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HomeMy WebLinkAboutMiscellaneous - 46 STANTON WAY 4/30/2018 (2) ❑ -44 STANTON UU4 _ p �.� COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 1/29/14 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Matthew Manning At: 46 Stanton Way Map 61 Lot 31 jT/'hli, North Andover, MA 01845 I�suance of this certificate shall of be construed as a guarantee that the system will function satisfactorily.hele Grant J Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com y} a i 0�'rry ur�Vc.ri i H ANDOVER HEAL-,' R'-P4-- - — - PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify at the Sewage Disposal System(qlconstructed;( )repaired; By: (PrintName) Located at: k0? 31 STA N 7 0&J WOO bs (Installation Address) Was installed in conformance with the North Andover Board of Health approved:plan,originally dated D,L2_0/3 and last revised on /�J�ZO�—� with a design flow of VQ 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: // 1.3 Engineer Representative(Signature) �C41-1iC( b �C�o qvle(� And—Print Name Final Construction Inspection Date: j Engineer Repres tative(Signature) CiI cl vme.(1 And—Print Name Installer:" (Signature) Date: And—Print Name Enginer i tore) Date: /21-12-/2,0 k 42 C-11 If S77i&X e-kl And-Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://Www.townofnorthandover.tom CL • S�gTL'Eb`y�a' • • Q�RAT'�AA�`t� North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 46 Stanton Way (lot 31) MAP: 61 LOT: 31 INSTALLER: Matthew Manning DESIGNER: Christiansen & Sergi PLAN DATE: 4/30/13 BOH APPROVAL DATE ON PLAN: 7/1/13 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 11/25/13 DATE OF FINAL CONSTRUCTION INSPECTION: 11/26/13, 12/6/13 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan N/A 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 N/A Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port tJ ® Outlet tee installed, centered under access port (gas baffle) ® 24" inch cover to within 6" of finish grade installed over one access port N/A Hydraulic cement around inlet & outlet Comments: Neoprene boots in tank DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) 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 N/A 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: want all paperwork on sand i SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers High Capactiy ® Number of chambers per row:10 ® Number of rows (trenches): 2 Comments: Total Chambers = 20 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer Erl"'As-Built Plan 11/26/13 BM = _118.59 HR = 2.52 HI = 121.11 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 7.72 113.04 113.06 Septic Tank IN 7.84 112.92 112.86 Septic Tank OUT 8.18 112.58 112.61 Distribution Box IN 8.54 112.22 112.17 Distribution Box OUT 8.70 112.06 112.00 Lateral 1 TOP 8.73 Lateral 1 INVERT 112.03 119.96 Lateral 2 TOP 9.30 Lateral 2 INVERT 111.46 111.46 i Top of Chamber Bottom of Bed/Chamber 10.09 / 10.59 111.02 / 110.52 111.00 / 110.50 f 12/6/13 BM = _118.59 HR = 1.00 Hl = 119.59 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Distribution Box IN 7.03 112.23 112.17 Distribution Box OUT 7.20 112.06 112.00 Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Top of Chamber Bottom of Bed/Chamber l{ i 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 Blackburn, Lisa From: Isaac Rowe <irowe@mill riverconsulting.com> Sent: Friday, December 06, 2013 10:00 AM To: Blackburn, Lisa Cc: Grant, Michele; Sawyer, Susan; irowe@millriverconsulting.com Subject: RE: Lot 31 Stanton Way Dan will be conducting the inspection today about 3pm. I will send along the updated inspection form after his inspection. Thanks, Isaac M.Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Wednesday, November 27, 2013 9:15 AM To: Blackburn, Lisa; 'Susan Sawyer(ssawyer@townofnorthandover.com)'; Grant, Michele Cc: 'Dan Ottenheimer'; 'Pam Lally'; irowe@millriverconsulting.com Subject: RE: Lot 31 Stanton Way Attachments: 46 Stanton Way Lot 31 Final inspection report.doc Susan/Lisa/Michele, Attached is the final inspection report for the above referenced property. All the elevations looked good but the d-box needs to be replaced as it was not H-20. This is a good example why the BOH has the engineer certify everything prior to the final inspection. I was there at the same time as the survey crew. In addition the d-box and piping was not installed upon my arrival so I had to wait about 30 minutes for them to finish the install.. too rushed. I told Matt that either myself or the Health Dept would contact him to set up an inspection. He wanted to do it today but considering the weather that was forecasted it did not seem logical. So this last inspection will,be beyond the construction season and not sure how you want to handle that? During the d-box inspection I would recommend elevations be taken again to verify that the d-box is installed at the correct elevation. Let me know how we should proceed and any questions. Thanks, Isaac M.Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 4umoy �D 4 a 1 Blackburn, Lisa From: Isaac Rowe <irowe@millriverconsulting.com> Sent: Monday, December 09, 2013 2:10 PM To: Blackburn, Lisa; 'Susan Sawyer(ssawyer@townofnorthandover.com)' Cc: 'Dan Ottenheimer'; 'Pam Lally'; irowe@millriverconsulting.com Subject: RE: Lot 31 Stanton Way Attachments: REVISED -46 Stanton Way Lot 31 Final inspection report.doc Susan/Lisa, Attached is the revised final inspection report for the above referenced property. Dan conducted the re-inspection of d-box on Friday and everything looked good. Let me know if you have any questions. Thanks, Isaac M.Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 I t s +1 d Yf tff� � #i,, rac 3 ;y �af"F M t�dlry'���j� )•t rM��.d Z 1i *3 ey � y�' ,�i , • 1+.�t s� � f y>` 5 aR d ��C k,��,�a4}1'�; �,, a ,�.��+F yA. NMI, L .. b 3 a 1 V fT J j�"}t y. �a_1`{1•-'`,y 4 i�4 ,�(��,� �i�' y, � p° Ft �ra(x� ? ,� �.7\y d` ,.1��,,:�� ��Y�''V+'� �'�•...,�' f� r -� � yjj f *f� i'n to Nli 14.1! w. � xi Commonwealth of Massachusetts Map-Block-Lot tet. ' 061.00016 ----------------------- BOARD OF HEALTH Permit No North Andover BNP-2o---1oa2 I FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT, Permission is hereby granted Matthew Manning __________________ to(Construct)an Individual Sewage Disposal System. at No 1679 OSGOOD STREET-____--__1_ _`Jl( V�1 -(-o-- . ... ........................... ------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2013-104 Date November 19,2013 ------------------------------ }r)V ---------- 4'.- --------------------------------------- I ssued ------------------------------------- Issued On:Nov-22-2013 BOARD OF HEALTH 4 A. Ir s. ► SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: Loi- 3 X Sa:� a,_ (Address of septic system) For plans by w1\k k` S-� Agin eer) Relative to the application of AA&ck l n� (Installers name) And dated -30 1 '3 � (uriigina ate Dated ldlq /X�� k711 / q ' 1-3 o a s ate With revisions dated (Last revised date) RECEIVED 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 approval plawlUl Q013 performing any work on a site. I must have the approved plans and the Permit 'nisi e,when ativ work is �.� hurt l it ANUOVER being done. HEALTH DEPARTMENT 2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager,oFany 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 mgy result in a$50.00 fine being levied against me and/or My company. a. Bottom of Bed—Generally,this is the first(VS inspection unless there is a retainingwall,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: healthdepatownofnorthandover.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 gradingis complete. Installer does not have to be on-site. 4. As the installer, I 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 allpersons 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, dump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: l y 3 (Today's Date) e-uj Mcul a, (Name—I-mint e—Signed) Application for Septic Disposal System ' Construction DATE Construction Permit — TOWN OF Ne: GIRTH ANDOVER, MA 01845 $ 250.00—Full Repair atNUse $125.00 -Component Important: Applicatiop is hereby made fora permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return key. A. Facility Information La$ 3l 50,,aa, o, wo��/ rd Address or Lot# _T r. AnAns)cK ' /iA City/Town 2.-*TYPE OF SEPTIC SYSTEM*: Nov 14 ?0,13 ❑Pump ErGravity(choose one) TOWN OF NQKCId ANDOVER ***If pump system, attach copy of electrical permit to application HEALTH DEPARTMENT El Conventional System (pipe and stone system) Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution.S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure`Dosec.(D-Box Present)S.A.S. t°-••> 2. Owner Information % ' 5 j?!L< Name Address(if different from above) e_a,S AR�O- Ao M A a I IS City/Town State Zip Code Telephone Number 3. Installer Information /M o,_kkk-,eG✓ Manek': +;6n Name Name of Company I c'e SS Address Sz AA6" /u l4 a 3 g? 3 City/Town State /` ?Zig C4�e —� Telephone Number(Cell Phone possible please) 4. Designer Information Name Name of Company 160 S:,M r" b� Address lAa.v,,_c h:l I /i/i A I q 30 City/Town State Zip Code C4 7 -373 - 0310 phone Nu ber(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 .. Application for Septic Disposal System ' TODM S DATE Construction Permit — TOWN OF $250.00—Full Repair OA'T'H ANDOVER MA 41845 ? $125.00 -Component R'SSACNiJSEt PAGE 2 OF 2 A. Facility Information continued.... 5. Tvpe of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. e Date Application proved By: (B and of Health Representative) It l � � 3 N; afion e Date A Disapproved for the following reasons: For Office Use Only: 1. Fee Attaclied? Yes No 2. Project Manager Obkoation Form Attacliedr' Yes No J pump Syste.m? Ifso, Attach copy of Electrical Permit Yes No 4. Foundation As-Built?(crew construction ronly). Yes No (Same scale as approvedplan) 5. Floor Plans?(hew construction only).• Yes No Application for Disposal System Construction Permit-Page 2 of 2 f� —Y Nofl�M Application for Septic Disposal system a+4, a4a TODAY'S DATE ° Construction Permit - TOWN OF ORT`H ANI�4VER 1VIA 01845 $250.00—Full Repair $925.00 -Component �SsrC,4 PAGE 2 OF 2 A. Facility-information-continued.... 