HomeMy WebLinkAboutMiscellaneous - 49 WINDSOR LANE 4/30/2018r
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PUBLIC HEALTH DEPARTMENT RECE:1
Community Development Division
TOWN OF NORTH ANDOVER JUL 2 '12014
SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION 1.TOWN OF NORTH ANDOVER
HEALTH DEPAPTRAChrr
The undersigned hereby certify that the Sewage Disposal System (constructed; ( ) repaired;
By:
(Print Name)
Located at: 41 ["ALk)
(Installation Address)
Was installed inconformancewith the North Andover Board of Health approved plan, originally dated
and last revised on �7^ Z� 14' , with a design flow of
gallons per day. The materials used were in conformance with those specified on the
approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local
regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on
the As -built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: 7— ` I
Engineer Representative (Signature)
And – Print Name ' 1
Final Construction Inspection Date:
[20 izn,�_;9tJi,
And – Print
Enginer• r 1LL u (Signature)
ly
Engineer Representative (Signature)
Date: 9— l & — I /
? And – Print Name
Date:
And – Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
NOTE** THIS PLAN & CERTIFICATION IS NOT
A WARRANTY OF THE SUBSURFACE DISPOSAL
SYSTEM. IT IS A RECORD OF THE LOCATION
AND ELEVATION OF THE EXISTING SYSTEM
COMPONENTS.
"I HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS -BUILT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
APPROVED DESIGNS PLANS.
SIGNATURE OFD SIGNER
(PAPER)
126.1
INSPE16ON1,-
s LEACH FIELD Pi7RT g !
,. 131x2 •� >"i �...-•-
r_
1500 Gam'' �~
SEP,,7 TANKS 1
SBM, t.F..142
520
pF.•19.
vD
Aj.
DA E
i�X
(43,714 S.F.)
150.00'
N
w
AS BUILT PLAN
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
To
NORTH ANDOVER, MASS. /49 WINDSOR LANE
CZ
AS PREPARED FOR
z
SANDRA GARRON TM:, 106D
n =
cm
DATE: 7-15-14 TL: 65 r!%6w__
no
� < :;z®
�'
—1n
SCALE: 1"=40'
0 20 40 80
X
MERRIMACK ENGINEERING SERVICES
66 PARK STREET
ANDOVER, MASSACHUSETTS 01810
N
w
of No R ry qti
p cn
�5
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 7/21/2014
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: Todd Bateson
At:
49 Windsor Lane
Map 106D Lot 65
North Andover, MA 01845
The Issuancgf this certificate shall not be construed as a guarantee that the system will function satisfactorily.
�d'sb Sawy
Public Heal
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
..
North Andover Health Department
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 49 Windsor Lane MAP: 106D LOT: 65
INSTALLER: Todd Bateson
DESIGNER: Merrimack Engineering
PLAN DATE: 5/8/14, rev. 6/16/14, 6/17/14
BOH APPROVAL DATE ON PLAN: 6/23/14
INSPECTIONS
TANK INSPECTION: 7/10/14
DATE OF BED BOTTOM INSPECTION: 7/9/14
DATE OF FINAL CONSTRUCTION INSPECTION: 7/16/14
DATE OF FINAL GRADE INSPECTION: -712, f/ !I
SITE CONDITIONS
Comments:
SEPTIC TANK
® Contractor reports any changes to design plan
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
X Building sewer in continuous grade, on
compacted firm base
❑ Cleanouts per plan
X Bottom of tank hole has 6" stone base
X Weep hole plugged
X 1500 gallon tank has been installed
H-10 loading
X Monolithic tank construction
® Water tightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
(gas baffle/effluent filter)
X inch cover to within 6" of finish grade
installed over one access port
X Hydraulic cement around inlet & outlet
Comments: MRC — Tank had rubber boots cast in place so no hydraulic cement
needed
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: very deep hole, soil changed in the hole, had to dig 8'deep, 60'Lx25',
50' from corner of the house
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
Vs -Built Plan
BM =
HR=
HI =
SYSTEM ELEVATIONS
ROD AS -BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark
Building Sewer OUT
Septic Tank IN
Septic Tank OUT
Pump Chamber IN
Pump Chamber OUT
Distribution Box IN
Distribution Box OUT
Lateral 1 TOP
Lateral 1 INVERT
Lateral 2 TOP
Lateral 2 INVERT
Lateral 3 TOP
Lateral 3 INVERT
Lateral 4 TOP
Lateral 4 INVERT
Lateral 5 TOP
Lateral 5 INVERT
Lateral 6 TOP
Lateral 6 INVERT
4.
