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HomeMy WebLinkAboutMiscellaneous - 44 MARIAN DRIVE 4/30/2018 frl;4,� 11 ve _ Ap7�5j C7 R l� r SUMMARY OF INVERTS BUILDING TIES ��^r SEWER 0 FDTN. 98.98 BLDG. CORNER A B C MQTE.* THIS PLAN & CERTIFICATION IS NOT ° SEPTIC TANK IN 98.53 SEPTIC TANK OUT 21.0 26.8 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 98.29 PUMP TANK OUT 29.3 36.5 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK 1N 98.15 DIST, BOX .86.0199,51 AND ELEVATION OF THE EXISTING SYSTEM T. BOX IN 99.48 COMPONENTS. DIST. BOX OUT 99.26 INV. IN CRAM, 99.19 BOTT. CHAM. 98.87 I I N� DA ARMS N mT QO3P. PORT NRTRATOR WOW ,g l 3y' 93 D-m rm-,-ti-,....-r-"'. —F j,- tx<r. a Y TP3 TAW 1.000011E qy� /q ;cp 17 txo GAL I7 u SWU TAW Y ; Tta ($4°960;SF.*) 1. , ���'. EAST.,a WFW. 11 7AVA"r�6 Ex{ 091£.IIHG OA (( / f t z i f MARIAN DF4VE O�A OF VLADIMiR L. \`r NEMICHENOK s\ C) - 1 f V � , GIST AS B P1UIT T PLAN /0 A� OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./ 44 MARIAN DRIVE AS PREPARED FOR IDU BOWAB TM: 107C DATE: 9-30-10 TL: 57 SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGSERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN, 98.98 BLDG. CORNER A B C NOTE, THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 98.53 SEPTIC TANK OUT 21.0 26.8 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 98.29 PUMP TANK OUT 29.3 36.5 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK 1N 98.15 DIST. BOX 186.0199.5 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 99.48 COMPONENTS. DIST. BOX OUT 99.26 INV. IN CHAM, 99.19 BOTT. CHAM. 98.87 N/R CAMS y N liEllT POUT 1$' gS f Fa157- Crs r 7 �' 1x000 CAI. r ; AAs Q0. }�, PIMP TANK IM: Jm CAL 107 SM TAW t`' Kot,M E T`i,• DNVE } it { .5L LAN OF p VLADIMIR L. NEMCHENOK 3 VY2 U, AS BUILT PLAN NAIL OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MASS./ 44 MARIAN DRIVE AS PREPARED FOR IDU BOWAB TM: 107C — - �� �� DATE: 9-30-10iRECTL: 57 SCALE: 1"=40' 0 20 40 so OnT - 5 2010 TOWN OF NORTH ANDOVER MERRMCK ENGINEERING SERVICES HEALTH DEPARTMENT 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 .Aid Y M f f l h t I �10RTN i. -• tom` � �9SSACIiU`�ES PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER ED SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(4d constructed;( )repaired; OCT —5z'010 TOWN F NORTH ANDOVER By: 10 V r2P ��� . HEA� DEPARTMENT (Print Name) Located at: (Installation Address) :Was installed in conformance with the North Andover Board of Health approved plan,originally dated 10 and last revised on � ,with a design flow of 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: Engineer Representative(Signature) And–Print Name Final Construction Inspection Date: Engineer Representative(Signature) 19U ante And—Print Name Installer: (Signature) f WDate: Lo—I—W •T Q A And—Print Name Enginer: 1/1�ol�u� ,u l i(Signature) Date: la-1 - 10 VLA is 1 &S) C And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com AS-BUILT CHECKLIST All changes to the design plan have been reflected on the as-built Is of suitable scale;(one inch=40 feet or fewer for plot plans and one inch=20 or fewer for details of system components) Lot number, Street Name,Assessors Map and Parcel Number �L Lot Lines and Location of Dwellings served by the system Locations&Dimensions of system,hiGlu- =g y aif applicable) Ties to dwelling or Permanent Structure&Wells a.From Septic Tank b.From Leach Area Ties to Lot Lines from leach area Locations of Deep Holes&Peres Elevations of Disposal System Top of Foundation Elevation Locations of Wells,Drains,Watercourses within 150 feet of system Location of water,gas,electric lines,cable r \ / Distances from Corners of House to Center of Tank&D-Box V Location of Structures within 6 Inches of Finished Grade C / / Original Stamp&Signature Location and holder of any easements which could impact the system Impervious Areas;Driveways,etc V North Arrow Location&Elevations of Benchmark used STATEMENT ON PLAN(NA 5.3) "I cert 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 or, if a STUCTURAL WALL IS PRESENT(NA 4.9)Letter or statement on the as-built indicating the wall was, or was not, constructed in accordance with the intended design and any manufacturer's specifications Signature of Designer Date As of:Wednesday,April 27,2011 NORTH q `, p 4Tueo ,6 �r , G aF o COCK'CIC IWKK V SSACNUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 44 Marian Drive MAP: 107C LOT: 57 INSTALLER: Todd Bateson DESIGNER: Vladimir Nemchenok PLAN DATE: 6/3/10 BOH APPROVAL DATE ON PLAN: 7/30/10 INSPECTIONS q 1 r I)b TANK INSPECTION. I DATE OF BED BOTTOM INSPECTION:1I�-I o DATE OF FINAL CONSTRUCTION INSPECTION: 9/29/10 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® 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 TANK ® Building sewer in continuous grade, on compacted firm base ® 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 t NORT11 O��t�eo bq�0 - i? 6 OL `O T n eb T O CP[MICMCWKM y7• ADR Are D 0P,t'�5 SSACHUgfc PUBLIC HEALTH DEPARTMENT (ommunity Development Division Visual testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to final grade installed over inlet and outlet access port ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1000 gallon Pump Chamber installed ® H-10 loading ® Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump 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 ® Hydraulic cement 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: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 L r� NORTH q ,6y6-r O FO- A- [O[MI[ lwK•V 7a 04 TED S`S C14Usfc PUBLIC HEALTH DEPARTMENT (ommunity Development Division 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 NA Speed levelers provided (not required) Comments: 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 NA Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Low Profile Infiltrator Chambers ® Number of chambers per row: 7 ® Number of rows (trenches): 6 Comments: Total Chambers = 42 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 r NORTH ` O e -1 '6 6 0 o i OL11K■ q. [O[Mlf MfwK•V AOAAVID SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division BM = 102.56 HR = 2.06 HI = 104.62 SYSTEM ELEVATIONS O S ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 102.56 Building Sewer OUT 5.31 98.96 99.5+/- Septic Tank IN 5.76 98.51 98.70 Septic Tank OUT 6.03 98.24 98.45 Pump Chamber IN 6.14 98.13 98.40 2" Pump Chamber OUT 9.22 95.23 ---- 2" Distribution Box IN 4.98 99.47 99.40 Distribution Box OUT 5.03 99.24 99.23 Lateral 1 TOP 5.08 Lateral 1 INVERT 99.19 99.18 Lateral 2 TOP 5.09 Lateral 2 INVERT 99.18 99.18 Lateral 3 TOP 5.12 Lateral 3 INVERT 99.15 99.18 Lateral 4 TOP 5.13 Lateral 4 INVERT 99.14 99.18 Lateral 5 TOP 5.10 Lateral 5 INVERT 99.17 99.18 Lateral 6 TOP 5.10 Lateral 6 INVERT 99.17 99.18 To of Chamber 5.10 99.5 1 99.5 Bottom of Bed/Chamber 98.8 98.9 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townotnorthandover.com Inspection Form June 2008 NORTH ��-- Ot LEO 16 O D COCMICMIWKM LA0 rE D PPP`y'�5 �SSACNUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division 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 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® 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) ryw ® D ells 20 25 ' Suction line 222(2) z 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 T Commonwealth of Massachusetts Map-Block-Lot 107.000 5777 ffi P. Board of Health ----------------------- Permit No North Andover BHP-2010-0708 P.I. n7nl F.I. FEE $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT-------- --------- Permission is hereby granted -Todd-Bate-son ---------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No _44 MARIAN DRIVE -------- -------- -- ---------- - --------------------------------------- --- shown on the application for Disposal Works Construction Permit No. BHP-2010-070 Dated August 26,201 0-------------- ssued On:Aug-26-2010 ------------ -C PY --------------------------- oard of Health v e ♦ 1 u NCRTN Application for Septic Disposal System �-Construction Permit - TOWN OF *' •f'' ORTH ANDOVER MA 018 250.0 Full Repair ys.... t I t E'� i.s�I�1,125.00 Component Important: Application is hereby made for a permit to: 'PAWN OF 149 T H AN �SER When filling out (] Construct a new on-site sewage disposal syst * P ..71�11ENT forms on the computer,use E Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. '411 741,C', t�Sl Address or Lot# Cityrr wn !' . A4 tln 2.-* ME OF SEPTIC SYSTEM*: Pump ©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 certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) C Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information 1A Name Address(if different from above) City/Town State Zip Code 7� G0',y- silo Telephone Number 3. Installer Informations Name JA '" `e�N eATsmKi ENTERPm,___ INC. Name of Cpany 111 ARGILLA ROAD A"vEk W o1 a10 Address — S )AIA e9jr/o Cityffown State p, Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information _ Name Name of Comp,an P Y Address AA Cityffown State 17� y 7S-- zip Code Teiephone Number(Best#to Reach) . Application for disposal System Construction Permit Page 9 of 2 r°RTN� Application for Septic Disposal System -�S"�!a `4t1.t0 .tiO 3r " ''• °c TODAY'S DATE p Construction Permit TOWN OF $.250.00-Full Repair ORTH ANDOVER, MA 01845 $125.00 -Component 9SSACNU`'ES PAGE 2OF2 A. Facility.Information continued.... 