5. Type of Buil_t11ng: [Residential Dwelling or❑commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of compliance has been issued by this Board of Health. �r a e �� Date Application proved By: (8 and of Health Representative) sit Name Date A ' ation Disapproved for the following reasons: Foro� ffice Uses 1. Fee Attached. Yes No 2, projectManVer Obkaation Form Attached. Yes No 3.. Pum p System? If so, Attach conn of Electrical permit Yes No 4. Foundation As-Buds?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor plans?(new construction only): Yes No Application for Disposal system construction Permit•Page 2 of 2 � A CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS cv, 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 Soil Borrow Management ' Title 5 sand at the Stanton Woods subdivision Date: May 7, 2014 Or g�Ct ppR�C (Note: revisions and new items are in blue text) 1. Sand that is intended to be used shall be stockpiled prior to sampling. Sand from each source location shall be placed in separate stockpiles for inspection and sampling. If during excavation the sand from a single source contains variations in color, consistency, or gradation a separate stockpile of each variant shall be made. A plan shall be prepared showing the locations of the stockpiles and the sources of the material. The project engineer (Christiansen & Sergi, Inc.) shall provide a base map to the site contractor/installer that the installer will update whenever sand is excavated, stockpiled, or moved. Copies of the updated plan shall be submitted to the Health Department within 48 hours of any new sand excavation, stockpiling, sampling, testing, or filling. i 2. Prior to the sampling of sand from a stockpile an inspection shall be made by ' the Health Department or their designated representative to ensure the consistency of the stockpiled material and to ensure that the sample is a valid representative of the material in the stockpile. The Health Department may authorize a representative of the site contractor/installer, such as the project engineer(Christiansen & Sergi, Inc.)to inspect and approve the sampling. 3. Samples to be tested shall be clearly labeled as to the source of the material and the location of the stockpile. 4. On-site sand shall not be used as the "System Sand" for the Presby Enviro- j septic systems to be constructed on Lots 1 and 4. t 5. If necessary, stockpiled sand shall be screened prior to placement in the disposal area to ensure that no material larger than 2 inches is present. f 6. If during the placement of sand in the disposal system it becomes necessary to use sand from two or more stockpiles an inspection shall be made by the design engineer, Health Agent, or Mill River Consulting prior to the placement of the sand from the second (or subsequent) stockpiles. i i i i i May 7,2014 7. A log book shall be kept by the site contractor/installer to document all activities relating to sand excavation, stockpiling, sampling, testing, and filling. Copies of all test results shall be kept in the log book. A copy of each new log entry shall be submitted to the Health Department within 48 hours of any new sand excavation, stockpiling, sampling, testing, or filling. 8. The Soil Borrow Management Plan will be incorporated into each DSCP issued for this project so it is acknowledged by the licensed installer as to the plan and procedures to be followed. 9. The site contractorrnstaller shall inform the Health Department which testing lab will be doing the testing prior to the sample being taken. 10. The Health Department will plan to take composite confirmatory samples at some or all of the onsite wastewater systems during installation. In addition to usual fees a regular"additional inspection fee" of$50 will be calculated per trip { to the site; along with the ongoing soil sample charges. Outstanding payment j shall be made prior to issuance of each Certificate of Compliance. 11. The installer is apprised that a Certificate of Compliance cannot be issued if a soil sample is taken at a particular onsite wastewater system until such time as i the laboratory results confirm compliance with Title 5 fill specifications. Failure will result in removal of all sand in that particular system bed. 1 7 i y3t f i I i I t i 3 0 Page 2 I STOCKPILE# STOCKPILE DATE(S) SOURCE LOT STOCKPILE LOT SEPTIC LOT 1 1112013 Lot 16-6 Lot I" Lot 16-6 LOT 16-2 3 412014 Lot 16.2 Lot 16-2 Lot 16-2 q1 4 x�'V 1 0 / 5 2 6 LOT 16-1 8 , 2 \ Y ( KEY I \ti " 1 SOURCE OF MATERI Tov,11yu F`+D ner. -f l Q1 STOCKPILE LOCATIO FILL(SEPTIC SYSTEM)LOCATION . LOT 16-4 PARCEL AO ONST CP WAY • K LOT 16 ` f u '', PARCEL B LOT 165 G SOIL BORROW PLAN LOT 16-7 � FOR LOT 16-8 STANTON WOODS IN 1 ' NORTH ANDOVER, MASS. LOT 31 SCALE:1"=80' ��� DATE:MAY 7,2014 REV: LOT 16-6 1 • S�TTGED 7� "f t. North Andover Health Department Community Development Division June 10, 2013 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for Lot 31 Saracusa Way (Map 61, Lot 31) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated April 30, 2013 and received on May 3, 2013 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please reference the Lakehi Coc chewick watershed in the notes on sheet 2 A 3.2). 