Top of Chamber
Bottom of Bed/Chamber
MRC — all components built to proper elevation
SKETCH PLAN
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
1 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
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 10'
®
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
1 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
i
Commonwealth of Massachusetts
BOARD OF HEALTH
North Andover
P.I.
F.I.
Map -Block -Lot
106.D0065
Permit No
BHP -2014-0676
-----------------------
FEE
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd -Bate -son
--------------------------------------------------------------------------------
to (Construct) an Individual Sewage Disposal System.
at No 49 WINDSOR LANE
$250.00
--------------
----------------------------------------------------------------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. B 20
t ated,,,J� e 25, 2014
----- - ..,—_----:-�- r � -- - -----------------
14-067-�,,.-D
-----------------------------------------------------------------
Issued On: Jun -25-2014
—------------------------------------------------------------------------- BOARD OF HEALTH
,,:. •.,. AgnAication for Seatic Disposal System _a I1- (V
TODAY'S DATE
a Construction Permit —TOWN OF
NORTH ANDOVER, MA 01845 $125.00 - 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 �e,,,�
pair or replace an existing on-site sewage disposal system`
only the tab key ❑ Repair or replace an existing system component – What?
to move your
cursor - do not
use the return A. Facility Information e / RECEIVED
key. n�GCSJ !L N
VQ Address or Lot #
CitylTown TOWN OF NORTH ANDOVER 2: *TYPE OF SEPTJC SYSTEM*: HEALTH DEPARTMENT
➢ ❑ Pump Gravity (choose one)
—if pump sy m, attach copy of electrical permit to application
➢ [conventional System (pipe and stone system)
➢ ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.)
➢ ❑ Pressure Distribution S.A.S. (No D -Box)
➢ ❑ Pressure Dosed (D -Box Present) S.A.S.
➢ ❑ Does the system require an effluent filter? Yes_L,____� 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? What is dre Model?
2. Owner Information nn
Name p
Address (if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information
Name Name of C
Address '
v l�4
City/Town
4. Desianer Information
ENTERPRISES, INC.
MA 01810
State Zip Code
Telephone Number (Cell Phone # if possible please)
/'1 -et P •`M.+�I C �ivci:.� •r!.P r�.5-c �� l t' lU�-c f'l(��•�-�
Name Name of Company
G� P.�r./C 5�•
Address //
��1dyl g--City/Town
State Zip Code
j� e 3s-�
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
ApDlic
ri fnr Aa
PAGE 2OF2
is Disposal
= TORN
s� tem
F,
A, Facility. Information continued....
5. Type- of Buildin esidential Dwelling or []Commercial
B. Agreement
TODAY'S DATE
$.250.00 - Full Repair
$125.00 - Component
The undersigned agrees to.ensure the construction and maintenance of the afore -described
on-site sewage disposal system /n 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 this Board of Health.
Name Date
plc ion Appro d of Health Representative)
Name Date
Application Disapproved for the following reasons:
For Office Use Only:
1
Fee Attached.
Yes_
No
2.-
Projectllfariager Obligation Form Attached.
Yes_
No '
A:
Pu-rapp S.M em? Ifsoj Attach copy ofElecbrical Permit` .
Yes
No
4.
Foundation As Built.? (hew construction zonly),
Yes_
No
(Same scale as approved plan)
b
5.
FloorPlans? (hew construction only):
Yes_
No
Appifcatibn'tirvjssposal 5ysteri5•:Gon*rjdiori Pemtft Page 2 4f 2
As
daa.Nprtla nuc vas die ed t 31 tfor #t~td=tmt fol theaegtic system for.theprnpestyat:
k1i,,vd1So ,X—
(fids of septic optcm)
F;htive tss *.:ppf d*z cf:::�a
wktkues M= -Y— AAd dated. � g-_ / l/
WA sns dated
- - (J,adt revised ease}
I undesatand the following gb9gatians fot agement of -this praiec ,.