5. Type of Building: Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Applicati Approved By' oard of Health Representative) Nam Date pli ation Di pproved r the following reasons: For Office Use Only: L Fee Attached. Yes t No 2. Project Manager Obligation Form Attached. Yes V No J. Pump Svstem? If so;Attach copy ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly). Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only). Yes_ No Application for Disposal System Construction Permit-Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) Fos plans byQt�°' '� (Engineer) Relative to the application of (Installer's name) And dated (Original date) Dated o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved:plans and the permit on site when any work is being done. 2. As the installer,.I must call for any and all inspections. If homeowner,contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall,be applicable. 3.` As the installer, I am-required to.have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company a. Bottom of Bed Generally, this is the first(15 'inspection unless tthere is a retaining wall,which should be doiie1rst. The installer must request the inspection but does not have to be present. b. Final:Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK(or e-mail to:.heald dept@townofnorthandover com)from the engineer must be submitted to he Board of Health,after which installer.calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work:must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete: Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work(other than:rimple excavation)and I am required to complete the installation of the system identified in the attached application for installation: '.I further understand:that work done by others unlicensed to " tall septic systems in North Andover can constitute reasons for denial of the system and/ revocation or suspension of my license to operate in the Town of North Andover. significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. A Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staffor consultant. d. Installation of tank,D-Box,pipes, stone, vent,pump chamber,retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the s ystern as 12er the approved plans. No instructions by the homeowner general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: ,.( (Today's Date) o Arne:— riiit e� ?gn i. TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 01845 , E�sasrh 1 Date Issued ' �'?•+'* k'`oaf x Expiration Date oug� Jackie's Law Permit Application Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant—,a Phone Cell Street Address l 114 �(. City/Town ^ MA ZIP AP - �l�/v cl O/5--3L703 Name of Excavator(if different from applicant) Phone Cell Street Address City/rbwn MA ZIP Name of Owner(s)of Property Phone Cell Street Address )H FDescripflon, MA ZIP /V11 rq t Permit Fee Received No Yes ocation and purpose of proposed trench: e the exact location of the proposed trench and its purpose(include a description of what is(oris intcnded)to osed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. Insurance Certificate#: MP S i�stil �- Name and Contact Information of Insurer: ' /vJ;G h20,x• 9— YZ b"` ` Q*y- >��Policy Expiration Eg iration Date: Dig Safe#: �o/v o1`a©S$'A1.6 FNamef Competent Person(as defined by 520 CMR 7.02): husetts Hoisting License# AF ®3.3 d-sa License Grade: R Ex iration Date: 3— 9 BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L. c. 82A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH. WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW, THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TU APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER.AND EXCAVATOR AGREE JOINTLY AND.SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT'OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAIL AND OTHER REMEDIAL,MEASURES DEEMED NECESSARY BY THE MUNICIPALITY, THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,AND ALL AND S AGENTS ES RESULTING FROM .OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON.OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT, APPLIC nn nnTGNATURE DATE EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S IGNATURE(IF DIFFERENT) DATE: 2 P a ge----------------------.--.__----- _ _—__..----._._...— �. .� ,�1a� -..7..Gh YJ ¢;;2r "'t< nr✓. ti::r-r:r,... qyr �;v .s ;3 r. .. .:r ,vF%';.�-^:"'s«4cr'}�i"�ul� ..�: ,h. ..IM'.� fh.!,'.,..°_ w�'!"l.' .J.•` I. �' +".sC , 4' S: q� ...d%Xj , ^:��._;^�./• Wy/�.�3'�r�',�fi<3 n .atE: Y?�-'r.F.ir ��'�"'%a�'.f✓;.�'��:1"s...,� r, .. - .13n. �beak:. �,1,'~ // �� o.•����' - - q ?K:-Ft•', f. �S?%`.� �f9',:-:�;:�.-'Y/lr�-.n-._r j[!_r+v. ¢ sx--'�,+/✓.^' - e,.�' r..� :N..'J�✓r•ar_2' �.r„r- F44].�~'r<..S�r'.`�Sr'�....Ka' ,LS:'.:�.u,•rir,'t�'�w",> j}�}j�7��. � �f:::i�%s�c: Y�•.^'3 ._.._r:r. �,1. 4, ./ Ys�. r2�... T,S�-,hZ '/--• �� U.M .p!'� '.�•"�a� r��*Y�''�-�� ""c�E','.wr„��r„&_',�='• '��n s�� ,�:.; :r n�i�'�a�r;:-4x*> - "«_�,.�.�dr�=".... � 5r;.•., 4r `t4�r?"`. ..0 e.. /�r :-+ .+ .J•_,e v .^� tx •��:„/p aw w'`y��'�r �� s ? .j�.�.��r'_�/�irk, 5- r -y ".. �5+ :'..'SN-'—' er'ri`:' n`� l•"�',e r`.C.�`a-1 „�-,'..-�,✓�,��'Ur�j� vct"C�--s'�x r. .3� ..... �,�.��'"l` .�r-.„�.,A"u�•• ' ''�'nlA" -'vR'"u�,:1+=-`9.-:..,H"aFC :a'''ry�l.sy- va•.r -'G'!..�'' .x. -xs .r.:£�r.p,:l F"�i.Wc.•_:.a n: f:�''�»� c:��, ��. `r•'.v. �'_=% -�. .nJ,'f ,F�.d��•w,�%•_r..'r; ��:g-r. •.7�g�v_:Nc��� z"w"d,.,rrrcb .t.��^ ,._ s.£.. .?y e2',� 3a a�"��. r- ._.✓!�•�':rp"fr:%"'er..�'p�:���;:'�i`:=.'= s�;c :�'>'v ..xyz /r.-:.r ,°.=.mC/C,k= ...r:V•7.-Sn,•,xK'k����t;:��.:G_�:` �5:a` w' �� �:...sf,{.y:,_a�: pP�=ar'- r,?�__..'rk%C'`-"^.v �:;,..._.;.-;r fir-'. CONDITIONS AND REQUIREMENTS PURSUANT TO G.IL,.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the application,the applicant understands and agrees to comply with the following: i. No trench may be excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as said system is defined in section 76D of chapter 164(DIG SAFE); ii. Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safety in order to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety hazards which may include covering, iii, barricadingor otherwise protecting open trenches from accidental entry, Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and.Health Administration on excavations:29 CFR iv. 1926.650 et.seq.,entitled Subpart P"Excavations”. Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related-excavations and trench safety.; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et seq,,entitled Subpart P"Excavations"as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of thepermit application,complied with the requirements of sections 40. 40D of chapter 82A, vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www mass Qov/dns T,Fa g e Summary of Excavation and Trench Safety Regulation(520 CMR 14.00 et seq., This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L,c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A,go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety,jointly with the Division of Occupational Safety, drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction-related purpose on public or private land or rights-of-way. All municipalities must establish a local permitting authority for the purpose of issuing permits for trenches within their municipality. Trenches on land owned or controlled by a public(state)agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators,whether public or private,take specific precautions to protect the general public and prevent unauthorized access to unattended trenches. Accordingly,unattended trenches must be covered, barricaded or backfilled, Covers must be road plates at least'/."thick or equivalent;barricades must be fences at least 6'high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times,for instance by hiring a police detail,security guard or other attendant who will be present during times when the trench will be unattended by the excavator. The regulations further provide that local permitting authorities,the Department of Public Safety, or the Division of Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury;the failure to obtain a permit, or the failure to implement or effectively use adequate protections for the general public. The trench shall remain shutdown until re-inspected and authorized to re-open provided, however,the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of Public Safety for identified violations. Summary of 1926 CFR Subpart P-OSHA Excavation Standard This is a worker protection standard,and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational purposes only and does not constitute an official interpretation by OSHA of their regulations,and may not include all aspects of the standard. For further information or a full copy ofthe standard go to www.osha.gov. Trench Definition per the OSHA standard: o An excavation made below the surface of the grotmd,narrow in relation to its length. o In general,the depth is greater than the width,but the width of the trench is not-greater than fifteen feet. • Protective Systems toprevent soil wall collapse are always required in trenches deeper than 5',and are also required in trenches less than 5'deep when the competent person determines that a hazard exists. Protection options include: o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices,the equipment manufacturer's tabulated data,or designed by a registered professional engineer. o Shielding(Trench Boxes). Trench boxes must be used in accordance with the equipment manufacturer's tabulated data,or a registered professional engineer. o Sloping or.Benching. In Type C soils(what is most typically encountered)the excavation must extend horizontally 1 %feet for every foot of trench depth on both sides, I foot for Type 8 soils, and%foot for Type A soils. o A registered professional engineer must design protective systems for all excavations greater than 20'in depth. continued 4 1 P a g e ----_ ____ _-- _-- --•-___--- —..