2. Please demonstrate that a conventional system in compliance with 310 CMR 15.000 can be built on the site in order to use the Infiltrator Chamber system according to Section I(3) of the DEP General Use approval letter. An outline and brief description of a conventional system on the site plan is sufficient. 3. Please depict the percolation tests on the site plan(3 10 CMR 15.220(4)(1)). 4. Please add a note to the plan to indicate that a riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade. 5. Please indicate the model/brands of the septic tank and distribution box (NA 3.2). 6. The existing grade below trench 2 appears to be 108.4+/- at the high point. The ESHWT should be adjusted accordingly based on the existing grade elevation below trench 2 and the 36" ESHWT at TP 511-1. Although not a reason for disapproval it should be noted that only one test pit is below the proposed leaching facility but it appears that adequate soil testing was conducted adjacent to 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 the proposed leaching facility and the soil logs are consistent throughout the area with no refusal documented. 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. /Sincer awy HS/RS Public Health Director cc: Green& Company 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 a CHRISTIANSEN & SERGI, INC. 1PROFESSIONAL ENGINEERS AND LAND SURVEYORS CS160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.csi-engr.com fax 978-372-3960 June 19, 2013 Ms. Susan Sawyer CEIVED Public Health Director North Andover Health Dept. JUN 19 N13 1600 Osgood Street, Suite 2035 North Andover, MA 01845 VVN��NO � .ENT Re: Subsurface Sewage Disposal System Plan for Lot 31 Saracusa Way (Map 61, Lot 31) Dear Ms. Sawyer: We have revised the plan to address your 6/10/2013 comments. To facilitate the review of this information we have reproduced your comments, and our responses follow each comment in blue italics. 1. Please reference the Lake Cochichewick watershed in the notes on sheet 2 (NA 3.2). (Note 16 on Sheet 2 has been revised accordingly.) 2. Please demonstrate that a conventional system in compliance with 310 CMR 15.000 can be built on the site in order to use the Infiltrator Chamber system according to Section 1(3)of the DEP General Use approval letter. An outline and brief description of a conventional system on the site plan is sufficient. (The proof plan and associated calculations have been added to Sheet 1.) 3. Please depict the percolation tests on the site plan (310 CMR 15.220(4)(1)). (The Perc Test locations have been added to the Site Plan on Sheet 1.) 4. Please add a note to the plan to indicate that a riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade. (Note 5 has been added to the Distribution Box Detail on Sheet 2 to include this requirement.) 5. Please indicate the model/brands of the septic tank and distribution box(NA 3.2). (The manufacturer and model numbers of the septic tank and distribution box have been added to the details on Sheet 2.) 6. The existing grade below trench 2 appears to be 108.4+/-at the high point. The ESHWT should be adjusted accordingly based on the existing grade elevation below trench 2 and the 36" ESHWT at TP 511-1. (Trench 2 has been raised by 12 inches to provide the required separation to ESHWT.) I trust that this response and the revisions made to the plan fully address all of your comments. Please contact me if you have any questions. Very truly yours, Christiansen &Sergi, Inc. l Philip G. Christiansen CALCULATIONS FOR _��� / / F g y ` RECEIVE® CONVENTIONAL SYSTEM F,1/ �a JUN 19 2013 E �8� DPGE�G»E.,,e.00 ,rACR» auwEO � � L„O �O�`♦\ � BOXFORD NO l � THANDOVER F REGD ED AGE E c,` »�. LOCUS .. t \4� t m-. ` HEALTH DEPARTMENT 1"' y rRE»cres PRwnEO "`.,, - ��` NORTH e• L,R ___. » r»»or, sn+w�o \ `�._'+,,`` �..>:. 4 _ _ �` J D ANDOVER LEAC»wG N.EA PROwDED wsse '- _ J \ GFFAI­ LOCU MAP N LOT 16-5 ASSESSORS REFERENCE: MAP 61,LOT 31 CONVENTIONAL SYSTEM PROOF PLAN ZONING DISTRICT:R2 IN,FRONI RKDE RG.N1. ^ 2�/ ' Ql.,�s eiG c»aweERs s'SOwPVC.s-zara / LOT 31D Po -TGPG° . m- ^`( LOT 16-6 � .� i G GMR�o�y uE7 \ ♦♦ / 4 `T •ta. 'z� luv®c„a/e i \\ J»)u»GnRDEry ; P 41 ( g♦ �. �. : � ro r PR GRADE .,, ENING JOB 12 ' ueGER- -_ rpt _ �' "`+� "�.�< /r \ NJ®SEPTIC T/wXwLEr•„2.ee , O1i) •: Yry®SEPTIC iam GOTLET•,126t FE- ELI OF R. \♦ ♦♦♦` •—�\`�`� ,as _ De«\- _ - \\' / 1_ke. 4I \\ ,w I°zs raTEs sREErx �� \ IrvP.) ♦ ♦ ♦ \>r ,-\ \ �♦ i�`;' _ ^„2° / EX�STNc lF \\ C� \ 5 ♦♦� ♦` ♦ `� -__h\ W-^ / GMDE T,tEe xOlEE213. SNEET2 \\E ♦4`�\♦ 'Ar.�:1a ` - lae-t''\ \ \_'Le.�, 0 I E EDGE OF I�eW .� ♦; \\ \\ IRI ��l _��'J$ � ,ma° ,mm - R 'E—E eenrt10NiNn - - - - - I wEAps - ITF.Sl \ mPa ­Gr () / Ae /' GPNE PROFILE(TRENCH I) o� CROSS-SECTIONA-A wnF xEoT SO..or, C`\ a° vsR�rrx—1.z° _ vER.Icu scuE, z Jsizes I J A P �/ mP.l O1�E`Rs,D­l°�iwo `E,orE`:�Eia Ew `r='�E` ORwu `J SEPTIC SYSTEM DESIGN SHEET 1 OF 2 I ELEVATIONS PG N E F� `;J LOT 31 SARACUSA WAY '»GEF=sw�F ENGINEER I � i i SITE PLAN ,„w„ R / ro„ OF-EATSEF­-K­ 112. NORTH ANDOVER,MASS. Dw»ER EPEIG,Nr: 1-GALLON MOF NPE AT EEF­TANK SPEC REALTY TRUST A GREEN F.&COMPANY WETLANDS OFFSET NOTES: sERnc ramWOFFIREITI-0— 1. E­ Easr�i srRa»wre,m T� \FAo°NGAREAISX sG.