HomeMy WebLinkAboutMiscellaneous - 440 BOSTON STREET 4/30/2018 (2) 1
c�a3�
N
O
O
J WO
gz �
m
o �
tt
V1
1
�46
North Andover Board of Health
Meeting Minutes
Thursday—October 27,2015
7:00 p.m.
120 Main Street,2nd Floor Selectmen's Meeting Room
North Andover, MA 01845
Present: Thomas Trowbridge,Frank MacMillan,Larry Fixler,Edwin Pease,Susan Sawyer,Michele Grant,
Lisa Hadge
I. CALL TO ORDER
The meeting was called to order at 7:04 pm.
II. PLEDGE OF ALLEGIANCE
III. PUBLIC HEARINGS
IV. APPROVAL OF MINUTES
A. Meeting minutes from September 24,2015 were presented for signature.
Motion was made by Mr.Fixler to approve the minutes,the motion was seconded by Mr.Pease,all
were in favor and the minutes were approved.
V. OLD BUSINESS
A. 700 Middleton Street—James Morin,representing owners of 700 Middleton Road requesting:
1. Local Upgrade Approval request to reduce the setback distance from the private well to the
proposed leach field of 77 feet where 100 feet is required.(310 CMR 15.405(1)(g)
2. Local Upgrade Approval request is required to have only one test pit in the proposed leach field
area where two are required.(310 CMR 15.405(1)(k)
3. Variance request from the NA BOH local of setback distances of wetlands to a SAS of 51 feet
where 100 feet is required.
Jim Morin approached the podium.Mr.Morin stated that he is a registered sanitarian in the state
of Massachusetts.A discussion ensued regarding the proposed septic system at 700 Middleton
Street and the requests before the Board.Dan Ottenheimer,Mill River Consultant,reminded the
Board that this request was brought before them at a previous meeting.There is a nearby well and
the concern was the proposed septic system being replaced within 100 feet of a well.A
representative for Mr.Morin was at the previous meeting and he was not able to answer some of
the Boards questions regarding the well so he was asked to do some homework and come back to
a future Board meeting.Mr.Morin stated that they hired a lab to come into the property and obtain
a water sample from the kitchen sink.The well water testing results have been forwarded to the
Board and the well water testing came back clean.A discussion ensued regarding the well.Mr.
Morin explained that no expansions or additions to the home are proposed.The homeowners are
selling the property and retiring. The home is a four bedroom and will stay a four bedroom.Mr.
Morin stated that he has filed with Conservation pertaining to the wetlands and offsets.He stated
that Conservation has given their verbal approval and Mr.Morin can pick up the conditions at the
next Conservation meeting.A discussion ensued regarding the soil testing at the site and the
2015 North Andover Board of Health Meeting Page 1 of 6
Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr.,
M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra
Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Hadge,Health Department Assistant
proposed placement of the septic system.Dr.MacMillan asked Mr. Ottenheimer if he had any
comments or concerns regarding the second request of having only one test pit.Mr. Ottenheimer
stated that he did not see any concerns.Dr.Trowbridge asked Mr.Ottenheimer that since the
Board now has a baseline test of the water and the up gradient,even though there are no
guarantees,can the Board accept it? Mr.Ottenheimer stated it is subjective but if the well was not
contaminated with the existing system there is very little risk of contamination with the new
proposed system.
Motion was made by Dr.MacMillan to approve the two local upgrade approval requests as listed in
the agenda as well as the variance request as printed in the agenda.Motion was seconded by Mr.
Pease.All were in favor and the motion was approved.
VI. NEW BUSINESS
A. 440 Boston Street—Douglas Smith,representing owners of 440 Boston Street,requesting:
1. Local upgrade approval for the requirement of a 4' separation between the bottom of the soil
absorption and high groundwater with a reported perc rate of 3 min per inch. This results in a F
reduction resulting in the bed bottom being 3' above high groundwater.(3 10 CMR 15.405(h))
2. Requesting a local upgrade approval for the requirement of a 12"separation between the inlet and
outlet tees and high groundwater. A 10"separation is provided for the septic tank and a 5"
separation is provided for the pump chamber. Rubber boots are provided on tank and pump
penetrations. (3 10 CMR 15.4050))
Douglas Smith approached the podium.A discussion ensued regarding the proposed septic system
at 440 Boston Street and the requests before the Board.Mr.Smith stated that the home does not
have a full foundation but has a crawl space.He stated that the proposed system fits in well with
the property and is esthetically a good situation.Mr. Smith described the layout of the property
and surroundings.The driveway is about 250 feet with the house sitting sideways with no street
anywhere near the system at all.He stated that the land has an unusual shape.Mr. Smith reviewed
the property lines.Dr.Trowbridge asked Mr.Ottenheimer to review the inlet/outlet tees and
groundwater. Mr. Ottenheimer explained that because of how the house is built they can't comply
with the design standards and the code.Mr. Ottenheimer reviewed design standards and the risk of
a tank sitting in the ground water table.He reviewed what the code says to prevent this risk.Mr.
Ottenheimer stated that because Mr. Smith doesn't have the flexibility to change where the pipes
come out of the house he can't raise up the tank to comply with the code.Dr.MacMillan asked if
12"to 10"is substantially different with regards to risk.Mr.Ottenheimer stated it was not.An
explanation ensued regarding the limitations with the existing basement.Dr.MacMillan asked Mr.
Ottenheimer if he had any reservations approving the two requests that were being requested.Mr.
Ottenheimer stated that the Board has had questions regarding this local upgrade approval in the
past to reduce the distance to the ground water.
Mr. Ottenheimer reviewed what Title V addresses.This request has been granted before in the
past,but there have also been times where it hasn't been granted.Dr.MacMillan asked if the
property was in the Lake Cochichewick watershed.The property is not.A discussion ensued
regarding the proposed system location.Mr.Ottenheimer reviewed the code with the Board. There
are two options for full compliance under Title V and there is an additional option which is to
request a reduction of the groundwater offset from 4'to 3'.This can be granted but the code does
give two options for full compliance which would be preferred. A discussion ensued regarding
the proposed septic system.Mr. Smith stated that not approving the requests before the Board
could be a hardship to the current homeowners with their buyers.The homeowner asked to address
the Board. She stated that she has lived there along with five other people for twenty eight years
with no issues of flooding.The delay would possibly cause them to lose their buyers.Mr.Fixler
asked Mr. Smith if he thought coming up with a larger system and asking for the local upgrade
approval was better alternative to the two Title V options that Mr.Ottenheimer had mentioned for
compliance.Ben Osgood Jr.,engineer for a couple of requests on the agenda,approached the
podium.Mr. Osgood discussed his thoughts as a designer for justifications on the Freduction
resulting in the bed bottom being 3' above high groundwater.A discussion ensued regarding Title
V and the local upgrade approval.Dr.MacMillan stated that what Mr. Smith requests,seems
reasonable.
Motion was made by Dr.MacMillan to approve the request,as listed in the agenda,for the
requirement of a 4' separation between the bottom of the soil absorption and high groundwater with
a reported perc rate of 3 min per inch. This results in a 1' reduction resulting in the bed bottom
being 3' above high groundwater.Motion was seconded by Mr.Fixler.All were in favor and the
motion was approved.
North Andover Board of Health
Meeting Minutes
Thursday—October 27, 2015
7:00 p.m.