____ Ladders must be used in trenches deeper than 4 . o Ladders must be inside the trench with workers at all times,and located within 25'of unobstructed lateral travel for every worker in the trench. o Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the ladder. • Inspections of every trench worksite are required: o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person(see below). • Competent Person(s)is: o QUable(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the trench,and other working conditions which may pose a hazard to workers,and o Authorized by management to take necessary corrective action to eliminate the hazards. Employees must be removed.from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation(e.g.,contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected,supported,or removed once exposed. • Spoils must be kept back a minimum of 2'from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. 0 Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench,they must be underpinned,braced,or otherwise supported. o Sidewalks,pavements,etc.shall not be undermined unless a support system or other method of protection is provided. • Protection from water accumulation hazards: o It is not allowable for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulation,this must be monitored by the competent person. o If the trench interrupts natural drainage of surface water,ditches,dikes or othermeans must be used j to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench,a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath Ioads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high-visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist(e'g.,Oz<19.5%or>23.5%,20% LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with must be provided for crossing over trenches>6'deep, y guardrails o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. i Jf \ 4V//►lI►U►►WCa1cI► U/ ►7aJDar.IIUDC!6.7 ----- - --- -- - _ Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC);527 CMR 12.00 (PLEASE PRINT IN INK QR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inten 'on to perform the el trical work described below. Location(Street&Number) lyari6 f o di�T_& A� Owner or Tenant ,[®lU f S /.J c•t G'��i Telephone No. ,4 5, �Q Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters .�hlLil}]nom nf_Ti and n.,�...-.7 • ---- -- —._-.__ - - - 9607 Date... � ......a""""""' . wing table may be waived by the Inspector of Wires. No.of Total pORTM Transformers KVA Tp1�1($1Np®QP F NORTH ANDOVER KVA Generators ° : PERMIT FOR WIRING ❑ No.of Emergency Lighting „ Battery Units • � `- ' FIRE ALARMS No.of Zones •f/ wO��r.o��y'ly ,ssACMU'J No.of Detection and Initiatin Devices � /�� g ..............••••••.•..... No.of Alerting Devices This certifies that ........ No.of Self-Contained ............ has permission to perform �• ......... . ............•. Detection/Alertin Devices Local❑ Municipal El Other wiring in the building of 1 .� `� .......................................... Connection Security Systems:* t{C� Z�1, P� ,North Andover,Mass. No.of Devices or Equivalent at................ . . Data Wiring; Fee.. S..s-Lic.No..3?,---,!5 7 .�'::•.•.... •..6, ... No.of Devices or Equivalent "" ELECTRICAL INS PE OR / Telecommunications Wiring: ( No.of Devices or E uivalent Check # __- desired, or as required by the Inspector of Wires. policy.) -vv-orx-to�tart: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in'force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thepains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: r.� p Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.• O' . Address: Alt.Tel.No.: Per M.G. �� �� L c. 147,s.57-61,security work requires Department of Public Safety S License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's Owner/Agent Signature Telephone No. PERMIT FEE: $ TOWN OF NORTVER NOR Tb Office of COMMUNITY DEVEL AND SERVICES HEALTH DEPA NT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ""° • = NORTH ANDOVER,MASSACHUSETTS 01845 ,SSACHUS 4� 978.688.9540—Phone Susan Y.Sawyer,REHS/R.S 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM ---. ,o Date of Submission: — 1© Ui1 Site Location: AVN bf NORTH ANPOVIR Engineer: H!h42,(p AC.,� EWl6(tjgj-:-:�rt4 l06 New Plans? Yes✓ $225/Plan Check#_Zl�_(includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? Yes ✓ No Telephone#�� j��-� �� J�7 Fax#: A ?QT q 7`5 -144 0 E-mail: 074 Homeowner Name: LOU I'S F2DWA1Z, OFFICE USE ONLY When the sub ssion is complete(including check): )01 Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts ► i` J + City/Town of North Andover Form 9A - Application for, Loca x roval 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 Louis Sowab Residence only the tab key Name to move your 45 Marian Street cursor-do not Street Address use the return key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address(if different from above): SAME Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Field t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4 r Commonwealth of Massachusetts City/Town of North Andover o 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: unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 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: New 1500 monolithic septic tank, 100 gal monolithic pump tank, simpOlex 0.4 h.p. pump and a 792 s.f. leach field with 42 LP Infiltrator Chambers. 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 ® Reduction in separation between the SAS and high groundwater: Separation reduction 1.0 ft. Percolation rate 11 min./inch Depth to groundwater 3.0 ft. t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 . Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M sve, 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): ❑ 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 evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe 6-3-10 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: Extremely high water table such that full compliance would result in a raised system to the extent it would inhibit reasonable use of the property and result in unreasonable financial hardship 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover 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. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None available 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): D. Certification "I, 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 deli erate violations." 6-16-10 Facility Owner's Signature Date Louis Bowab Print Name Bill Dufresne/Merrimack Engineering 6-16-10 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 x-20 State/ZIP Code Telephone I t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 Location: s . Onmerts Name; L CW .f� &OL �A A MaP/Parcel:__ 5 7 Addtrss:.� Inaler: Td :10M-54 I O Nnr / M°L._._.-RePiir ✓ Date: 3l0 5 p° w�— - zone O= Gluvs Srnbot 3— �O_A Sotl Rhmeu& � Oil QM ? �IOWAH p ��p r (c+P�,t--1 OVZAIne Deep Observati-on Hole Logs �' "°"'N aq—rc I Elm-zdan Depth Son H6hon Soil Testate Son Color Sollmottllag• % Gmvdq Stones,eta r 10 Y Z .�...--•- j fL / mak, 4 P-AMU Ae ' FK I Am GF, i �tzIAl�l, 2-"5y% 2to" HA-e751 5Y �/Z . l Parent ASatetial. 'l'l L.L. • Deptl�tagedzad�_stn=NatetLttf�e8ala�E�Lf Areepin=tcoat?IlFaa„Z,�,��g�y�'�"� P I vi Psseat 1►4aeetw T l LL lkpth a B�ritse�sp�=�a�ta nta Rote,�_ZVeepW=Croat rx Faee�__ Dat c �'�j...l-0 1'crcoIatFon Tests .Q Obsenr �. a o tionH leg uN � Depth of Petr 2 fi �pV�R p,N StatPsi►-soilti Time at no H Time at 9” Time at 61- Time(9"-61— .Rate Mtnnuch AI Performed Bru , � ,L Witnessed B�� 3 Commonwealth of Massachusetts ` City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information O er ame L7.1 \/eF 171 TOWN OF NORTH ANDOVER Street Address Map/Lot# City State Zip Code B. Site Information 1. (Check one) ❑ New Construction /upgrade ❑ Repair 2. Published Soil Survey Available? Lei Yes ❑ No If yes: 16 e Year Published Publica ion Scale Soil Map Unit Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes [?"'No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? [ Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): M th/Year Range: ❑ Above Normal ❑ Normal ®Below Normal 7. Other references reviewed: t5form1l.