—T Ron+r FES-FRONANA w,sGm-Er w�oF rNE<EP»r 1­5,. Ps tw ERGw T�EDGE OFwETFaVOG.r R O»THE GROu»p. 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ICH SNN4 BE ETOC%PLEOFJFNF OEOFTNEE%G TONANO FILLEDN sNMa B1e..111a S THEBOTTENOF THE NOLL BES rJED ANo REUTFreLY Gar,MLswot NOTeE LENGTHOFCNN R UTNE WATER TABLE ELEVATION G ABOVE THE ELEVATXN OF TIE Em NeeeeL Bis Toru NO.of c11ANBENs eoTroM OF TNEIXGVATXN.TIE E%GvnlpN srw.BE DEwnTEnEn n9 NELE55utY. eelaa xs 0� _,N, td-,xn C x.SY Ne MTS SEPTIC TANN USED ,bo GutON E. �' RVE"R BEFTIC iau WmPINGSCIEWLEISPECONMENOEDTO"vgO__E`._ Pan Pan.�l MlnMupvYM Pen:Reuc xNMYMBPee Yrn Olnvrm Wmr. Sowq®'� e. CALCULATIONS BELL PENS. SEMBYSMMLBEPERFORe1EDePERMNFODRERs ESMVT@ ee'NE00%1Dee., LEA.—AREA REaRREO• SPEGFICATTONS. 4a0oPD 10.TIOPorsF.S%sF T. THE WLL04+O SEWER BNL BEe'ECH.0 FVC PIPE SURRWNOFD ev A NNNUN OF W GRAVEL LWEDB. TIEREARE NO I" -ULE 111121111111 THE PROPOSED SYSTEM. ED a gxALr5188nxtBESUBMITTED TOTHEED BGRD GNEUTH FORAPPRWALFRIOR TOAxvPUCEEMENTSOF FkE .71 EFE?Mn GALLIX+-1 10. THE FLL UATEPoU USED 5HKLBEPIACED N ITMAYIMUMCOUPACTEDLFTS. 11. 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E FPTE TARN@TO BE NONFc`URECMSTNUCTXNAWD BwLLI BE Z ry. �N- I IR A RNGNTTNRwGNM.M1FADruRER55F��R:ATIwANDwARRANry �BE�N N� Ex°r.EEEONw`1r` ;ANoDw TEoIIFTHE-TTIB."DSNBOX II~ BAssEPARA �{I NORTH ANDOVER.MASS. i PLADEDNFELPROPERcowArnoN1sREOUIRED1oNmoPEs� 1 owNER PFLEANr _ oTnERWISE AOEOGTE. 'HA11NE CRwNOvnTNAspc elcN «+E SEs G.M.Z.REALTY TRUST " GREEN 8 COMPANY NNRDMOwE'F��E�:5ETTLING.TIESEP GTAFNSH „ EA PRO DEDNPaDTEE EG HENLE B FFLL. "EG F NWR N YBE TYPICAL CROSS SECTION NORTNA MO ERM B B N MP�-15 TNESEPTIDTAreLODYERs.o«.PIEDTRX15ArmPB,NGSN.ILBE�51Gr.EDA� IGNEDANDGONBTRucTEnSD�To QUICK-4 HIGH CAPACITY INFILTRATOR TRENCHES GwsmuCTEO 50AS TO n5TAN0AN ANTXTPATFDMNIuuN N-1.­NE. n-xOLOAONc. NOT TO SLUE �1 PROFESSIONAL ENGINEERS BLAND SURVEYORS GRADEISREO1uEOF,NEd5TRIBuipx CHRISTIs1NSENB SERGI,INC. y B. Bo%IS To1wvEGREATERTHA,.ISNGNEsoFDOLER ERnaBarz,o6050" ♦ S��VLED 1 6 ¢r��Al'EU Nl'�'`�h• North Andover Health Department Community Development Division July 1, 2013 Green& Company 11 Lafayette Road North Hampton,NH 03862 RE. Re: Subsurface Sewage Disposal System Plan for Lot 31 Saracusa Way Salem (Map 61, Lot 31) i Dear Applicant, I The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by the Christiansen& Sergi, Inc. dated April 30, 2013, and revised June 19, 2013. The design has been approved for use in the construction of a new 4- bedroom, on-site septic system. This plan is good for 3-years from the date of approval. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed b the installer, designer and the Town f p y g o North Andover. 1. Prior to the issuance of the Disposal Works Installers Permit, the applicant must submit a foundation as-built at the same scale as the approved plan. 2. Prior to the issuance of the Disposal Works Installer's Permit, the applicant must submit the floor plans of the home showing no greater than four bedrooms or a total of nine rooms. 3. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Page 1 of 2 North Andover Healtli Department, 1600 Osgood Street. Building 20. Suite 2035. North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Lot 31 Saracusa Way July 1, 2013 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. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerel Sus Y.Sa�r, S/RS ublic Heal Dir or cc: Phil Christiansen, PE file encl: Licensed Installers list I Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2035, ! North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Art form Architecture, Inc. 580 Greenland Rd, Portsmouth, NH 03801 603-431-9559 October 31, 2013 RE: Lots 31 and 16-6 Stanton Way To whom it may concern, Please be advised that the plans dated October 9 for Lots 31 and 16-6 Stanton Way and originally submitted with a dry stamp were prepared under my direction. An additional wet stamped set is being provided for your records. So that construction is not delayed and your records are satisfied while those wet stamped plans are in transit, please accept this letter as verification that they were prepared by a licensed architect. We will be provided wet stamps on future submittals. Please feel free to call me with any questions. _ Sincerely, V. t01u 3 i 7 c ��,J :�iG�Weny W ton, a ff% . MA license#30167 President, Art Form Architecture, Inc. • 5 TOED j • • North Andover Health Department Community Development Division November 4, 2014 New Homeowner 46 Stanton Way North Andover, MA 01845 Re: Your new home and your 4-bedroom septic system Dear Resident, Congratulations on your move to North Andover and on your new home. The North Andover Health Department has overseen the design approvals and installation of the septic system on your property and believes that it is important that you understand the details of the system that services your home. Enclosed is information on how to care for your septic system and notification of restrictions in case you intend on finishing additional spaces, which are currently designated as "unfinished space", in your home. The house plans that were submitted prior to construction of your home show multiple