I. As tete raster, I am.obligat cd t cibtd& %li pet�tits and Bbard of f-Hezith appoved plans. to
pedo g any:WOA ca a � . n '
uk done. '
. As Clic iaatltlZcr;.I,#nust sash fo r =7 and 9111a9cdow, If hotneg contmctQ4 -project massages, or any
other person not o4odhtedWIffi stay 4601npiZy W inspect = and the syatein to not react, the.
ibcm tl:ree•a�ll.k� os�p�icAble. �' . , '
` Ae t ��i+ ,rte rte. hsev tdre stems r aroma r m t� d pt#o tlt� thc.apglsr bye Mvec.tiptts as
itttl Ied �t O.W T. 4,W AAMt;� A a# ty liiil�' e±d_n �titte�wFYnis i 1o1 E i1S�it[l4t�t'ifl.nf` t3lf �fUtws i�r eswwe�vJliwr.•..
gene, t# ss'a} tpn eta c is si=rioug tga3, v�h~ch• .
ah •be�dtmt t: 'bio �a fVr "ti
%%pWf.e ihapecton but does• not have to batt prep zit:
b i It of�► t clert e% sp cftoa for Ok74011N-thea, etc.
Aa -b ocb�idd QK (cam e-dt•io: frosa the es�Egirzeer mast
be itubtaiittrd ix►*hc Bot d'oflriaarl sft4t� � I'z.iit�t� W fords Specs a t ,sa I�stslie= Must
bepreca; r < far el s iaspe&dt?a, Va pump qt 'be readjr sty}• able to
cause puua4p.td ve�orlcd-isu to. .
C, — ftsouer utast s quot utspamoa Ia Wei docs not
. - h�vve #o be �n�ita. ` - •
4. As -the installer, -I undthat oidly IMyped%nn the '(Wt who 4 mwfivo) and IAtft-togtsired
aat�piete tiic ttiaa ofti trstx idast its #tit�ted isppiit<afYos foz istzttiatlon
n
5. Iia thesaat:Iliifs,�I uiiderr taad int I a die ons the;•perfo nu . ce of t faHowittg cogst ctioa .
Svc
�: DetemrlSr��o� �! die�� elevrt�arit ofiht r�eaevat�osr hss•bcrr: s�eacbea't .
A &speeithe ofthe'ssadandetnWeta be went
F�sffaspeettforr hp8rd o%a%ttlt sffarcosrstaltt
d ItWWMYoAOfuxEk, D - Pox) I POV.t M04 VW4 p=, I,P ChAuvber, rdtx4t&9 tmff Wd outer .
-
6.
Undetsianed i3ceascd Sentle-R etnAt: It'oc Date1-
-' ''' ..� a •.c:�idk5. ...
North Andover Health Department
Community Development Division
June 23, 2014
Mike & Sandra Garron
49 Windsor Lane
North Andover, MA 01845
Re: Subsurface Sewage Disposal System Plan for 49 Windsor Lane, Man 106D, Lot 65
Dear Mr. & Mrs. Garron:
The proposed wastewater system design plan for the above site dated May 8, 2014 with a final
revision date June 16, 2014 received on June 17, 2014 has been approved.
The design has been approved for use in the construction of a replacement onsite septic system
for a 4 -bedroom (max 9 -room) home. This plan is generally good for 3 -years from the date of
approval however, as this is for a repair system, this is reduced to 2- years.
During this time, a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover. In the event 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.
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
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
"49 Windsor Lane June 23, 2014
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.
Si e ely,
san Y.
ublic 14-6
Encl. Installers list
cc: Merrimack Engineering Services
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
Sawyer, Susan
From:
wrdufresne@comcast.net
Sent:
Thursday, June 19, 2014 3:27 PM
To:
Sawyer, Susan
Subject:
Fwd: 49 Windsor Lane
Susan
Please edit note #14 on the Subsurface Sewage Disposal System Plan prepared for Sandy Garron with a
revised date of 5-29-14, to say "NO WETLANDS EXIST WITHIN 130 FEET OF THE PROPOSED SYSTEM"
Thank You,
From: "Heidi Gaffney"<HGaffney(a)-townofnorthandover.com>
To: "wrd ufres ne(@-com cast. net" <wrd ufresne(a)-com cast. net>
Sent: Thursday, June 19, 2014 2:17:05 PM
Subject: RE: 49 Windsor Lane
Hi, I hadn't realized you had Norse visit, but yes, I believe the 130' estimate to be fairly accurate. I don't think you need
to revise the plan, but if you can send Susan an e-mail and just ask her to note it on the plan, that should be fine.