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 3 y • Commonwealth of Massachusetts i 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 reserved disposal area) 1— —1� '9 °®v A� � yw2 s? /�5- Dee Observation Hole Number: Date Time father 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): t'A 2. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) t �✓ Vegetation Landform Position o Landscape(attach sheet) o � 3. Distances from: Open Water Body feet Drainage Way y Possible Wet Area et feet Property Linef e� Drinking Water Well feet Other feet 4. Parent Material: L'L' Unsuitable Materials Present: ❑ Yes [?' O If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 75 b0 8e 5. Groundwater Observed: Yes ❑ No If yes. Depth We from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: ,dC� O inches elevation t5forml 1.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 rt Commonwealth of Massachusetts mom 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 Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist Munsell USDA Structure Consistence Other y ( ) Depth Color Percent ( ) Gravel Cobbles& (Moist) Stones V. 13-2 C,► V3 IV.,V ��,t / — — I' Ipigoako 24e-N20 G Additional Notes: t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 I 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: �@ e.? 4,5_7®o — Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): 2. Land Use (e.g. woodland,agricultural field,vacant lot,etc.) Surface Stones ..�^ Slope(%) • Pf, ��7 9�6� t t Vegetation Landform f Position oh Landscape(attach sheet) a 3. Distances from: Open Water Body feet Drainage Way feet@ Possible Wet Area feet Property Line feet Drinking Water Well feet Other feet 4. Parent Material: —TTIA` Unsuitable Materials Present: ❑ Yes ETO'No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: R(Yes ❑ No If yes: ,r Depth Weeping from Pit Depth Standing Water in Hole XV Estimated Depth to High Groundwater: inches elevation t5form11.doc•rev. 1/10 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: �+ Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Munsell (USDA structure Consistence Other Layer Moist y ( ) Depth Color Percent ) ravel Cobbles& (Moist) Stones vie, Iva 1�I W Additional Notes: t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 - Commonwealth of Massachusetts i City/Town of i` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal r D. Determination of High Groundwater Elevation �- 1. Method Used: ❑ Depth observed standing water in observation hole A. B.incnes inches B. El De weeping from side of observation hole in inches ninches Dep Deth to soil redoximorphic features (mottles) inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches ' 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level i 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 1, ptm? a� ion system? Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: inchesLower boundary: inches t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 l r 1 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. 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. Signature of Soil Evaluator Date JA IWIftNt Gtr � ? tai + Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam o) Name of Board of Health Witness Board of Health r 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. t5form11.doc rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 NUMBER BHP-2010-0613 COMMONWEALTH OF MASSACHUSETTS BER 010 NUMBER HP 4, FEE North Andover $100.00$100 .00 Board of Health BOWAB, LOUIS G JOYCE-A--BOWAB--------------------- ------------------------------------------------------ -- NAME 44-MARIAN --DRIVE------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Trench for Soil Test Pits This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires -----------September-02, 2_0_1 0-----------unless sooner suspended or revoked. ----------------------------------------------------------------- Board of June 02, 2010 --------------- ------------- Health --------------- ------------------- ----------------------------------------------------------------- Board of Health Chairman ----------------------------------------------------------------- i 1 t-� c TOWN OF NORTH ANDOVER Permit Number NORTH ANDOVER,MASSACHUSETTS 01845 tiORYh Date Issued O .101410 " �°?•+{ oo, R% Expiration Date r-11Hig t aitw. JUN r� ------- - o"enn -- �Sscc►+uat TOWW OP N H AMOOVER HEAL�ARTMENT JUN - 22010 TOWN OF NORTH ANDOVER HEALTH D PARTMENT Jackie's Law Permit App 1 a ion Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant Q N ZN14 Phone ^ Cell Street Address �l/ ll04 `tom ` O �f'.�-�gC)3 CityfTownMA ZIP Name of Excavator if different from applicant) Phone Cell Street Address City/Town MA ZYp Name of Owner(s)of Property Phone Cell Street.Address ` J� 9^� G '�7 /-�i9P rvN �(� City/Town MA I ZIP No Other Contact Permit Pee Received No Yes Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. Insurance Certificate __•- �..;` � i _ _ _ _ i ' ! �'� �:�" .'. ' .'. ...�..J W . . x I i 1 i Name and Contact Information of Insurer: ®t"S '! i-4. o ��v✓,l� to S�-� � �� l Fl �� Policy Expiration Date: S— / d / Dig Safe#: Name of Competent Person(as defined by 520 CMR 7.02): Massachusetts Hoisting License# cj, License Grade: 6-I- Expiration Date: BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L.c. 82A,520 CMR 7.00 et seq.,AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TU APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND.SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO.ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE AND EMPLOYEES FROM MUNICIPALITY AND ALL OF ITS AGENTS ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON.OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APPLIC GNATURE DATE EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OW ER'S SIGNATURE DIFFERENT) DATE: 2 J P a g e--.---------------_ _y__.�—.-------.._ ---- - ._...._ _..._.__._..----- ------ _ —_ Summary of Excavation and Trench 5afetq Regulation 620 CMR 14.00 et Seq.) This summary was prepared by the Massachusetts Department of Public Safety pursuant to 01,c.82A and does not include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.e.82A,go to www/mass.gov/dps Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety,jointly with the Division of Occupational Safety, drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code.of Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a trench made for a construction-related purpose on public or private land or rights-ofway. All municipalities must establish a local permitting.authority for the purpose of issuing permits for trenches within their municipality, Trenches on land owned or controlled by a public(state)agency requires a permit to be issued by that public agency unless otherwise designated. In addition to the permitting requirements mandated by statute, the trench safety regulations require that all excavators,.whether public or private,take specific precautions to protect the general public andprevent unauthorised access to unattended trenches. Accordingly,unattended trenches must be covered, barricaded or backfilled, Covers must be road plates at least 3/.''thick or equivalent;barricades must be fences at least 6'high with no openings greater than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators may choose to attend trenches at all times,for instance by hiring a police detail,security guard or other attendant who will be present during times when the trench.will be unattended by the excavator. The regulations further provide that local permitting authorities,the Department of Public Safety, or the Division of Occupational Safetymay order an immediate shutdown Of trench in the e to obtain vent of a death or serious tarn a permit; o us injury;the r , r the failure to implement or effectively use adequate protections for the general public.ajlThe trench shall remain shutdown until re-inspected and authorized to re-open provided, however,.the excavators shall have the right to appeal an immediate shutdown. Permitting authorities are fbrther authorized to suspend or revoke a permit following a hearing. Excavators may also be subject to administrative fines issued o the suspend o Department of Public Safety for identified violations. Summary of 1926 CFR Subpart P.OSHA Excavation Standard This is a worker protection standard,and is designed to protect employees who are working inside a trench. This summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational Purposes only and does not constitute an offi aspects of the standard. cial interpretation by OSHA of their regulations,and may not include all For further information or a full copy Of the standard go to www.