120 Main Street,2nd Floor Selectmen's Meeting Room
North Andover,MA 01845
Motion was made b Dr.MacMillan to approve the request as listed in the agenda for the
y rr �
requirement of a 12"separation between the inlet and outlet tees and high groundwater. A 10"
separation is provided for the septic tank and a 5"separation is provided for the pump chamber.
Motion was seconded Mr.Fixler.All were in favor and the motion was approved.
B. 415 Winter Street—Benjamin Osgood,Jr.,representing owners of 415 Winter Street,requesting:
1. Local upgrade approval to allow a reduction in the separation distance between the water table and
bottom of leach stone in the leach field from 4 feet as required by Title 5 Section 15.212 to 3 feet.
2. Local variance for reduction in the offset distance between the edge of a leach field and a wetlands
from 100 feet required to 55 feet.
Ben Osgood Jr. approached the podium.Mr. Osgood gave information regarding the home's
septic systems history.The system is a reconstruction of what was done about 10 years ago.The
home is an older duplex.Mr.Osgood's firm was hired originally in 2001 to design a replacement
system.The soil testing was done,permits pulled and the system was installed per the plans.He
recently received a call from the owner looking for a designer and Mr.Osgood just happened to
have been the designer back in 2001.Mr.Osgood gave his opinion on why the current 15 year old
system failed.He stated that there had been home renovations and items i.e.paint was put down
the drains that shouldn't have been.His opinion was that the system failed from abuse..Pumping
records showed it was only pumped once or twice since it was last installed.The septic plans were
done and he has gone before Conservation.He is asking for same waivers that were asked for
originally.Mr.Osgood reviewed his requests for approval.Dr.MacMillan asked if they planned
on just excavating the sight and reinstalling the system.Mr. Osgood stated that was the case.The
regulation from the last installation is still the same as before.Mr. Osgood stated that if the system
was not misused,the system probably would not have failed.A discussion ensued regarding
maintaining a septic system,the lifespan of a septic system and the current proposed system and
an addition of a wall.Mr.Osgood would like to dig down a foot or more until good clean sand is
identified.It will be replaced by another type of sand.Ms.Grant asked Mr.Osgood if he planned
on removing and replacing the current sand.Using less sand could mean a good savings to the
home owner,added Ms.Grant.A discussion ensued regarding replacing the sand and the type of
sand.Ms.Grant added that an out of season permit can be pulled in emergency situations if time
runs out.
Motion was made by Mr.Fixler to approve both requests as listed in the agendas;it was seconded by
Mr.Pease:
-to allow a reduction in the separation distance between the water table and bottom of leach stone
in the leach field from 4 feet as required by Title 5 Section 15.212 to 3 feet.
2015 North Andover Board of Health Meeting Page 3 of 6
Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr.,
M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra
Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Hadge,Health Department Assistant
-reduction in the offset distance between the edge of a leach field and a wetlands from 100 feet required to
55 feet as written on the agenda.
Chairman called for discussion.Ms.Grant had an additional item for discussion. She requested the board
consider adding a requirement to test the sand to ensure compliance with Title V standards and if it does
not pass,it will be replaced by C-33 sand.
Larry Fixler offered the amendment to include the following; that the original sand that is in the ground
below the system,is to be tested. If it doesn't pass as Title V sand,the sand will be completely removed and
replaced with C-33 sand.Motion was seconded by Mr.Pease.There was a unanimous vote by the board for
the amendment.The chair returned to the amendment to the motion.Frank MacMillan made the motion to
approve the amended motion and Mr.Pease seconded the motion. All were in favor and the complete motion
below was approved.
-to allow a reduction in the separation distance between the water table and bottom of leach stone in
the leach field from 4 feet as required by Title 5 Section 15.212 to 3 feet.
-reduction in the offset distance between the edge of a leach field and a wetlands from 100 feet
required to 55 feet as written on the agenda.
-that the original sand that is in the ground below the system,is to be tested. If it doesn't pass as
Title V sand,the sand will be completely removed and replaced with C-33 sand.
C. 415 Boxford Street—Benjamin Osgood Jr.,representing owners of 415 Boxford Street,requesting:
1. Local upgrade approval to allow a leach field to be designed in an area with only one test pit in
lieu of 2 as required by Title 5 sections 15.405(k).
Mr. Osgood gave history of the property located at 415 Boxford Street.The reason for the failure was
that the owner installed a water softener and the back flush went into the septic system.The water
softener can cause a failure by the salts going into the tank and then the solids going out into the
system.The homeowner is sold a product and does not know it could fail their septic.A discussion
ensued regarding installation of water softeners.It was noted that no permits are needed to install
water softeners.Ms.Grant compared it to a garbage grinder. She stated that no garbage grinder is safe
for a septic system and yet,the manufacturer and sales person markets it as safe for septic systems. She
also stated that homeowners may not be educated on the dos and don'ts of a septic system.The new
plan will include a location for a drywell for the back flush of the water softener. Mr.Osgood
discussed the proposed septic system and what was being requested by the Board.It is the same as the
plan for the system currently in the ground.The designer feels that this system was properly designed
and the local upgrade approval given by the board of health a decade ago was appropriate and they are
still the best application for the property today.Mr.Ottenheimer did not see a problem with the local
upgrade approval being requested.
Motion was made by Dr.MacMillan to approve the local upgrade approval as listed in the agenda to
allow a leach field to be designed in an area with only one test pit in lieu of 2 as required by Title 5
sections 15.405(k).Motion was seconded Mr.Pease.All were in favor and the motion was approved.
D. Town of North Andover Dumpster Regulations—To amend section 2.2 of the local regulation: to
modify the annual expiration date for a permit to maintain a trash or refuse dumpster from the calendar
year to the last day of February in order to be aligned with the food permits.To amend section 2.4 to
exclude certain parties from this regulation.The amendment will take effect immediately.
Motion made by Dr.MacMillan to amend the dumpster regulation by way of addition and
deletion as stated in the agenda.The motion was seconded by Mr.Pease.All were in favor and
motion was passed.
E. Town of North Andover Regulation Concerning the Hauling and Disposal of Solid Waste—Susan
Sawyer described the need to modify the regulation to eliminate conflicting phrases regarding
distinction between hauling waste and traversing the town roads.This regulation oversees the
movement of the trash trucks that go to Wheelabrator,TBI and Covanta solid waste facilities.
Authority to set truck routes was given to the Town's Board of Health as North Andover is the host
community to multiple facilities.The board felt it necessary to exercise that right.The regulation has
been modified on occasion to attempt to make it more understandable and workable to the N.Andover
Police Department and the Health Department.
The NAPD does the enforcement on these vehicles for the Health Department.Larry Fixler
commented on the process that was done to identify sections or phrases of the current regulation that
North Andover Board of Health
Meeting Minutes
Thursday—October 27, 2015
7:00 p.m.