Thank you,
Heidi Gaffney
Conservation Field Inspector
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
Phone 978-688-9530
Fax 978-688-9542
Email hsaffnev@townofnorthandover.com
Web www.TownofNorthAndover.com
` O� NORTfr qti
A7
4
O p
b,SSAGIIUS£S1
From: wrdufresne0comcast.net [mailto:wrdufresne@comcast.net]
Sent: Thursday, June 19, 2014 2:44 PM
To: Gaffney, Heidi
Cc: Sawyer, Susan
Subject: Re: 49 Windsor Lane
Heidi
In response to the Board of Health's requirement that wetlands within 150 feet be shown on the plan,
I had Norse Environmental do a site visit and give me a verbal confirmation that no wetlands existed
within 150 feet. Subsequently I revised my plan stating no wetlands existed within 150 feet and I re-
submitted the plan to the BOH already.
In light of the fact that you also did a site visit and that your assessment is approximately 130 feet,
would you like me to revise the plan stating 130 feet or perhaps Susan would allow me an e-mail
authorizing an edit to 130 feet?
Please advise.
Thank You,
From: "Heidi Gaffney"<HGaffneyCcD-townofnorthand over. com>
To: "wrdufresne(aD-comcast. net" <wrdufresne(a)-comcast. net>
Cc: "Sawyer, Susan" <ssawyer .townofnorthandover.com>
Sent: Thursday, June 19, 2014 9:13:37 AM
Subject: 49 Windsor Lane
Hi Bill, For 49 Windsor Lane the wetlands are approximately 130 feet from the corner proposed system. We are not
confident that access/delineation permission would be granted by the owner of the land where the wetland is and
because it is far enough from the system for conservation regulation purposes that instead of requesting that you seek
permission we are comfortable with you adding a notation to the plan stating that wetlands are estimated to be
approximately 130' from the system. Instead of re -printing the plan, Susan has said that you can send her an e-mail
requesting her to make the edit on the plan on your behalf.
Heidi Gaffney
Conservation Field Inspector
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
Phone 978-688-9530
Fax 978-688-9542
Email heaffnev@townofnorthandover.com
Web www.TownofNorthAndover.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://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
�!
North Andover Health Department
(ommunity Development Division
May 29, 2014
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover, MA 01810
Re: 49 Windsor Lane, Map 106D, Lot 65
Dear Mr. Nemchenok:
t 1 ~.
i._.d . 1Y
The proposed wastewater system design plan for the above site dated May 8, 2014 and received
on May 15, 2014 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, the septic tank appears to be potentially less than 5 feet to the existing
deck footings. Please depict the location of the deck footings or request a variance from
Please sho all wetlands within 150 feet of the proposed soil absorption system (NA
3.2). If n etlands existing within 150 feet of the proposed soil absorption system then
plea ndicate this in a note on the design plan.
riser to within 6 inches of finish grade is required above the distribution box if greater
V hthan 9 inches below grade. Magnetic tape cannot be used as an alternative to providing a
\(V
/ riser. Please modify the note in the profile on sheet 2. If a riser is proposed above the
distribution box then please clearly indicate this requirement on the design plan.
Y4.'lease specify all system components shall be marked magnetic marking tape (310 CMR
5.221(12)).
5. It appears that the Bw layer is proposed to remain below the soil absorption system.
Please clearly indicate this on the design plan to assist the installer.
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
6. The height of the HDPE impervious barrier is depicted at the breakout elevation of the
low end of the leach field (136.4'). The breakout elevation at the high end of the leach
field (136.65') is not met on the northeast side (310 CMR 15.255(2)(d)).