unfinished areas,but this system can only serve a 4-bedroom home (maximum 9-room). A home with this sized system,which as defined by the MA Department of Protection regulations 310 CMR 15.000,will have a maximum of a 9 rooms in total (not including bathrooms; laundry rooms etc). Therefore, according to our file, your home is currently at its maximum capacity in room number. This ass umesou did not finish more than y the plans originally identified. If you have gone over the approved number, a violation to MA DEP code may already exist. The multiple unfinished areas in your home are allowed by state code and are not counted until finished. The inclusion of this amount of square footage, as unfinished space, was discussed with your builder. The Green Co. chose to inform homeowners upon purchase,that if you plan on finishing any of the areas for living space, above the 9-rooms, the expansion of the septic system and the compliance with the code will be done by the new homeowner. No building permits,to finish additional rooms, will be supported unless compliance is achieved. If at any time you do plan to inhabit any of these multiple unfinished areas,please contact our office and we will be happy to discuss the options with you. i I i 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 46 Stanton Way November 4, 2014 As the homeowner, we want you to be fully informed on how disposal systems work. The document provided will help you care for your system. You can also access numerous guides to assist you on the MA DEP website, http://www.mass.gov/eea/agencies/massdep that will help you maintain your system in good working order, so it will protect you and the environment for many years to come. Finally, it is important to note that this septic system is not designed for use with a garbage grinder. Installation of a garbage grinder will cause damage to your septic system and will void any guarantees for its proper service by the septic installer from the date you install the grinder. We hope you are enjoying your new home in North Andover. The Health Department staff members are here to answer your questions on septic systems or any other Public Health related subject. Feel free to contact us. 7ublic ely, Sa er, HS/RS Health Director Encl. "Caring for your Septic System: A Reference Guide for Homeowners" North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 2 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 �. . Cq'ring for your Septic System I MassDEP Page 1 of 2 The Official Website of the Executive Office of Energy and Environmental Affairs t is Energy and Environmental Affairs 1t EEA Home > Agencies > MassDEP > Water Resources > Wastewater&Septic> Caring for Septic System:Reference Guide for Homeowner Caring for your Septic System: A Reference Guide for Homeowners __ .. .... Caring for Your Septic System ��• Water Resources (Conventional Septic System,Innovative/Alternative(I/A)System,or Cesspool) The accumulated solids in the bottom of the septic tank should be pumped out every three years to prolong the life of your system.Septic systems must be maintained regularly to stay working. r Neglect or abuse of your system can cause it to fail.Failing systems can cause a serious health threat to your family and neighbors, r degrade the environment,especially lakes,streams and groundwater, reduce the value of your property, A to Z Quick Links 1 • be very expensive to repair, li and,put thousand of water supply users at risk if you live in a public water supply watershed and fail to maintain your Water Resources Index. r- system. Be alert to these warning signs of a failing system: sewage surfacing over the drainfield(especially after storms), sewage back-ups in the house, lush,green growth over the drainfield, slow,draining toilets or drains, sewage odors. -77 •„ Inspection(pump aid)pats" - Fee h.r r5 •: Sc a.:t:r�§' x�rty �y inlet:sewage -." �}•F v� � _ Ovtlet:treafed enter from house �� wastavatergoes to distribution ^•�`- + -^•� bcx and drain field tMas a te"I Sludge I Tips to Avoid Trouble DO have your tank pumped out and system inspected every 3 to 5 years by a licensed septic contractor(listed in the yellow pages). DO keep a record of pumping,inspections,and other maintenance.Use the back page of this brochure to record maintenance dates. DO practice water conservation.Repair dripping faucets and leaking toilets,run washing machines and dishwashers only when full,avoid long showers,and use water-saving features in faucets,shower heads and toilets. DO learn the location of your septic system and drainfield.Keep a sketch of it handy for service visits.If your system has a flow diversion valve,learn its location,and tum it once a year.Flow diverters can add many years to the life of your system. DO divert roof drains and surface water from driveways and hillsides away from the septic system.Keep sump pumps and house footing drains away from the septic system as well. DO take leftover hazardous household chemicals to your approved hazardous waste collection center for disposal.Use bleach,disinfectants,and drain and toilet bowl cleaners sparingly and in accordance with product labels. DON'T allow anyone to drive or park over any part of the system.The area over the drainfield should be left undisturbed with only a mowed grass cover.Roots from nearby trees or shrubs may clog and damage your drain lines. http://www.mass.gov/eea/agencies/massdep/water/wastewater/caring-for-septic-system-re£.. 