120 Main Street,2°d Floor Selectmen's Meeting Room
North Andover, MA 01845
conflict with other sections or phrases.The corrections proposed are all in line with the intent of the
regulation as first approved.Health staff and Larry Fixler spent a number of hours going line by line to
find inconsistencies.It is the intention to reduce the conflicts that arose last year.Nothing of substance
or of the original intent has been changed. We also took out sections that were basically outdated and
not relevant on how the regulation is applied and corrected process inconsistencies.This is a change in
process.We fully expect that other items may come up from time to time that may need addressing.At
that time the Board can take action on those items.It did not meet the timeline to be sent prior to the
trash truck applications,but everyone who should be aware and will have to comply with the changes
to be fair to all.The process is ongoing and these changes are needed to be in place for this renewal
period.Larry Fixler noted that the office will notify the public via local newspaper and for the
Ed Pease presents that he has reviewed and marked up the document for numerous grammatical errors
and formatting errors.It is just clean up stuff,not sustentative.He noted the use of capitals;missing
periods etc.Larry pointed out that Ed's capacity was not as a legal advisor for this review.These are
editorial comments and Dr.Trowbridge proposed that he would be able to review and approve the final
draft,but the vote can be taken now and signed at the November meeting. The final revised document
will be distributed as soon as it can be signed.The final approved,but unsigned document will be
distributed prior to signing to assist the applicants.Ms. Sawyer noted that these changes do not affect
any permit holder or applicant to appeal any decisions made by the staff reviewing the applications.
Motion made from Dr.MacMillan moved to accept the changes as presented and the Board will
designate to the chairman final approval of any grammatical corrections that he deems are
necessary.Larry Fixler seconded. All were in favor and the motion was passed.
VII. COMMUNICATIONS,ANNOUNCEMENTS,AND DISCUSSION
A. 2016 BOH Agenda—Due to renovations of Town Hall,the 2016 BOH agenda was presented with the
meeting days to be held on the fourth Tuesday instead of Thursday for 2016.The Superintendent's
room at 566 Main Street was suggested. The Superintendent's room is about the same size of the
Selectmen's room and is wired for recording with NA CAM. Parking is convenient.There was no
opposition in changing the meeting from a Thursday to a Tuesday by members present.Dr.
Trowbridge asked if there was anything written anywhere in the Town Charter or By-Laws stating that
the Board is to meet on a Thursday.The Health Department staff will look into whether or not it is
written anywhere that the day must be the 4t'Thursday.A vote will be held off until the next BOH
meeting if there is a need to address.
VIII. CORRESPONDENCE/NEWSLETTERS
Mrs. Sawyer gave feedback on the recent flu clinic held at North Andover High School. Over 530
vaccinations were given. The next flu clinic will be held on November 5,2015 from 2-3pm at the Senior
Center.Everyone is welcomed.There is no charge,but please bring your medical cards.
2015 North Andover Board of Health Meeting Page 5 of 6
Board of Health Members: Thomas Trowbridge,DDS,MD,Chairman;Larry Fixler,Member/Clerk;Francis P.MacMillan,Jr.,
M.D.;Joseph McCarthy,Member; Edwin Pease,Member Health Department Staff:Susan Sawyer,Health Director; Debra
Rillahan,Public Health Nurse;Michele Grant,Public Health Inspector;Lisa Hadge,Health Department Assistant
Ms.Rillahan,Public Health Nurse,has also been signing up people for pneumonia clinics and has been
doing homebound who need flu shots.Please call the Public Health Nurse if you need a flu shot and are
homebound.
Merrimack College Give Back Program will be coming up on November 7th. There are over 100 volunteer
students coming to clean up around the lake and Ms. Sawyer also coordinated with the NA Housing
Authority to have 40 student volunteers to help beautify their community rooms and surrounding grounds.
The new Fire Station's"open house"will be on the morning of November 71b.
Mrs. Sawyer stated that it is time for permit renewals.The reminder letters are set to be mailed out at the
end of the week.When establishments receive their new permits,they will also receive a letter to let them
know that their food and/or dumpster permits will run through the end of February 2017.Permits will then
run from March 1St through February 28th of each year after.
IX. ADJOURNMENT
MOTION made by Dr.MacMillan to adjourn the meeting.Mr.Fixler seconded the motion and all
were in favor.The meeting was adjourned at 8:53 pm.
Prepared by:
Lisa Hadge, Health Dept.Assistant
Reviewed bv:
All Board ofHealth Members&Susan Sawyer, Health Directorr
Signed by:
Larry F417er, Clerk of the BoaiGd Date Signed
I
s�Ks n_y-
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 11/24/15
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair of an
On-Site Sewage Disposal System
p Y
By: Chad Jablonzki
At: �
440 Boston Street
Map 107D Lot 3
North Andover, MA 01845
The j s ace this certificates Yhot!y construed as a guarantee that the system will function satisfactorily.
`1VIiWele Grant
Public Health Agent
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com
• Sgt?�D y,
c;•
•
North Andover Health Department
fommunity and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 440 Boston St. MAP: 107D LOT: 3
INSTALLER: Chad Jablonski
DESIGNER: Doug Smith
PLAN DATE: 9/1/15, rev. 10/5/15
BOH APPROVAL DATE ON PLAN: 10/27/15
INSPECTIONS
TANK INSPECTION: 11/9/15
DATE OF BED BOTTOM INSPECTION: 11/6/15
DATE OF FINAL CONSTRUCTION INSPECTION: 11/17/15
DATE OF FINAL GRADE INSPECTION: iaU
ll
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
X Bottom of tank hole has 6" stone base
® Weep hole plugged
X 1500 gallon tank has been installed
H-10 loading
X Monolithic tank construction
®
Watertightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
(effluent filter)
❑ inch cover to within 6" of finish grade
installed over one access port
❑ Hydraulic cement around inlet & outlet
Comments: 11/17/15 — Rubber Boots on tank, no cement needed
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(s) installed on stable base
® Alarm float working
® Pump On/Off floats working
® Separate on/off floats
® Drain hole in pressure line
❑ cover at final grade installed over pump
access port
® Water tightness of tank has been achieved by
visual testing
❑ Hydraulic cement around inlet & outlet
Comments: 11/17/15 — Rubber Boots on tank, no cement needed
CONTROLPANEL
❑ Alarm & Pump are on separate circuits
® Alarm sounds when float is tripped
® Location of control panel: basement
® Alarm signal located inside: basement
Comments:
DISTRIBUTION-BOX
❑ Installed on stable stone base
® H-20 D-Box
® Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
❑ Speed levelers provided (not required)
® Schedule 40 PVC Pipe
Comments:
SOIL ABSORPTION SYSTEM (General)
X Bottom of SAS excavated down to C soil layer,
as provided on plan
X Size of SAS excavated as per plan
X 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
❑ Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments: 40Wx35L with overdig
FINAL GRADE
X Loamed
X Seeded
X Cover per plan
Comments:
DOCUMENTS NEEDED
X Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
X As-Built Plan
BM = 101.70
HR = 2.57
Hl = 104.27
SYSTEM ELEVATIONS
ROD AS-BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark
Building Sewer OUT
Septic Tank IN 6.00 97.94 97.70
Pump Chamber OUT 6.21 97.89 97.36
Distribution Box IN 3.55 100.39 100.42
Distribution Box OUT 3.90 100.04 100.25
Lateral 1 TOP 3.73 100.21 100.17
Lateral 1 END 3.89 100.05 100.02
Lateral 2 TOP 3.71 100.23 100.17
Lateral2'END 3.90 100.04 100.02
Lateral 3 TOP 3.72 100.22 100.17
Lateral 3 END 3.91 100.03 100.62
Lateral 4 TOP 3.69 100.25 100.17
Lateral 4 END 3.94 100.00 100.62
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)
® Drywells 20 25
Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA
wetland bylaws
PUBLIC HEALTH DEPARTMENT '
Community Development Division
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(constructed;( )repaired;
By:
(Print Name) cc /► }—
Located at: i 6 0 60'&+0V)
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
2 201 0�-t 5 2-0
e12-015
and last revised on 5 with a design flow of
3 0 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: V) 0 V 2 0 l S
Engineer Representative(Signature)
And—Print Name
11. � Z
Final Construction Inspec 'o1 n�Date: 0V 3) )S
Engineer Representative(Signature)
And—Print Name
Installer: (Signature) Date:
And—Print Name
Engineer: (Signature) Date: OU Z 4, 2.-0 1 5
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web h"p://www.townofnorthandover.com
Town of North Andover — Septic System - AS-BUILT CHECKLIST
1) VAR changes to the design plan have been reflected and noted on the as-built plan
2) _L-'�As-built plan has a suitable scale; (1 inch= 40 feet or fewer for plot plans)
3) Street Address,Assessor's Map and Lot Number
4) Lot Lines and Location of Dwellings served by the system
5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
6) _Je!!�Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure
i) �etback distances are shown on the as-built plan from system components to:
h Subsurface,interceptor&foundation drains
Catch basins
t/Property lines
wellings or other structures
wP 'vate water supply or irrigation wells
atercourses or wetlands
8) 1, Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) _J�Location of water,gas,electric lines,cable,control panel (if applicable)
10) --"cation of Structures within 6 Inches of Finished Grade
11) _I riginal Stamp&Signature
V L
12) ocation and holder of any easements which could impact the system
13) impervious Areas;Driveways,etc
14 _-L,/North Arrow
15) Location&Elevation of Benchmark used
16) _STATEMENT ON PLAN (NA 5.3)
a. "I certify the locations,elevations, ties, cover material;exposed component covers etc.,
shown on this as-built substantlallyagive with the approved plan and have determined that the
break out elevations,ifapplicable,have been met."
