EJ Test Failed: ❑ Test Failed: El i �-p-t^'►�'S 1`'��Lv�N' ���.a'�17���r� ✓a IyU ���'s� � � i Test Performed By: T5 0A i'\(-� c�{ Board of Health Witness Comments: Perc Test•Page 1 of 1 t5forml2.doc•08/15