11/4/2014 Caring for your Septic System I MassDEP Page 2 of 2 DON'T make or allow repairs to your septic system without obtaining the required health department permit.Use professional licensed contractors when needed. DON'T use commercial septic tank additives.These products usually do not help and some may hurt your system in the long run. DON'T use your toilet as a trash can by dumping nondegradables down your toilet or drains.Also,don't poison your septic system and the groundwater by pouring harmful chemicals down the drain.They can kill the beneficial bacteria that treat your wastewater.Keep the following materials out of your system: NONDEGRADABLE& grease,disposable diapers,plastics,etc. POISONS: gasoline,oil,paint,paint thinner,pesticides,antifreeze,etc. Septic System Explained Septic systems are individual wastewater treatment systems(conventional septic systems,innovative/alternative(I/A) systems,or cesspools)that use the soil to treat small wastewater flows,usually from individual homes.They are typically used in rural or large lot settings where centralized wastewater treatment is impractical. There are many types of septic systems in use today.While all systems are individually designed for each site,most systems are based on the same principles. I A Conventional Septic System A conventional septic system consists of a septic tank,a distribution box and a drainfleld,all connected by pipes,called conveyance lines. Your septic system treats your household wastewater by temporarily holding it in the septic tank where heavy solids and lighter scum are allowed to separate from the wastewater.This separation process is known as primary treatment.The solids stored in the tank are decomposed by bacteria and later removed,along with the lighter scum,by a professional septic tank pumper. After partially treated wastewater leaves the tank,it flows into a distribution box,which separates this flow evenly into a network of drainfield trenches.Drainage holes at the bottom of each line allow the wastewater to drain into gravel trenches for temporary storage.This effluent then slowly seeps into the subsurface soil where it is further treated and purified (secondary treatment).A properly functioning septic system does not pollute the groundwater. For More Information For more information about maintenance or inspection of your septic system,contact your local board of health. Did you find the information you were looking for on this page? O Yes O No Send Feedback ©2014 Commonwealth of Massachusetts. - EEA Site Policies Contact EEA About EEA Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. http://www.mass.gov/eea/agencies/massdep/water/wastewater/caring-for-septic-system-ref... 11/4/2014 Blackburn, Lisa From: Sawyer, Susan Sent: Thursday, November 21, 2013 5:08 PM To: Grant, Michele; Blackburn, Lisa Cc: Isaac Rowe <irowe@millriverconsulting.com> (irowe@millriverconsulting.com); Dan Ottenheimer(dano@millriverconsulting.com) Subject: FW: Health Permit for Stanton Woods To all, Please read my email below first that is to a new installer who is doing the Saracusa.. now called Stanton Woods...subdivision. Dan and Isaac, maybe you know this company Dirt Pro and Matt Manning the installer?They are pushing the limits on our season. So this is an afterthought. If they do pull the permit tomorrow and agree to the Monday proposal.We will do the bed and tank holes.They may not be able to make the Wed. deadline and We do not work Friday, but maybe they would like to pay Mill River extra to do so on Fri or Sat. This is not a request per say,just a thought in case you really are working the holiday weekend.Some do. Thanks, Susan -----Original Message----- From: Sawyer,Susan Sent:Thursday, November 21, 2013 5:01 PM To: 'michael@greenandcompany.com' Subject: Health Permit -----Original Message----- From: Sawyer,Susan Sent:Thursday, November 21, 2013 5:00 PM To: 'Dirt Pro' Cc: Grant, Michele; Blackburn, Lisa; michael@greenandcompany.com Subject: RE: Copy of Licenses Matt, Unfortunately, I have to report that the fee has not been paid and I have not received your references. We also noticed you did not sign your application for your DWC application,which must be done. Though you applied for the permit prior to the 15th,the application has still not been completed. Our regulation states that permits will not be issued after the 15th but we were working with g p th ou in hopes for you to g Y p get at least one system in this year. Today is the 21st. Friday we close at noon. Next week is a holiday week; and we are closed Thursday and Friday, as I expect you are as well.And the 30th is Saturday which is when we request all work be done. 1 My administrative assistant and myself have contacted you more than once, and you have indicated your full intention to do the job in the time left. But you also stated to me that your priority