Si ture of Desi Date
b. "Ifa STVC7URAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-builtindica
The wall- was,or was not,constructed in accordance with the intended design and any
manufacturer's specifications."
Signature of Designer Date
As of:Tuesday,March 17,2015
Town of North Andover — Septic System - AS-BUILT CHECKLIST
1) 12All changes to the design plan have been reflected and noted on the as-built plan
2) V As built plan has a suitable scale; 0 inch = 40 feet or fewer for plot plans)
3 _7"Street Address,Assessor's Map and Lot Number
/
4) V" Lot Lines and Location of Dwellings served by the system
5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable)
6) " Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure
Setback distances are shown on the as-built plan from system components to:
��' Subsurface,interceptor&foundation drains
w Catch basins
Property lines
_Dwellings or other structures
Private water supply or irrigation wells
Watercourses or wetlands
8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system
9) ✓ Location of water,gas,electric lines,cable,control panel (if applicable)
10) J r Location of Structures within 6 Inches of Finished Grade
11) '/ Original Stamp&Signature
12) Location and holder of any easements which could impact the system
13) " Impervious Areas;Driveways,etc
14) North Arrow
15) J Location&Elevation of Benchmark used
J
16) STATEMENT ON PLAN (NA 5.3)
a. "I certify the locations, elevations, ties, cover material;exposed component covers etc.,
shown on this as-built substantiallyagree with the approved plan and have determined that the
break out elevations,if applicable,have been met."
Signature of Designer Date
b. "If a STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating
the wall- was, or was noticonstructed in accordance with the intended desirr and any
manufacturer's specifications."
Signature of Designer Date
As of:Tuesday,November 24,2015
• � Application for Septic Disposal System r l / ze, 1,5-
TODAY'S
,5-TODAY'S DATE
Construction Permit — TOWN OF
$250.0 —Full Repair
NORTH ANDOVER, MA 01845 o-component
Important: Application is hereby made for a permit to:
When filling out ❑Construct a new on-site sewage disposal system*
forms on the
computer,use '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? 1 %
cursor-do not t �l IL6
use the return A. Facility Information
key.
!�o Sys r✓ S
Address or Lot#
tab
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
➢ ❑ Pump ❑Gravity(choose one)
***If pump syst , attach copy of electrical permit to application***
➢ L&Conventional System (pipe and stone system)
➢ ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.)
➢ ❑ P essure Distribution S.A.S.(No D-Box)
);- essure Dosed(D-Box Present)S.A.S. /
➢ Eg"Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES=(no further info. needed)
NO=(installer must specify brand of filter before DWC issuance)
What is the Make? ¢���'t' [[What is the Model.
2. Owner Information
Name
Address(if different from above)
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
C t-a t� 3� u1 c a.✓S/. ) -3 S+<.
Name Name of Company
Address
City/Town State y Zip de
J
likephone Number(Cell PhoneI possible please)
4. Designer Information
57o Jai S "^
ion
NameN me of Co an '
iNt-) R0,011A "Y
Address �� � ►�, 1
City/Town State 003 Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
• Application for Septic Disposal System
Construction Permit - TOWN OF TODAY'S DATE
$250.00—Full Repair
NORTH ANDOVER, MA 01845 $125.00-Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: 'T 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. I understand that until a final Certificate of Compliance has been issued by
thisr 71th, the installed system is not approved.
t 2si cS
Name Date
AAi0'atfii n Approv B : ( oar f Health Representative)
� 6� aor�
Name Date
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached.P Yes V No
2. Project Ma ger Obligation Form Attached? Yes No
�l
3. Pump Ssy tem? `�o,Attach copy ofElectrical Permit Yes No
Applicant received c?jof
"Electrical InspectiS Notes for Septic Systems" Yes No
Handout?
4. Reviewed approvalletter, all paperwork received.? Yes No
Missing.
5. Foundation As-Built. ew construction only): Yes No
(Same scale as a roved plan)
6. Floor Plans?(new constructio only): Yes No
I
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) For plans by O U S 1—r -y-
(Engineer)
y(Engineer)
Relative to the application of
(Installer's name) And dated
rigtna ate
Dated t s i
o ay s ate With revisions dated Z(0
(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 (1'� inspection unless there is a retaining wall,which
should be done first. 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: healthdept aktownofnorthandover.com) from the engineer must
be submitted to the 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,l understand that only I may perform the work (other than simple 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 install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer,I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank, D-Box, pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer. I understand that I am solely responsible for the installation of the system as per the
apt2roved plans. No instructions by the homeowner_general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: Toda te)
(Name—Print) a e
app Jon
�p accomance wttn the provisions of TITLE 5 of e S ate Environmen)kI(lode as described in the
on for Disposal Works Construction Permit No. BHP-2015- Dated November 05 2015
Printed On:Nov-05-2015 ---------------------------------------------------------------
---------------------------------------------------------------------------------- BOARD OF HEALTH
•st�!'•e°`' Commonwealth of Massachusetts Map-Block-Lot
• 1003
07.D0
• ' BOARD OF HEALTH -- - - -7.
--------------
Permit No
North Andover BHP-2015-0899
FEE
$250.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Chad Jablonski
-----------
to(Repair)an Individual Sewage Disposal System.
at No 440
--BOSTON STREET Fit-E -Copy
as shown on the application for Disposal Works Construction Permit No. BHP-2015-089— Dated November 05 2015
'
Issued On:Nov-05-2015 ----------------------------------------------------------------
------------------------------------- ------------------------------------------- BOARD OF HEALTH
i
i
i
Department
Health De
North p
Community and Economic Development Division
October 27, 2015
Frank Villalobos
440 Boston Street
North Andover,MA 01845
Re: Subsurface Sewage Disposal System Plan for 440 Boston Street(Map 107D,Lot 3)
Dear Mr.Villalobos:
The proposed wastewater system design plan for the above site dated September 1, 2015 with a
final revision date of October 5, 2015 and received on October 5, 2015 has been approved.