__ oshag�., Trench Definitfon per the OSHA standard: o An excavation made below the surface of the ground,narrow in relation to its Iength, o In general,the depth is.greater than the width,but the width of the trench is not.greater than fifteen feet. Protective Systems to-prevent soil wall collapse are always required in.trenches less than 5'deep when the competentpersontdeterminesred in cthat$ehpazardexists PdoatreCalso options include: o Shoring' Shoring must be used in accordance with the OSHA Excavation standard appendices,the equipment manufacturer's tabulated data,or designed by regist ered professional engineer, o Shielding(Trench Boxes). Trench boxes must be used in accordance with the equipment manufacturer's tabulated data,or a registered professional engineer. o Sloping or Benching• In Type C soils(what is most typically enpountered)the excavation must extend horizontal];r 1 '/z feet for every foot of trench depth on both sides, 1 foot for T and /foot for Type A sails. Type B soils, o A registered professional engineer must design protective systems fo 20'in depth. r all excavations greater than continued 4 Page ---- r Ladders must be used in trenches deeper than 4'. o Ladders must be inside the trench with workers at all times,and located within 25'of unobstructed lateral travel for every worker in the trench. o Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the ladder. • Inspections of every trench worksite are required: o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm. o Inspections must be conducted by the competent person(see below). • Competent Person(s)is: o Cable(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the trench,and other working conditions which may pose a hazard to workers,and o Auftarized by management to take necessary corrective action to eliminate the hazards. Employees must be removed from hazardous areas until the hazard has been corrected. • Underground Utilities must be: o Identified prior to opening the excavation(e.g.,contact Dig Safe). o Located by safe and acceptable means while excavating. o Protected,supported,or removed once exposed. • Spoils must be kept back a minimum of 2'from the edge of the trench. • Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep heavy equipment and heavy material as far back from the edge of the trench as possible. • Stability of Adjacent Structures: o Where the stability of adjacent structures is endangered by creation of the trench,they must be underpinned,braced,or otherwise supported. o Sidewalks,pavements,etc.shall not be undermined unless a support system or other method of protection is provided. • Protection from water accumulation hazards: o It is not allowable-for employees to work in trenches with accumulated water. If water control such as pumping is used to prevent water accumulationthis must be , monitored by the competent person. o If the trench interrupts natural drainage of surface water,ditches,dikes or other means must be used to prevent this water from entering the excavation. • Additional Requirements: o For mobile equipment operated near the edge of the trench,a warning system such as barricades or stop logs must be used. o Employees are not permitted to work underneath loads. Operators may not remain in vehicles being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6). o Employees must wear high-visibility clothing in traffic work zones. o Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous atmosphere exists. If a hazardous atmosphere is found to exist(e.g.,02<19.5%or>23.5%,20% LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space. o Walkways are required where employees must cross over the trench. Walkways with guardrails must be provided for crossing over trenches>6'deep. o Employees must be protected from loose rock or soil through protections such as scaling or protective barricades. ..a 1 ' a• fr�p'Cxat_"�••' a^J'''l�r 6JY� �'r, r?73f v,...yy,r��';wyAl .Y.r.R .ri:Y• J`z'r/,:°,�Ay;:','" r. P.fif' - .�� IN 'y.�. �• ..r ,� �y rte.. ,,-�"�..:�s>,,. �,.: ...f �;,.'::;�%.,,'�,�r,.f.r � a,.f'"`r.•,-� -s. w"„ G�..•;'...•,:+'..^'F:.: '•' ^.`d; .,•:XF!.V.�'�,1/.e!!41_-.2i,".k� ny�.r_."•��-':i��w,r•S'.1G.✓ .<i`:a'Jia' a.��•%•a�,.r_ r. .r r,.�i; ..j v y✓'.''',,4 _ %J.:F.,,�. /. J 1F- .!'°l .NN''7< y.4s./m�t�s,_:r.... �+r`''�+'t-• .=7, t�-•_cr "v: t�T'��9,'�eF,4�'�''-c''�rc.-2� ''�.'.�irri�,�-•i y/i ... ;s> r .r '.a. �.P. ...� � �M�a,'�'-�`..:'�.,r..5'-yx -"°" +�•_�/� � " +..rN v �,^!; ✓a�✓°.: iai '^Y'J'^": � r 459' 1.�_-:f��`'F:-ti:t£%�•-./tri�,�' '3.. Jc�aKc..:,- .,:�.� afi`.ti"'`�f" �.af.l�� -'�= i'�`_'.'- .r rf-,-... J;w, .:✓s -_�J`f:=�� �'r=�Gw�--•'-,`j'''E,:;T'lr_r:�sr-' _ .-.�`s�='u= .. �R,_�t�..fsrx. �'1 �.�.A''w,l-x''''r•.�"m�:=<,v,� ..-�f'= ,�°.' - - �'�"'4` '':�'�=.t� ..-..,r�;�r,€fi�E-r�.:'�' -a'=:�'l;';r3�g,w'•'f fir:✓_ H. �-i.-^...nl��...•e'�' ...e.,.,"..,,�r :�i.=✓�.-5d,�v...r...c��. @. ��<�,�,1- .ui.,� _ y�.. /^' =Ul-� ,,.eJj^•rP:c _�"MY IC�^'F. lS - ::F�'i?1/'�i.T ri'F"'^- 1;.:..._v�'-:�'-`�-sr-'f�r r+T";' - +'�"=�w'.1�_ ..'p"F,:-'.:;-v'+rwM..,✓rrf%.-",eF''f't;i: `i,J,,.. *6 r- _r3�<.�rt�r'il.'r Ms~..r u,i ?,:F�,.�,l�r.�,F,IJ -ic':^^5h-/-r- t-.�yn,_' r 't.: �`// {' /:y J.. -`E� _,,�y..�'," -��1y�v 4�.�' �w ."5t..an�•,+k:�,�rr'c:,!_�,:. -n��., spa,- Biu`�'�--:x,�. -S�' ,-rr� '.'Cr-J7� .a"G:-e,:,Y c "P:r tF.. s'``"y;N ?N� _ �F.o`��.r. �f'`'✓..T:. '•r ee: �g�w..? r� ar"� '4R�w+.�.fsy�4=t "i'ir�5.:-1; f .r„''-.',`"' � df �l:fJ,d�. ,:.-_+-..✓'? ./ F�<:.r...„,,.. �i�`-.-ra..�,.�J_..rr_'��.f,_,y-.te..s: �'..'si!��r' .r�.�,s.CAa�'n3,.4:r'� ,-��ti•�+��^`.-�,-r",'',w=C.r t,"-,."y"(..rJ�;s.�:l�'✓.J::[;✓.x;:.�G,.�,':-��..•<s3�''; CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended) By signing the.application,the applicant understands and agrees to comply with the following: i. No trench may,be excavated unless the requirements of sections 40 through 40D of chapter 82,and any accompanying regulations,have been met and this permit is invalid unless and until said requirements have been complied with by the excavator applying for the permit including,but not limited to,the establishment of a valid excavation number with the underground plant damage prevention system as ii, said system is defined in section 76D of chapter 164(DIG SAFE); Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the General Laws,an excavator shall not leave any open trench unattended without first making every reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said open trench unattended. Excavators should consult regulations promulgated by the Department of Public Safe in or p Safety der to familiarize themselves with the recognized safety hazards associated with excavations and open trenches and the procedures required or recommended by said department in order to make every reasonable effort to eliminate said safety-hazards which may include covering, barricading or otherwise protecting open trenches from accidental entry, Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CFR iv. 1926.650 et.seq.,entitled Subpart P°`Excavations". Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment subject to chapter 146 shall only employ individuals licensed to operate said equipment by the Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed operator before any excavation is commenced; V. By applying for,accepting and signing this permit,the.applicant hereby attests to the following:(1)that they have read and understands the regulations promulgated by the Department of Public Safety with regard to construction related excavations and trench safety.; (2)that he has read and understands the federal safety standards promulgated by the Occupational Safety and Health Administration on excavations:29 CMR 1926.650 et.seq.,entitled Subpart P°`Excavations,,as well as any other excavation requirements established by this municipality;and(3)that he is aware of and has,with regard to the proposed trench excavation on private property or proposed excavation of a city or town public way that forms the basis of the permit application,complied with the requirements of sections 40- 40D of chapter 82A. vi. This permit shall be posted in plain view on the site of the trench. For additional information please visit the Department of Public Safety's website at www mass Qovi+r� 3 P a g __ ._._.. _ .__________-----..._._.. - '-'—--- - - ---------— TOWN OF NORTH ANDOVER f NUR7{{ Office of COMMUNITY DEVELOPMENT AND SERVICES Zo�,+. � °y°L HEALTH DEPARTMENT 160®OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 ��SsACHus{�ti Susan V.Sawyer,RENS,RS EC w 78.688.9540—Phone Public Health Director 78.688.8476—FAX APR i 5 ZI-010 althde t townofnorthandover.com t� ww.townofnorthandover.com APPLICATION FOR SOILAwrUFUT DATE:_ �(�— MAP&PARCEL: O7�/ zJ7 LOCATION OF SOIL TESTS: ` r)M 1 t_9 G OWNER:�QU L�js!'�L. Contact APPLICANT: Gf,�� Contact#: ADDRESS: ENGINEER �,v rA 'i41�y, Contact#: `�? 