was getting a couple more foundations in the ground rather than begin the system. This has now come to the critical point. It would be unfair to extend courtesies to you on your first installation and yet ask other installers to comply with the regulation. If you do not complete the process tomorrow morning, with the stipulation that the system installation will begin and the bed and tank hole will be ready for inspection on Monday and a final on Wednesday; I feel that you have not done your due diligence to comply with our regulation. Specifically, if you cannot agree to complying,the permit application will be held until March 1st. I have copied this to Michael,so that he understands that we have done our very best to help and we look forward to working with you all next installation season. Thank you, Susan -----Original Message----- From: Dirt Pro [mailto:matt@dubeplus.com] Sent:Tuesday, November 12,2013 12:59 PM To: Sawyer, Susan Subject: Fwd: Copy of Licenses Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 2 Grant, Michele From: Blackburn, Lisa Sent: Monday, November 25, 2013 2:31 PM To: Grant, Michele Subject: FW: Lot 31 Stanton Way(formerly Saracusa Way) From: Dan O'Connell [mai Ito:dano@csi-engr.com] Sent: Monday, November 25, 2013 2:30 PM To: Blackburn, Lisa Subject: Lot 31 Stanton Way (formerly Saracusa Way) Hi Lisa. Could you please forward this to Michele for me? I don't have her email address. t Michele,this is my understanding of how Dirt-pro would like to proceed: Matt will call you for a final bottom of bed inspection when they are finished with it later this afternoon. After you ok the bottom he will start to fill to the elevation of the bottom of the chambers with sand from Torromeo. He will not use the on-site material for fill under or around this system. The septic tank will be installed this afternoon as soon as it is delivered by Shea. He will install the chambers, piping, and d-box tomorrow as soon as the sand filling is complete. He will call you to set up the inspection with Mill River as soon as he is confident on the timing. Once the system is complete and we and Mill River have inspected and approved it, Matt will begin backfilling in an attempt to get as much covered as possible before the heavy rain on Wednesday. He will leave the d-box and the ends of the chambers and pipes uncovered so that we can do our as-built survey on Wednesday morning. After the as-built survey he will cover the remaining exposed areas. Let me know if you have any questions. Best regards, Daniel J. O'Connell, P.E. CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 Summer Street i Haverhill, MA 01830 Tel. 978-373-0310 Fax 978-372-3960 E-mail: dano(a)csi-en r.com www.csi-engr.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http:/lwww.sec.state.ma.us/pre/preidx.htm. 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New Plans? Yes XX $225/Plan Check# 3�(includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No XX Local Upgrade Form Included? Yes No XX Telephone#:978-373-03.10 Fax#:978-372-3960 E-mail: Phil@csi-engr.com Homeowner Name:SPEC Realty Trust Applicant: Green & Company, 11 Lafayette Rd, No.Hampton, NH 03862 800-429-8615 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 ECEIVED - H?AY 0 3 2013 TOWN OF NURTH ANDOVER HEALTH DEPARTMENT i No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH ZMAI - OF NORM ANDOVE1 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct O( Repair ( ) Upgrade ( ) Abandon ( ) - 'Complete System ❑Individual Components LOT 3/ SARACUSA WP/ -/ Location Owner's N me 34 ' 3 I 11 LAFAy&-7TF IZQ. N HAM"t 0 ,00 63F62— Map/Parcel# ® Address f-goo - 42! ' ?6 IS- Lot# Telephone# r_i+Rl Srir4 AJf S fW61 Ne- Installer's Name Designer's Name lbo stlm �E/L s /4ftVE91+/LC , NIA 0183 Q AddressAddress 9,jg-3_73 -0 316 Telephone# Telephone# Type of Building: 5,06L_a FAM I C.1/ Lot Size 47, 723 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder (�_o Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required). q4b gpd Calculated design flow gpd Design flow provided gpd Plan: Date 4 30 13 Number of sheets a Revision Date Title SEP776 S+ISTEM 1)ES166/ 6W2 LdT 31 SAO -CUSIg WAV &),A Description of Soil(s) FS – IVI S Soil Evaluator Form No. Db.J FIL67 Name of Soil Evaluators FO64evmn11e_4,- Date of Evaluation 6 q 1 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agr es ins above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furth n until a Certificate of Compliance has been issue a Board of Health. Signed Date 3 / RECEIVED Inspe ons f'nl i ,,.201,3 <TO v nnv ER HF. T >�r T FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ------------------------------------------------- ------ ---------- No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 i I i "Doug Brolin Construction Supervisor 603.379.8425 G R E E N 00 0- REAL ESTATE •oo• development • commercial • residential • brokerage 11 Lafayette Road(Rt. 1) doug@greenandcompany.com Mail: PO Box 1297 www.greenandcompany.corn North Hampton,NH 03862 Main:603.964.7572 Fax:603.964.7574 jGREEN&CO. :•:$REAL ESTATE development.commercial.residential.brokerage 603.964.7572 www.greenandcompany.com