The design plan has been approved for use in the construction of a new on-site septic system for
a 3-bedroom home utilizing a gravity leaching facility. This design plan approval is valid until
October 27, 2017.
During this time, a licensed septic system installer must obtain a permit and complete this work,
Certificate of Compliance be endorsed by the installer, designer and the Town of North
andaC
Andover. In the event an imminent health problem, such as sewage backup into the dwelling is
occurring,the North Andover Board of Health may reduce the time period for which this plan is
valid.
At a regularly scheduled meeting of the Board of Health, this plan received the following
approvals by the members.
Local Upgrade Approvals:
• To reduce the separation
distance from the soil absorption system to the estimated
seasonal high ground water table from 4' to 3'
• To reduce the separation distance from inlet and outlet tees to the high ground water
elevation from 12"to 10"
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
440 Boston Street October 27, 2015
This approval is also subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design
plan and/or soil evaluation,the originally issued Disposal System Construction Permit is
void, installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit(3 10 CMR 15.020(1))
2. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission,
Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical
Inspector. The issuance of a Disposal System Construction Permit shall not construe
and/or imply compliance with any of the aforementioned requirements.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
S I trely,
r
Michele Grant
Health Inspector
Encl. Installers list
cc: Doug Smith, RS
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
Grant, Michele
From: Grant, Michele
Sent: Thursday, October 15, 2015 3:05 PM
To: 'fsrv382@gmail.com'; 'SOILS MITH@aol.com'
Cc: Hadge, Lisa
Subject: Mtg Change
Hi Doug
Just letting you know the North Andover Board of Health meeting has been rescheduled from October 22, 2015 to
Tuesday Oct. 27`h, at 7:00pm in town hall, on the second floor, in the selectman's room.
Sincerely,
Michele E.Grant
Public Health Agent
Town of North Andover
1600 Osgood St I Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email merant@townofnorthandover.com
Web www.TownofNorthAndover.com
•P
x
r
1
Douglas J. Smith
R. Kate Smith
15 Foxbert y Drive
Neiv Boston, NH 003070 RECEIVED
(603) 487-2298 0 C 0 2015 O 1
Soilsmith@aol.com
TOWN OF NORTH ANDOVER
October 6, 2015 HEALTH DEPARTMENT
To: North Andover Board of Health:
Re: Variances for septic system located at 440 Boston St., Tax Map 107-D Lot 103 for
Frank Villalobos.
I would like to be put on the agenda for the Board of Health meeting on Oct. 22, 2015 to
discuss local upgrade variances.
The variances we are seeking are State DEP local upgrade variances:
1) 310 CMR 15.405(h) requesting a local upgrade approval for the requirement of a
4' separation between the bottom of the soil absorption and high groundwater
with a reported perc rate of 3 min per inch. This results in a l' reduction
resulting in the bed bottom being 3' above high groundwater.
2) 310 CMR 15.4050) Requesting a local upgrade approval for the requirement of a
12" separation between the inlet and outlet tees and high groundwater. A 10"
separation is provided for the septic tank and a 5" separation is provided for the
pump chamber. Rubber boots are provided on tank and pump penetrations.
I appreciate your consideration!
Sincerely,
Douglas Smith, RS, MS,CWS,SE
Grant, Michele
To: SOILSMITH@aol.com
Cc: Hadge, Lisa;fsrv382@gmail.com
Subject: RE: Revised pdf 440 Boston
Hi Doug,
Now that we have an approval plan to present to the Board of Health. I Just wanted to follow-up on our phone
co ersation this morning in regards to the 3 items that are needed to move forward.
1. Check for$75.00 made out to the Town of North Andover.
✓2. A Letter requesting to come in front of the Board. Listing the LUA's and why.
J3. 3 Copies of the Approvable Plan for our Board Members and the file.
Again, please call me with any questions you may have.
Sincerely,
Michele E.Grant
Public Health Agent
Town of North Andover
1600 Osgood St I Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email merant@townofnorthandover.com
Web www.TownofNorthAndover.com
From: SOILSMITH@aol.com [mailto:SOILSMITH@aol.com]
Sent: Tuesday, October 06, 2015 7:55 AM
To: Hadge, Lisa
Cc: Grant, Michele
Subject: Revised pdf 440 Boston
Hi Lisa and Michelle enclosed is the revision per the Sept. 30 comment letter Thank You!
3rgle
1
1,5,�7m6ex7
C7�osto�z, 9��0070
603-487-2298
i '
I
c = 1
•
•
F
i!
North Andover Health Depar ent
(ommunity and Economic Develo ent Division
September 23,2015
Douglas J. Smith,R.S. v
Soil Smith Designs
15 Foxberry Drive o� k
New Boston,NH 03070 ,
Re: 440 Boston Street(Map107%Lot 3)
Dear Mr. Smith: h'
The proposed wastewater system design plan for the above site dated September 1,2015 and
received on September 11,2015 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. r
On sheet 1 of 2,proposed finish grade contours need to be labeled.
The existing grade contours are different on sheet 1 (site plan view)and sheet 2(profile
view).
3.
On sheet 1 of 2,the exiting/finish grade above the pump chamber appears to be close to
the maximum 3' of cover material. A proposed spot grade elevation should be depicted
y / to ensure the maximum cover requirement is achieved.
/,/�4• On sheet 1 of 2,the approximate location of the existing system is not shown(NA 3.2).
V 5. On sheet 2 of 2,the pump performance curve graphic detail was blank.
The On and Alarm float heights are different on sheet 1 (11"& 16.5") and sheet 2(11.5"
& 16"). l(o'' 1 S covoevfi
VSoil and percolation tests results ijeed to be submitted on the most current DEP forms 11
and 12 (NA 2.3) 2 V-% OVA
8.
Specifications for the sand fill are required(3 10 CMR 15.255(3)).
9.
On sheet I of 2,the Typical End Cross Section indicates the removal of the topsoil &
organic material. It appears the Bw layer will need to be removed as well. Please clearly
indicate on the design plan the soil layers that are being proposed for removal,
. A weep hole in the force main pipe is required to allow drain back to the pump chamber.
I
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover,MA 01.845 Phone: 978.688.9540 Fax: 978.688.8476
f
1/1- Please indicate design ESHWT on the design plan. It appears to be 96.52' based on the
test pit logs.
L2.Although not a reason for disapproval you may wish to consider the following
Based on the proposed elevation of the distribution box outlet(100.19)and leach
field inlet(100.17)the longest line(8'+/)will have a slope of 0.002. You may
wish to consider providing a minimum slope of 0.01.
kAg �-CeYA Onv�-w
v
Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any
questions you may have. We look forward to working with you to obtain a wastewater treatment
and dispersal system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
iiicerely,n ("
C
Michele Grant
Health Inspector
i
cc: Frank Villalobos
File
i
I
1
1
i
1
p
1�
r
f
E
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 0 1.845 Phone: 978.688.9540 Fax: 978.688.8476
4
4
Commonwealth of Massachusetts4-OVER
City/Town of North Andover 01 0 5 2015
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
OWN OFNORTH ANDOVER
w HEALTH DEPARTMENT
A. Facility Information
Frank Villalobos
Owner Name
440 Boston Street map 107-D -lot 3
Street Address Map/Lot#
North Andover Ma 01845
City State Zip Code
B. Site Information
1. (Check one) ❑ New Construction ® Upgrade ❑ Repair
2. Soil Survey Available? ® Yes ❑ No If yes: Web soil Survey 421 B
Source Soil Map Unit
Canton
Soil Name Soil Limitations
till
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ❑ Yes ® No If yes:
Year Published/Source Publication Scale Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No
If Yes,continue to#5.