/1D On sheet 1 of 2, note #11 indicates seepage pits to be abandoned. Please indicate the
approximate location of the seepage pits or modify the note accordingly.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sincerely ,,,-?
an Y. Savq, , RE S
Public Healt Direct
cc: Mike and Sandra Garron
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fat: 978.688.8476
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: healthdeptaa,,townofnorthandover.com
WEBSITE: http://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: 1; '-
Site Location: Lj I._ I ►� �®t7� L¢
Engineer:
��CC r
New Plans? Yes Z$225/Plan Check #_��(includes 1St ubmis�o�r e -
review only)
MAY 15 2014
Revised Plans?Yes $75/Plan Check # TOW OF NORTH ANDOVER
NEpLTH DEPARTMENT
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? /�-K Yes No
Telephone #: 62p) k7Z& Fax #:
E-mail: L,4 {W 2rj d ft X .� Cil
Homeowner
k
Name: I 1 � E Gt'LN- c*.s
OFFICE USE ONLY
When the submission is complete (including check):
➢ ✓ Date stamp plans and letter
➢ _iComplete and attach Receipt
Copy File; Forward to Consultant
➢ +,Enter on Log Sheet and Database
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Important:
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ISI
Commonwealth of Massachusetts
City/Town of
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.
A. Site Information /�
Il I" ��� % r/ A rC M(a�}
C.) J
Owner Name
41,
�� I �cz�,�c,►�t�
Street Address or Lot #
Citylrown State Zip Code
Contact Person (if different from Owner) �ele'p'hond'Number r
B. Test Results
Date Time
Observation Hole
Depth of Perc
Start Pre -Soak
End Pre -Soak
I I 0
Time at 12"
Time at 9"
I
Time at 6"
Time (9"-6")
Rate (Min./Inch)
E
Test Passed:
T tFHd❑
Date Time
Test Passed: ❑
—�� �U es ale Test Failed: ❑
r
Test Performed By:
Comments:
t5form12.doc- 06/03 Perc Test • Page 1 of 1
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
healthdept(&townofnorthandovor.comAPR G 4 2014
www.towno fnorthandover. coni'
APPLICATION FOR SOIL TESTS ,iEAt 7ti DFP'
DATE: MAP & PARCEL: 06D V /
LOCATION OF SOIL TESTS: 4q (� b �_ (✓
OWNER:�Z&W" 1fD A- Q -,y yContact #:. %7 1—
APPLICANT:
APPLICANT: 6A W c-, Contact #:
ADDRESS:
ENGINEER: If _(u r qi Contact #: (qg r5
CERTIFIED SOIL EVALUATOR: S(L L - C1 2 �D 97
Intended Use of Land: Reside ial Subdivision �i e Family H e Commercial
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No V '
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
8.5"x 11 " Plot Plan & Location of Testing (please indicate test nit sites on the Plan
➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of3$ 60.00 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
Signature of Conservation
c
Date back to Health Department: (stamp in):
o' L 1-k-
eL
L�J. o
N6P-A. .'GA2Ra 1J
Blackburn, Lisa
From: Isaac Rowe <irowe@millriverconsulting.com>
Sent: Thursday, May 01, 2014 10:50 AM
To: Blackburn, Lisa; Sawyer, Susan
Cc: 'Pam Lally'; irowe@millriverconsulting.com
Subject: RE: 49 Windsor Lane
Attachments: 49 Windsor Lane - Soil testing results 4-22-14.PDF
Susan/Lisa,
Please find attached the soil testing results for the above referenced property.
Sorry I thought this was already sent.
Please let me know if you have any questions.
Thanks,
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930-2719
Phone: 978-282-0014 ext.804
Fax: 978-282-1318
irowe@millriverconsultine.com
www.milIriverconsulting.com
-----Original Message -----
From: Blackburn, Lisa [mailto:LBlackburn(a@townofnorthandover.com]
Sent: Monday, April 14, 2014 8:27 AM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Subject: 49 Windsor Lane
Good Morning,
Please call Bill Dufresne to set up soil testing. Thank you.
-----Original Message -----
From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com]
Sent: Monday, April 14, 2014 8:25 AM
To: Blackburn, Lisa
Subject: Message from "ComDev-Health-Ricoh"
This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002).
Scan Date: 04.14.2014 08:25:29 (-0400)
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