7Cj CERTIFIED SOIL EVALUATOR A m) 4:5® i�67'1d9 (" Intended Use of Land: Residential Subdivision Single—Family 11eeme Commercial Is This: Repair Testing: V Undeveloped'Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No 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 nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. > Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent. ci!L" Date back to Health Department:(stamp in): j 250.00' W . .:f APPROXIMATE LOCATION W /' OF EXISTING PRESS URE -:: 44 MARIAN DRIVE + r \ WATER SERVICE ASSESSORS MAP 1070,LOT 57 r I _ 441t S.F. .1p W ILIMB OF SANO ( (SEE CONST NOTE I INSPECTION PORI r 3EXISTING FOUR S CONTROL PANEL BEDROOM HOUSE '.:'D,RIVEWAV.:?;.p;:;_ 8 COMPRESSOR SILL ELEV.102.58 93 eT \ PORCH TP3 � �,1y.�� I 1T 30'AkWHOLE I MENERZ 1 TP2 r "0 32 EXISp NIF NG SEPTIC TAW / 2T 3 _ oval DECK __ / - O _ N -._ 2.600 GALLON280ST4 / N NIF AIR RELEASE VALVES \ PRETREATMENT TANK WES'TPHAI„$N EDGE OF U6VN IN COMMON ITP1 \ RISER —— — 150p GALLON MONOLITHIC PUMP^IAMBEM PTI r———— � 0'�r I \ HY--1-10UN7 -_ LIC UN APPROXIMATEL o�p I I r✓VISITING LEAH BED - \ I GARDEN AREA 1 1 ' 1 \ BENCHMARK;SPIKE IN TREE ELEV.f00.00(ASSUMED DATUM] 220.02' , S89°39'20"W NIF ARMSTRONG NIF DAVIS a r DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Thursday, June 03, 2010 1:43 PM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 44 Marian Drive Attachments: 44 Marian Drive-Soil Testing Sketch Plan 6-3-10.pdf; 44 Marian Drive-Soil Testing Results 6-3-10.pdf Susan, Please find attached the soil testing results and sketch plan for the above referenced property. This was a site that had a treatment device w/drip dispersal system proposed and I believed approved. However, the owner wishes to have a conventional system instead due to the projected cost of the original system. Ben Osgood designed the original system. As you will notice the perc rate was considerably faster at 11 mins/inch compared to Bern Osgood's perc rate of 30 mins/inch. Bill did dig the pert hole carefully and made sure to scarify the sides prior to adding the water this may of made the difference. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 r I i a APPROXIMATE LOCATION W OF EXISTING PRESSURE WATER SERVICE W ' Alp W J ' LIMIT OF SAND 1 : (SEE CONST.NOTE#3) INVECTION PORT EXISTING FOUR HOUSE [ CONTROL PANEL BEDROOM 36' SILL ELEV.o 102.56 22' &COMPRESS01I 47` a PORCH ,. 93' m«st S N CTP3—�\ a 30"MANH 17' EXISTING 27' 3 TP2 2� - ' DECK ,00gl k 'L 2,600 GALLON 250ST4 PRETREA'TMENf TANK ' I AIR RELEASE VAIN ES ' I IN COMMON RISER \ 1500 GALLON N.INOLITFiiC >I' TP1 PUMP CHAMBER 'y 98#32 ` � --- ---` PTI ` `100 j \ HYDRAULIC UNI,' APPROX fV `` OF EXIST' 00 Go GARBf � A 1 3 1 � i BENCHMARK:SPIKE IN TREE \ ELEV.100.00(ASSUMED DATUM) ICIVI Pav 7-6 LEI 0 0 - 43 r- 1 2� . ,zo f- 2.s Z7-IZ4-+ C. i I �2p 115 -9- 48' /0 Z� win * . rA, I _ I S D TOWN OF NORTF ANDOVE.� Office of 1`.." MIg .U?' ITY DEV.IJLOPMENT AND SER ICF—S A�y HEALTH DEPA. TMW <:t a: A- 1600 OSGOOD STREET; BUILDING 705 SUl`FE 2-36 NORTH ANDOVE R,1MA.SSA('IiUSE'F]'S..O184 Snyam Y.Sawyer,RE,H:S,Rel 978.698.9,540 Phone Public Ilea th Director 97&688.8476 FAX 1 ealtice:>trLtc�.vf3(5t7toiflTafEcl v 'IRF C wv��v.ta�r!�ofnori:lta.mctoverao!�f { APPLICATION FOR SOIL TESTS � JUN 27 2008 jQ �y, _� "�Ot�}N�O�� <:.,' DATE: MAP&PARCEL: LOCATION OF SOIL TESTS: OWNER: L6(W' ,'xD0ux,,b Contact#: APPLICANT: , m Contact#: ADDRESS: ��Y((�6� �r w'" _ ENGINEER: Contact#: CERTIFIED SOIL EVALUATOR: . Intended Use of Land: Residential Subdivision Single Family Ho Commercial Is This: Repair Testing:--�Zundeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM > Proof of land ownership(Tax bill,or letter from owner permitting test) > 8.511 x H"Plot plan&Location of Testineylease indicate test pit sites an the r�lan} > Fee of$415.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or uatgrades. 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 EtOH 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"-1 00')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 A+IDate.- / l JUL 00 11 M Signature of Conservation Agent. TOWN OF NORTH ANDOVE;kEALTH DEPARTMENT Date back to Health Department: _W PIT a. A-a 64- 2 r -- i TL%. 274 ' 271 � DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Tuesday, May 25, 2010 3:31 PM To: DelleChiaie, Pamela; 'Daniel Ottenheimer'; 'Isaac Rowe'; 'Randy Burley' Cc: 'Bill Dufresne' Subject: RE: I.R. -Septic-44 Marian Drive-Soil Testing Request(Bill Dufresne) All, This has been scheduled for next Thursday, June 3rd @ 9:30 a.m. with Isaac. Thanks, Marianne From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Tuesday, May 25, 2010 3:08 PM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Bill Dufresne (brdufresne@comcast.net) Subject: FW: I.R. - Septic -44 Marian Drive - Soil Testing Request (Bill Dufresne) Hello, Attached is a soil test application for 44 Marian Drive submitted by Bill Dufresne in April. Conservation signed off. Evidently it was too wet in April to test this property, but Bill is ready to setup the testing now. Please call him at: (978)502-6206 or(978)475-3555 x20. Thank you. Best regards, Pamela DelleChiaie "We can never see the path of our life if'we are too busv focusing on the pebbles under our feet."^---Anonvmous Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20; Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie(a.townofnorthandover.com-E-mail htti)://www.townofnorthandover.com/Pap,es/index-Website Notes: If copied to BOH Members—Reference Copy Only—no response requested at this tune 1 T., DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Tuesday, September 21, 2010 4:46 PM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 190 Mill Road Attachments: 190 Mill Road -Soil Testing Results 9-21-10.pdf Susan, Please find attached the soil testing results for the above referenced property. Please let me know if you have any questions. Thank you, Isaac Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street IIS i a ! i ! i _I. i i ,fj I i � � I � � �� 11 i l i i i i -'Z I S I I , i i I I .i .L 1!Z 21 1 � I , I A JI •V (4)U-11 N)-# r' I I Ile ! I IAI 4Y 1 I 1 1 1 I I I I I m 4,1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / Permit NO: Date Received _aLL—a Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION / `,� �� 141, A,� ��,1 /�;� �� PROPERTY OWNERS / Pant -- - � � - 0� _Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes <ZD, Machine Shop Village yes (zD 100 year-old structure yes rAlteration VEMENT PROPOSED USE Residential Non- Residential ❑One family ❑Two or more family ❑Industrial No. of units: ❑Commercial ment ❑Assessory Bldg ❑ Demoliti_on ❑ Others: 0Other ep+tic ®Well ,,y 'T, p Filoodpl-1 � [7 We ands�� - - y- .,na 1xr +• # t`. < ® D1SMcct DESCRIPTION OF WORK - - 36 TO BE PERFORMED: (Identification Please Type or Print Clearly) ' OWNER: Name: � -l ./ ��,I✓J p���l - Phone ����o Address: � % -- - r����� �:A a1�� CONTRACTOR Name: Address: A 1x,C-:—' Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F, Total Project Cost: $ 61'6(90, D � FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfundnaturgenf/Owner :; ' t _ � , :nature`ofcontactortt s 9� ��, Plans Submitted ❑l. Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El TYPE OF SEWERAGE DISPOSAL Public Sewer E Tanning/MassageBody.Art ❑ Swimming Pools ❑ r Well ElTobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ E COMMENTS CONSERVATION Reviewed on Signature 4 11 '' , COMMEN I S N O QJ, Lj) kW (Q�)\ HEALTH Reviewed on Si nature. COMMENTS ;Illy a Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments lig Conservation Decision: Comments ( Water&Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date i C0M1VlENTS NORT11 ` .. Q� .'IED �Ir � 6* O oqLt ~ r 'P ��SSAC HUs���y PUBLIC HEALTH DEPARTMENT (ommunity Development Division September 15, 2008 Louis Bowab 44 Marian Drive North Andover, MA 01845 RE: Septic System Design, 44 Marian Drive, North Andover, Map 107C, Lot 57 Dear Mr. Bowab, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by New England Engineering Services, dated July 23, 2008, last revised Sept. 4, 2008. This design plan has been approved for use in the construction of an onsite septic system for a 4-bedroom house (maximum 9-room) and is valid for a period of two years from the date of this letter or from the date that the system failed a documented Title V inspection. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event of an imminent health problem, such as sewage backup into the dwelling, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. The Clean Solutions system shall be under an operation and maintenance agreement throughout its life. No Operation and Maintenance agreement (O&M) shall be for less than one year. Prior to receiving a Certificate of Compliance a copy of a signed agreement must be submitted to the Health Office. All parts of the DEP approval must be adhered to. 2. Prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds or Land Registration Office, as applicable, a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the local Approving Authority. (15.287; 10) 3. 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. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 4. Throughout its life, the owner shall operate and maintain the System in accordance with the Company and designer's operation and maintenance requirements and this Approval. To ensure proper operation and maintenance (O&M), the owner shall enter into an O&M agreement. No 0&M agreement shall be for less than one year. All parts of the DEP approval must be adhered to. 5. Prior to the issuance of a Certificate of Compliance for the System, the System owner shall record and/or register in the appropriate Registry of Deeds and/or Land Registration Office, a Notice disclosing both the existence of the alternative septic system subject to this Approval on the property and the Department's approval of the System. If the property t subject to the Notice is unregistered land, the Notice shall be marginally referenced on the owner's deed to the property. Within 30 days of recording and/or registering the Notice, the System owner shall submit the following to the Department and the local approving authority: (i) a certified Registry copy of the Notice bearing the book and page/instrument number and/or document number; and (ii) if the property is unregistered land, a Registry copy of the owner's deed to the property, bearing the marginal reference. 6. 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. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincere! S san Y. Sawyer, RE /RS Public Health Director Encl: list of licensed septic system installers Cc: New England Engineering Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com NORTH ` 3?OQ,���io Ya e�•COL 40- p �4SSACHUS Health Department August 29, 2008 Benjamin Osgood, P.E. ' New England Engineering Services, Inc. 1600 Osgood Street- Building 20, Suite 2-64 North Andover, MA 01845 Re: Septic System Repair Plan for 44 Marian Drive-Map 107C,Lot 57 Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated July 23, 2008 and received on August 8, 2008 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. 1. Please indicate the presence or absence of wetlands within 150 feet of the proposed leaching facility in accordance with NA 8.02(r). 2. Please state the required maintenance for the proposed effluent filter in accordance with 310 CMR 15.227(7). 3. On sheet 2 of 2 the Hydraulic Unit detail indicates a to elevation of 98.00' and a bottom Y p elevation of 94.81'. The Hydraulic Unit has an overall height of 18 inches and the return line to the septic tank must flow by gravity. Therefore, a top elevation of 100.6'+/- and a bottom elevation of 99.1'+/- appears to be required. Please confirm these calculations and make any necessary corrections. 4. Please provide a draft maintenance agreement for the Clean Solutions Pretreatment Unit and the Perc-Rite Drip Disposal System. 5. Please specify the on center distance between the Perc-Rite drip tubing. 6. Please indicate that the cover above the pump chamber will be 24 inch diameter. Although not reasons for disapproval, you may wish to consider the following: a. The 5' overdig is not required per the DEP remedial use approval letter for the Perc- Rite Drip Dispersal System. b. The drip tubing will be installed on a sand bed. Therefore, a 1' on center spacing between drip tubing is allowed. 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 t 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. Sincerely, /san . Sawyer, REHS RS Public Health Director cc: Owner File r NORT#j tLlG �2 y°c,` , ,6 0 O L � � OI COCKIC H wK• 1 ��SSACHUS���y PUBLIC HEALTH DEPARTMENT Community Development Division July 14,2010 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewage Disposal System Plan for 44 Marian Drive May 107C Lot 57 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 3,2010 and received on June 21,2010 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. 1. The pump chamber outlet invert is not depicted on the design plan. Please provide this elevation. 2. In the scaled profile on sheet 1 of 2,it appears that the pump chamber outlet invert is approximately at elevation 96.00' and the graphic profile indicates the ESHWT at elevation 97.23'.If this is accurate,a Local Upgrade Approval must be requested for being less than 12"above ESHWT with the tank invert(3 10 CMR 15.405(1)0)).If not,please note this on your response letter. 3. Please submit the results of the soil testing on the current DEP soil evaluation forms 11 & 12(NA 2.3). Please note that this requirement is now in the newly revised local regulation. 4. Please indicate that a riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade(3 10 CMR 15.221(13)). 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 public health and the environment of North Andover. Sincerely '! Susan Y. Sawyer,REHs S Public Health Director cc: Louis Bowab File 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS • PLANNERS 66 PARK STREET• ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1448 • E-MAIL info@merrimackengineering.com July 15, 2010 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 RCCRIVb North Andover, MA 01845 JUL 20 2010 TOWN OF NORTH ANDOVER RE: 44 Marian Drive IHEALTH DEPARTMENT Dear Susan, We received your review dated 7-14-10 for the above referenced site. We are in disagreement with the reviewer with regard to items 1, 2 &4 of the review letter. Items 1 &2 pertain to CMR 15.405(1)0). I 15.405(1)0) specifically refers to inlet and outlet TEES and their relationship to high ground water. The word TEES is not used casually in Title 5, but specifically to refer to gravity pipes and not force mains which don't utilize tees. The significance is that if a gravity pipe is at or near the water table, ground water could infiltrate the pipe and be conveyed to the soil absorption system. The location of the force main and the height it is cored through the tank wall is irrelevant because the force main is a sealed pipe with a connection directly to the pump unit. If 15.405 (1)0) did apply to force mains,then it would apply to the height of the pump connection which is usually always below the high ground water elevation. We are confident that the system, as designed, meets the requirements of CMR 15.405(1)0) and that there is no discrepancy with the plans in that no elevations should be scaled off the graphic profile as it is for graphic purposes only. With regard to item#3, enclosed are copies of the soils reports on current DEP forms. With regard to item#4, as we have explained in the past,the soil absorption system is in fill, and the elevations and grading on the plan represent the final grade at the distribution box to be 5 inches below the surface, as such,no riser is required. f I • July 15, 2010 Susan Sawyer (page 2) We feel the plans as originally submitted, meet the requirements of Title 5 and the North Andover Board of Health and should be approved as originally submitted. We appreciate your prompt attention to this matter, as the home owner is anxious to proceed with the replacement of their failed system in the best interest of public health and environmental protection. Yours Truly, William Dufresne Merrimack Engineering MERRIMACK ENGINEERING SERVICES,INC. 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810 L NORT11 r 0fl-10 16 6 OL O to °'pA coc 'c N, �•9 °R�reo �Pp��S SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division July 14,2010 Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover,MA 01810 Re: Subsurface Sewaze Disposal System Plan for 44 Marian Drive,Mau 107C,Lot 57 Dear Mr.Nemchenok: The proposed wastewater system design plan for the above site dated June 3,2010 and received on June 21,2010 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. 1. The pump chamber outlet invert is not depicted on the design plan. Please provide this elevation. 2. , In the scaled profile on sheet 1 of 2,it appears that the pump chamber outlet invert is approximately at elevation 96.00' and the graphic profile indicates the ESHWT at elevation 97.23'.If this is accurate,a Local Upgrade Approval must be requested for being less than 12"above ESHWT with the tank invert(3 10 CMR 15.405(1)0)).If not,please note this on your response letter. 3. Please submit the results of the soil testing on the current DEP soil evaluation forms 11 & 12(NA 2.3). Please note that this requirement is now in the newly revised local regulation. 4. Please indicate that a riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade(3 10 CMR 15.221(13)). 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 public health and the environment of North Andover. Sincerely, r f Susan Y. Sawyer,REH S Public Health Director i B cc: Louis wab o File 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476 TIC copy North Andover Health Department (ommunity Development Division August 2,2010 Louis Bowab 44 Marian Drive North Andover,MA 01845 RE: Septic System Design, 44 Marian Drive,North Andover,Map 107C,Lot 57 Dear Mr. Bowab, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated June 3, 2010. This approval includes the Health Department approval of a local upgrade for allowing the reduction in separation between the Soil Absorption System and the high ground water table from four(4) feet io three(3) feet. Please keep a copy of the attached document for your records. J This design plan has been approved for use in the construction of an onsite septic system for a 4- bedroom house(maximum 9-room) and is valid for a period of two years from the date of this letter or from the date that the system failed a documented Title V inspection. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event of an imminent health problem, such as sewage backup into the dwelling, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. 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 or imply compliance with any of the aforementioned requirement. 2. 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. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com i 44 Marian Drive Septic Plan Approval Letter August 2,2010 Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincer usan Y. awyer,RU SIRS Public Health Director Cc: Merrimack Engineering Services Attach: Form 9B —Local Upgrade Approval Form List of licensed septic system installers 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 913 5V`a DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Louis Bowab key to move your Name cursor-do not 44 Marian Drive use the return Street Address key. North Andover MA 01845 City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir Nemchenok ❑ PE ❑ RS Name 66 Park Street North Andover MA, 0184 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 44 Marian Drive,North Andover,MA 01845•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover a o Local Upgrade Approval Form 9B I B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 11 min/inch min./inch Depth to groundwater 3 ft. ❑ Relocation of water supply well (explain): ❑ 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 List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department 112 Approving Authority Susan Sawyer, Health Director July 30, 2010 Print or Type Name and Title Sig ature Date 44 Marian Drive, North Andover,MA 01845•rev.7/06 Local Upgrade Approval* Page 2 of 2 Smart&c,,.e Communications Center Page 1 of 1 SmartZone Communications Center brdufresne@comcast.ne + Font size- 44 Marian Drive From :Susan Sawyer<ssawyer@townofnorthandover.com> Fri Jul 30 2010 1:41:48 PM Subject:44 Marian Drive To:'Bill Dufresne' <brdufresne@comcast.net> Bill,in response to your letter regarding the force main proposed for 44 Marian Drive,I decided to forward the question to Claire Golden. My concern was that the installer does not know where the water table is and by coring a hole it would be compromising the tank.Yes,I understand it can be sealed properly of course, but I definitely want to check that on inspection. It appears your conclusion was accurate,however it was for a different reason.The word outlet was not the issue.As I understand her,it was actually that it is.a pump tank and not a septic tank. Please read the correspondence below.I will be approving the plan and sending the letter possibly by the end of the day,or on Monday. Feel free to call next time if you would like to.The regulation is the rule but I could have explained why I agreed with the reviewer. Thank you. Susan -----Original Message----- From:Golden,Claire(DEP)[mailto:Claire.Golden@state.ma.us] Sent: Friday,July 30, 2010 8:31 AM To: Sawyer,Susan Cc: Ferris, David(DEP) Subject: RE:can I have your input Susan, Bill Dufresne is correct in the following regards: a) Title 5 does not specify that that outlet elevation of a pump chamber be denoted. This information is required for septic tanks. Whereas I concur that most installers will use the existing precored outlet,some may not for whatever reason. The elevation of the force main as it exists the actual pump must be noted as that will affect the associated pump curve. b) Given the above,the location of the pump chamber inlet and/or outlet as they related to ESHGWE does not trigger the need for LUA approval. However,that does not mean that the requirements of 15.254(2)(b)can be ignored.Specifically this section of the Code requires that pump chambers be designed in accordance with 310 CMR 15.231. 310 CMR 15.231(11)requires watertightness. The entire tee location(as it relates to ESHGWE)was added to the Code to address the common leaking into a septic tank through the coring of the tank to place pipes into or out of tanks. Besides the joint around the tank,the coring is the next logical location for a leak.So the approach should be to demonstrate that the pipe opening has been sealed properly and that the pump chamber is watertight. Claire Claire A. Golden ` Environmental Engineer IV Watershed Permitting Program MassDEP/NERD/BRP 205B Lowell Street Wilmington,MA 01887 direct:978-694-3244 fax: 978-694-3498 or 978-694-3499 claire.golden@state.ma.us http://sz0020.wc.mail.comcas,t:net/zimbra/h/printmessage?id=S 1760&xim=1 7/30/2010 N/ DAMS N/F• ARMSTRONG 2 0,0 TM: 107C TL: 57 AREA=44,160 S.F.f =1.0137 AC.t o PROPOSED ads o 1 STY. NW.F. GARAGE oeac PORCH o c� EXIST. 4 BDRM. DWELLING #44 92 4, O co Roe781,4 MARIAN DRIVE "� TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ZONING DISTRICT: RESIDENTIAL DIST. 2 "I H �x,. RTIFY PLOT PLAN THE DWELLII�I IS LOBATED ON.THE_,LOT AS SHOWN AND THAT If DOES COMPORM :'WITH THE TO` OF NORTH IN ANDOVER ZONING REGULATIONS'"REGARDING SETBACKS FROM THERSTRECgI ; HIS DWELLING IS NOT NORTH ANDOVER, MA. I FURTHER C LOOOD HAZARD AREA SHOWN IL�N �� 250098 0008 C DATED DRAWN FOR JUNE 2, „5 4;1 }r1iO-KI I�. IDU BOWAB 44 MARIAN DRIVE 12/6/11 JAMES KLOPO OSKI, P.L.S. DATE SCALE: 1"=40' DATE: DECEMBER 6, 2011 THIS PLAN YOR Re��SE•S—NOT FOR MERRIMACK ENGINEERING SERVICES BOUNDARY DETERMINATION. BOUNDARY INFORMATION 66 PARK STREET TAKEN FROM EXISTING RECORDS. ANDOVER, MASSACHUSETTS 01810 SUMMARY OF INVERTS BUILDING TIES SEWER 0 FDTN. 98.98 BLDG, CORNER A B C T % THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 98.53 SEPTIC TANK OUT 21.0 26.8 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 98.29 PUMP TANK OUT 29.3 36.5 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK 1N 98.15 LQIST. BOX 86.0 99.5 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 99.48 COMPONENTS. DIST. BOX OUT 99.26 INV. IN CRAM. 99.19 BOTT. CHAM. 98.87 { i I I N/F - QAd1S ARMS I a N VENT No PORT LEACH MW W/43 a j WURAWR $ ' 39' TIN g e� tlY � �F I ausr. ct x Y as ' two CAL ."•,C 0. PIMP TANK �� 1.=GAL qn $ M; 107V �- i-F-• l7 f SEP11C TANK (44,160 S.F. ) } Fasr ,max f is / rta• �� i j, t { 1C7 Az mow MARIAN DIVE TOWN OF NORTH ANDOVER HEALTH DEPARTMENT VLADIMML s s�. l t r: s. ' r fi 41 AS BUILT PLAN fi�� r�fP- OF SUBSURFACE DISPOSAL S YL S.TE LOCATED IN NORTH ANDOVER, MASS./ 44 MARIAN DRIVE AS PREPARED FOR IDU BOWAB TM: 107C DATE: 9-30-10 SCALE: I"=40' TL: 57 r--�---- 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET I� ANDOVER, MASSACHUSETTS 01610 i .. e i i E I . _ r I i I t t} 1 t , } y � j t 6 � � � {.�.(, i I Hillside Acres Lot 6 Z, APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereb make application for a permit for a sewage disposal installation at L`3t 2-, Hillside Acres I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gals in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 lineal C=== ) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No. single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE // - c� C/ -lo 6/ Lw r at a of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 4 6 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE 2 -- Signature of I specting Offic r Percolation Test 8 min, Soil; Clay Garbage Grinder ev�1A BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 0 '�` � ; ► � �t/./1 rr�.Ott �u ti �.o rJ t t , a t t d .u►►t l ► . � r qs J- 1. NAME �"���� AI�e/�i` .IKt. DATE d/y4 /i t. 2. ADDRESS a��_I'nf f f . LOT NO. �Z TEL. !6 y -100 3. NO. OF BEDROOMS ¢ DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OU'T'CROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. a v Commonwealth of Massachusetts � :� . tts �® � City/Town of . `�" ul� I SYS item Pumping@COI'CI .HEALTNORTH aAND00 Form RTiyENT N DEP has provided this form for useby 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: Left/Right front of house, Left 1 Right rear of house, Left/right side of house, Left I Right side of building, Left/Right front of building, Left/Right rear of building, Under deck . Address � •��r- 1i�1� ; v� CWrown State Zip Code 2. System Owner. Name' Address(d different from location) Cityrrown Stafi Zip Code Lo , Telephone Number !;r .B. Pumping Record � 1. Date of Pumping Date \ 2. Quantity Pumped: Gallons 3. Type-of system. ❑ Cesspool(s) eptic T k ❑ Tight Tank ther(describe): 4. EfFluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No, ' 5. Condition of System: 6. System Pumped By- Nell.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Lo contents-were disposed: Lowell Waste Water Sign a cf Haul Date f t5formCdoc•06/03 System Pumping Record•Page 1 of 1 ax- SS smo"ecuei e 1_ S O � I O $. 3-g, 1.- s0 6>LAt,i S+�ow '» G, I-A-l-,* k f PIPE -TD 0-90x I� IDATESON EMTF?^p!1S.FS, INC. 111 APClLL" ,'%0AD ANDOVER, MAG-1810 • J t`