5. Within a velocity zone? ❑ Yes ® No
6. Within a Mapped Wetland Area? ❑ Yes ® No MassGIS Wetland Data Layer:
Wetland Type
7. Current Water Resource Conditions (USGS): Range: ❑ Above Normal ® Normal ❑ Below Normal
Month/Year
8. Other references reviewed:
t5forml l (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
Commonwealth of Massachusetts
City/Town of North Andover
a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: 1 8-20-2015 8:30 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 98.85 Latitude/Longitude: /
feet
Description of Location:
2. Land Use house lot few 4%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope(%)
grass/wooded
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 152'
feet feet feet
Property Line 41' Drinking Water Well 138' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 28" 96.52
inches elevation
t5form11 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 1
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-11" A 10YR3/3 sandy loam granular friable
11'-28" B 10YR6/6 sandy ;loam granular friable
28"-105" C 2.5Y6/4 28" 7.5YR5/8 5% loamy sand
Additional Notes:
t5forml 1 (2)frank north andover•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
i
C. On-Site Review (continued)
Deep Observation Hole Number: 2 8-20-2015 9:30 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 99.12 Latitude/Longitude: /
feet
2. Land Use house lot few 4%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
grass/wooded
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body none Drainage Way none Wetlands 112'
feet feet feet
Property Line 45' Drinking Water Well 124' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 30" 96.62
inches elevation
t5form11 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 2
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-11" A 10YR3/3 sandy loam granular friable
11"-25" B 10YYR5/6 sandy loam granular friable
25"-100" C 2.5Y6/4 30" 7.5YR5/8 loamy sand massive
Additional Notes:
t5form11 (2)frank north andover•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
City/Town of North Andover
R - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: 3 8-20-2015 9:30 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 98.85 Latitude/Longitude: /
feet
Description of Location:
2. Land Use house lot few 4%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
grass/wooded
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 152'
feet feet feet
Property Line 41' Drinking Water Well 138' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 28" 96.52
inches elevation
t5form11 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 3
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-13" A 10YR3/3 sandy loam granular friable
13'-28" B 10YR6/6 sandy ;loam granular friable
28"-92" C 2.5Y6/4 28" 7.5YR5/8 5% loamy sand
Additional Notes:
t5form11 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#1 Obs. Hole#2
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches
® Depth to soil redoximorphic features (mottles) 28" 28"
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh)
(USGS methodology) inches inches
Index Well Number Reading Date
Sh = Sc—[Sr X(OWc—OWmax)/OWrl
Obs. Hole# Sc Sr OWc OWmax OWr Sh
Obs. Hole# Sc Sr OWc OWmax OWr Sh
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: Lower boundary:
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5form11 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
�_L\ Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Board of Health Witness
Issac Rowe North Andover
Name of Board of Health Witness Board of Health
G. Soil Evaluator Certification
I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and in accordance with 310 CMR 15.100 through 15.107.
Sept 26, 2015
u e of Soil Eval or Date
Douglas Smith Ma SE 2267 6-30-2016
Typed or Printed Name of Soil Evaluator/License# Expiration Date of License
Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and
to the designer and the property owner with Percolation Test Form 12.
t5form11 (2)frank north andover•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
�L\, Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams:
t5forml 1 (2)frank north andover•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8
Y
Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
' Form 12
�M
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. 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
the local Board of Health to determine the form they use.
Important:When A. Site Information
filling out forms
on the computer,
use only the tab Frank Villalobos
key to move your Owner Name
cursor-do not 440 Boston Street
use the return Street Address or Lot#
key.
North Andover Ma 01845
" City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
august
202015 Time Date Time
Observation Hole# P-1
Depth of Perc
64"
Start Pre-Soak 10:18
End Pre-Soak 10:33
Time at 12" 10:33
Time at 9" 10:40
Time at 6" 10:49
Time
(9"-6")
9
Rate (Min./Inch) 9/3=3 min per inch
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Douglas Smith
Test Performed By:
Issac Rowe North Andover
Board of Health Witness
Comments:
t5form12.doc•08/15 Perc Test•Page 1 of 1
I
North Andover Health Department
Community and Economic Development Division
September 30, 2015
Douglas J. Smith, R.S.
Soil Smith Designs
15 Foxberry Drive
New Boston,NH 03070
Re: 440 Boston Street(Map107D, Lot 3)
Dear Mr. Smith:
The proposed wastewater system design plan for the above site dated September 1, 2015 revised
on September 26, 2015 and received on September 30, 2015 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 existing grade contours still are different on sheet 1 (site plan view) and sheet 2
(profile view). The profile view depicts an original and final grade of approximately 99.5
above the septic tank and pump chamber. This does not match the contours shown on the
sitelan view which depict existing grades of approximately 99.8-101.02.
p p gg Pp Y
2. The On float heights are different on sheet 1 (11 ) and sheet 2 (11.5 ).
3. On sheet 1 of 2, the design ESHWT is depicted as 99.52 instead of 96.52.
4. Although still not a reason for disapproval you may wish to consider the following:
Based on the revised proposed elevation of the distribution box outlet(100.18)
and leach field inlet(100.17)the longest line (8'+/-) will have a slope of 0.001.
You may wish to consider providing a minimum slope of 0.01.
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any
questions you may have. We look forward to working with you to obtain a wastewater treatment
and dispersal system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
i rel
Michele Grant
Health Inspector
cc: Frank Villalobos
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
• S�gTL-ED'y . r
•
1
North Andover Health Department ----
(ommunity and Economic Development Division
September 23, 2015
Douglas J. Smith, R.S.
Soil Smith Designs
15 Foxberry Drive
New Boston,NH 03070
Re: 440 Boston Street(Map107%Lot 3)
Dear Mr. Smith:
The proposed wastewater system design plan for the above site dated September 1, 2015 and
received on September 11, 2015 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. On sheet 1 of 2,proposed finish grade contours need to be labeled.
2. The existing grade contours are different on sheet 1 (site plan view) and sheet 2 (profile
view).
3. On sheet 1 of 2,the exiting/finish grade above the pump chamber appears to be close to
the maximum 3' of cover material. A proposed spot grade elevation should be depicted
to ensure the maximum cover requirement is achieved.
4. On sheet 1 of 2,the approximate location of the existing system is not shown (NA 3.2).
5. On sheet 2 of 2, the pump performance curve graphic detail was blank.
6. The On and Alarm float heights are different on sheet 1 (11" & 16.5") and sheet 2 (11.5"
& 16").
7. Soil and percolation tests results need to be submitted on the most current DEP forms 11
and 12 (NA 2.3)
8. Specifications for the sand fill are required (3 10 CMR 15.255(3)).
9. On sheet 1 of 2,the Typical End Cross Section indicates the removal of the topsoil&
organic material. It appears the Bw layer will need to be removed as well. Please clearly
indicate on the design plan the soil layers that are being proposed for removal.
10. A weep hole in the force main pipe is required to allow drain back to the pump chamber.
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
11. Please indicate design ESHWT on the design plan. It appears to be 96.52' based on the
test pit logs.
12. Although not a reason for disapproval you may wish to consider the following:
Based on the proposed elevation of the distribution box outlet(100.19) and leach
field inlet(100.17)the longest line (8'+/-) will have a slope of 0.002. You may
wish to consider providing a minimum slope of 0.01.
Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any
questions you may have. We look forward to working with you to obtain a wastewater treatment
and dispersal system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
af�cerely,,�
Michele Grant
Health Inspector
cc: Frank Villalobos
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Frank Villalbos
Owner Name
440 Boston Street 107.D Lot 3
Street Address Map/Lot# RECEIVED
Haverhill Ma 01830
City State Zip Code SEP 10 2015
Yf1wN OF NORTH ANDOVER
B. Site Information HEALTH DEPARTMENT
1. (Check one) ❑ New Construction ® Upgrade ❑ Repair
2. Soil Survey Available? ® Yes ❑ No If yes: 421-B
Source Soil Map Unit
Canton
Soil Name Soil Limitations
till
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ❑ Yes ® No If yes:
Year Published/Source Publication Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 500-year flood boundary? ❑ Yes ❑ No
If Yes,continue to#5.
Within the 100-year flood boundary? ❑ Yes ® No
5. Within a velocity zone? ❑ Yes ® No
6. Within a Mapped Wetland Area? ❑ Yes ® No MassGIS Wetland Data Layer:
pp Wetland Type
7. Current Water Resource Conditions (USGS): Aug 2015 Range: ❑ Above Normal ® Normal ❑ Below Normal
Month/Year
8. Other references reviewed:
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
Commonwealth of Massachusetts
City/Town of North Andover
r•
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: 1 August 20, !0:00 sunny
2015 Time Weather
1. Location
Ground Elevation at Surface of Hole: 98.85' Latitude/Longitude: /
feet
Description of Location:
2. Land Use existing house none 3
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
grass wooded
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 152'
feet feet feet
Property Line 40" Drinking Water Well 144' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 28" 96.52
inches elevation
.y
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
i
�_L_\ Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 1
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
&Stones
0-11" A 10YR3/3 sandy loam granular friable
11"-28" B 10YR6/6 sandy loam granular friable
28"-105" C 2.5Y6/4 28" 10YR5/8 5% fine I sand
Additional Notes:
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
�_L\_ Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 2 August 20, 2015 11:00 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 99.12 Latitude/Longitude: /
feet
2. Land Use house lot none 3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
grass wooded
Vegetation Landform Position on Landscape(Su,SH,BS,FS,
3. Distances from: Open Water Body none Drainage Way none Wetlands 112'
feet feet feet
Property Line 45' Drinking Water Well 121' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ❑ No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 30" 96.62
inches elevation
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
City/Town of North Andover
R Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 2
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
Stones
0-11" A 10YR3/3 sandy loam granular friable
11"-25" B 10YR6/6 sandy loam granular friable
25"-100" C 2.5Y6/4 30" 7.5YR5/8 5% loamy sand massive friable
Additional Notes:
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
�_L\_ Commonwealth of Massachusetts
City/Town of North Andover
a V Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#1 Obs. Hole#2
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches
® Depth to soil redoximorphic features (mottles) 28" 30"
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh)
(USGS methodology) inches inches
Index Well Number Reading Date
Sh= Sc—[Sr X(OWc—OWmax)/OWrl
Obs. Hole# Sc Sr OWc OWmax OWr Sh
Obs. Hole# Sc Sr OWc OWmax OWr Sh
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: Lower boundary:
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5form 11 North Andover frank 1 •rev.9/14 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
�_L\ Commonwealth of Massachusetts
Cityfrown of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#:_ Obs. Hole W
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches
® Depth to soil redoximorphic features (mottles) 28" t
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh)
(USGS methodology) inches inches
Index Well Number Reading Date
Sh= Sc—[Sr x(OWc—OWmax)/OWrl
Obs. Hole# Sc Sr OWc OWmax OWr Sh
Obs. Hole# Sc Sr OWc OWmax OWr Sh
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: Lower boundary:
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5form11 North Andover frank page 2•rev.9/14 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: 3 August 20, 11:00 sunny
2015 Time Weather
1. Location
Ground Elevation at Surface of Hole: 98.85' Latitude/Longitude: /
feet
Description of Location:
2. Land Use existing house none 3
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
grass wooded
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 142'
feet feet feet
Property Line 58" Drinking Water Well 152' Other
feet feet feet
4. Parent Material: till Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 28" 96.52
inches elevation
t5forml 1 North Andover frank page 2-rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 3
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Soil
Depth(in.) Layer Moist MunsellSoil Structure Consistence Other
y (Munsell)
Depth Color Percent (USDA) Gravel Cobbles Stones (Moist)
0-1311" A 10YR3/3 sandy loam granular friable
13"-28" B 10YR6/6 sandy loam granular friable
28"-92" C 2.5Y6/4 28" 10YR5/8 5% fine I sand
Additional Notes:
t5forml 1 North Andover frank page 2•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of North Andover
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.
August 20, 2015
Si ature of Soil E I for Date
Douglas J. Smith ma SE 2267 6-30-2016
Typed or Printed Name of Soil Evaluator/License#
Issac Rowe North Andover
Name of Board of Health Witness Board of Health
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 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams:
t5form11 North Andover frank 1 •rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. 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
the local Board of Health to determine the form they use.
Important:When
filling out forms A. Site Information
on the computer,
use only the tab Frank Villalbos
key to move your Owner Name
cursor-do not 440 Boston Street
use the return Street Address or Lot#
key.
North Andover Ma. 01845
� City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
Aug 20 2015 10:18
Date Time Date Time
Observation Hole# P-1
Depth of Perc
64"
Start Pre-Soak 10:18
End Pre-Soak 10:33
Time at 12" 10:33
Time at 9" 10:40
Time at 6" 10:49
Time(9"-6") 9/3= 3
Rate(Min./Inch) 3 min per inch
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Doug Smith
Test Performed By:
Issac Rowe
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test•Page 1 of 1
I{
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
978.688.9540—Phone
Susan Y.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthdept c,townofnorthandover.Ri
�d.CElV
WEBSITE:http://www.townofnorthandover.com En
SEPTIC PLAN SUBMITTAL FORM SEP 1 1 2015
R.ECEIMED NORTH ANDOVER
HEALTH DEPARTMENT
Date of Submission: e1P g 2O 15 SEP 10 2015
Site Location: y 0 6 os+ov) 5t p'eefi TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Engineer: �Dv�l S _ �✓>71-1 rso)Lsv-i'llt V1_S)
New Plans? Yes�225/Plan Check# (includes lst submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes V No
Local Upgrade Form Included? Yes V No
Telephone#: &D S g 2 2 g Fax#:
E-mail: O 1 L SVy) D VY)
Homeowner
NameFrwV -v1 "l V l t Iv-) L6 a s G1
SDS tl-Y) St0 -6�t V)0,4.0 ftvJ0t fA .I/ 10 0189 S
OFFICE USE ONLY
When the subm' sion is complete(including check):
{ ➢ Date stamp plans and letter
➢ Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
I
i
TOWN OF NORTH ANDOVER .
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
978.688.9540—Phone
Susan V.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthdet)!@townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM l
��� 1` �.•l .l
Date of Submission:
S-e •t 20 15
Site Location: H � 0 6 os•toy) S-fik eel-
Engineer: Duv�I I'9 S - �w�If" (so)LS
New Plans? Yes—Z$225/Plan Check# f/ /
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes V No l/
Local Upgrade Form Included? Yes V No
Telephone#: &O S 'i R-) 22-9 9 Fax#:
E-mail: 9 o i L SVv)L`f' ) ft-L - Co VV-)
Homeowner
NameFrzt+v, "l Vi l Iy4 LO6 6, s - t 7 O �0
6DSiC,) StA--est M-0-0 "UUeA 'MO 0194 S
OFFICE USE ONLY
When the submission is complete(including check): '
➢ Date stamp plans and letter
➢ Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of North Andover
a Form 9A - Application for Local Upgrade Approval
wM 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 forms 1. Facility Name and Address:
on the computer, p
use.only the tab Frank d Asbr-AS V B {I&I O DOS'
key to move your Name
cursor-do not 440 Boston St
use the return Street Address
key.
North Andover Ma 01845
Cityrrown 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. Describe Facility:
existing 3 bedroom house
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ❑ Conventional ® Other(describe below):
existing tank and system
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
unknown
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4
Commonwealth of Massachusetts
City/Town of North Andover
a
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: 330
gpd
Design flow of proposed upgraded system 330
gpd
Design flow of facility: 330
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:
1500 gallon 2 compartment tank, 1000 gallon pump chamber, and a 600 sq. ft. stone and pipe system
3. Local Upgrade Approval is requested for(check all that apply):
❑ Reduction in setback(s)—describe reductions:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
® Reduction in separation between the SAS and high groundwater:
1'
Separation reduction ft
Percolation rate 3
min./inch
Depth to groundwater
28"
i
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4
� i
Commonwealth of Massachusetts
City/Town of North Andover
Form 9A - Application for Local Upgrade Approval
M 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:
i
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 ora agent of the local approving authority.
5 PP 9 Y
High groundwater evaluation determined by:
Douglas Smith August 20, 2015
Evaluator's Name(type or print) Signature Date of evaluation
i
C. Explanation
j 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:
This will allow system to fit in desired location and fit the landscape nicely
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
this is the best option for this property
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•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:
A shared system is not feasibile
4. Connection to a public sewer is not feasible:
muncipal sewer is not 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 deliberate violations."
Facility Owner's Signature Date
FrankVittafts Vtilzlabos
Print Name
Doug Smith Sept 1, 2015
Name of Preparer Date
15 Foxberry Drive New Boston
Preparer's address City/Town
NH 03070 603 487 2298
State/ZIP Code Telephone
i
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4
c 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.
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 forms 1. Facility Name and Address:
on the computer,
use.only the tab Frank Walbms V i I I a(o koS
key to move your Name
cursor-do not 440 Boston St
use the return Street Address
key.
North Andover Ma 0
City/Town State Zipp Code
2. Owner Name and Address(if different from above):
Name Street Address
Cityrrown State
Zip Code Telephone Number
3. Type of Facility(check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
existing 3 bedroom house
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ❑ Conventional ® Other(describe below):
existing tank and system
6. Type of soil absorption system(trenches,chambers, leach field, pits, etc):
unknown
i
4
4
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4
I!
I
i
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 t
local Board of Health to determine the form they use.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
330
Design flow of existing system: gpd
gpd
Design flow of proposed upgraded system 330
gpd
Design flow of facility: gpdo
B. Proposed Upgrade of System
i
1. Proposed upgrade is(check one): j
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301:
date of inspection
f
2. Describe the proposed upgrade to the system:
1500 gallon 2 compartment tank, 1000 gallon pump chamber, and a 600 sq. ft. stone and pipe system
3. Local Upgrade Approval is requested for(check all that apply):
❑ Reduction in setback(s)—describe reductions:
i
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'
Percolation rate 3
min./inch
Depth to groundwater
28"
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4
I
Commonwealth of Massachusetts
City/Town of North Andover
„ F
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
1
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 evaluatormustbe a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Douglas Smith August 20, 2015
Evaluator's Name(type or print) Signature Date of evaluation
i
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:
This will allow system to fit in desired location and fit the landscape nicely
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
this is the best option for this property
i
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4
i
i
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. E
i
C. Explanation (continued)
3. A shared system is not feasible:
A shared system is not feasibile
4. Connection to a public sewer is not feasible:
muncipal sewer is not available
i
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
® Application for Disposal System Construction Permit
® Complete plans and specifications
® Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
I
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate,and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
i
i
Facility Owners Signature Date
FrankVHWbos VillalobOs
Print Name
Doug Smith Sept 1,2015
Name of Preparer Date
15 Foxberry Drive New Boston
Preparees address Cityrrown
NH 03070 603 487 2298
State/ZIP Code Telephone
i
t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4
i
I
�Z(O d �c�o.�e✓
Iii !
E I f
7
f
LL
4-1
! i
1
y 3
-
3
! ; I
1
s ,
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
Susan Y.Sawyer,REHS,RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX kn2ECEIVED
healthdeptAtownofnorthandover.com
www.townofiiorthandover.com k�0 I I NO
APPLICATION FOR SOIL TESTS TOM..-P�fAPRTH ANDOVER
DATE: MAP&PARCEL:
8/4/15 107D -3-0 HEALT-a QLP-ARTMENT
LOCATION OF SOIL TESTS: 440 BOSTON ST.
OWNER: FRANK VILLALOBOS Contact#: 978-681 -8698
Frank Villalobos SP 3
APPLICANT. Contact#:
440 Boston St. No. Andover, MA 01845 �"�'
ADDRESS: Q
ENGINEER: Douglas Smith Contact#: 603-487-2298
CERTIFIED SOIL EVALUATOR Douglas Smith
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing:X Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership(Tax bill,or letter from owner permitting test)
➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan)
➢ Fee of$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 A ent: U Q JA b f\ pro I v o'
g 1 I
�
Date back to Health Department: (stamp in):
g<<1 firma-i e C, PdC-es5 Cc'w V� I
A� -
N
Net l'oScn.6
,Vp
�
/ PLANT off' LAND
IN
MORT14 ANDOVF-R,MASS.
SCALE: +IN=50r'C. ApRiL.28,1962
4r GEORGE E.RAPES CIVIL ENGINEL:R
�0 101 ALTAMo•NT AYE. M£LROSS,MASS.
auFSEIIY L.. Sr,�T++
0 LOT i
a ga .95,09/a:F
G° 3 �w,vu.nrc.I °,r.8,19La oL 16.sa R.lhu.
s./ee/i Se?S +/
ID
J
S�
� ,...5?4 LOT 2
�£�9 3S�•c2X1'2
a s
I,
S.aa,
n yy ••, �n ss
Y
2,-, ""'a '�q22 'N°N ¢
�Qe
os fso.00
a, £g.Bd. 125.45 .=•�a.A
......o..
NORTH ANDOV£RPLANNING BOARD -.. 501-49-00e 275.45
APPROVAL UNDER SUBDIVISION CONTROL
L. C.�•. ON 5T REET
AW M/a�r REIR
QUED. O5 ,
DATE1 CJ
i
s cnrc An6
+ir'-