HomeMy WebLinkAboutMiscellaneous - 51 HAY MEADOW ROAD 4/30/2018 51 HAY MEADOW ROAU
210/104.B-0098-0000.0
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PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 5/21/15
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair of an
On-Ste Sewage Disposal System
p Y
By: Robert Daigle
At:
51 Hay Meadow Road
Map 104.B Lot 0098
North n over, MA 01845
,The I ce o this certificat 1 onstrue as a guarantee that the system will function satisfactorily.
r
Michele Grant
Public Health Agent
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
40RTN
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�SSACIN4
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: 1EVF2 �^lC LE
(Print Name)
Located at r71 kAy 1✓I�&7WA IP
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
g— ey- I t and last revised on O' — � ,with a design flow of
L{ f� 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: J'
Engineer Representative(Signature)
BHN z6-2015
70;
And—Print Name
Final Construction Inspection Date:
Engineer Representative(Signature)
I l)U F iIJG
And—Print Name
Installer: A, k,47 (Signature) Date:
v
A� � And—Print Name
Enginer: V�rluV 4!;L4 R/e�ignature) Date:
And—Print Name
1600 Osgood Street, North Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 web http://www.townofnorthandover.com
• S�TTCED'76y6
•
North Andover Health Department
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 51 Hay Meadow MAP: 104B LOT: 98
INSTALLER: Robert Daigle
DESIGNER: Merrimack Engineering
PLAN DATE: 8/18/14, Rev 10/1/14
BOH APPROVAL DATE ON PLAN: 10/7/14
INSPECTIONS
TANK INSPECTION: 11/20/14
DATE OF BED BOTTOM INSPECTION: 12/1/14
DATE OF FINAL CONSTRUCTION INSPE_TION: /5/14
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
® Contractor reports any changes to design plan
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
Comments:
SEPTIC TANK
® Building sewer in continuous grade, on
compacted firm base
N/A Cleanouts per plan
® Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading
® Monolithic tank construction
® Water tightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
(effluent filter)
® 24" inch cover to finish grade installed over
outlet access port
® Neoprene boots around inlet & outlet
Comments: He is deeper than it needs to be. Extra stone in bottom of hole.
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)
® Schedule 40 PVC Pipe
Comments:
SOIL ABSORPTION SYSTEM (General)
® Bottom of SAS excavated down to C soil layer,
as provided on plan
® Size of SAS excavated as per plan
® Title 5 sand installed, if specified on plan
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:
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand and Model of Chamber: Low Profile
Quick 4 Infiltrator Chambers
® Number of chambers per row: 11
® Number of rows (trenches): 4
Comments: Total Chambers = 44
m
FINAL GRADE
Loamed
[� Seeded
Cover per plan
Comments:
DOCUMENTS NEEDED
12/ Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
As-Built Plan
BM = 157.80
H R = 0.54
HI = 158.34
SYSTEM ELEVATIONS
ROD AS-BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark
Building Sewer OUT 6.00 151.99 151.75
Septic Tank IN 6.46 151.53 151.50
Septic Tank OUT 6.70 151.29 151.25
Distribution Box IN 6.88 151.11 151.00
Distribution Box OUT 7.04 150.95 150.83
Lateral 1 TOP 7.15
Lateral 1 INVERT 150.84 150.78
Lateral 2 TOP 7.15
Lateral 2 INVERT 150.84 150.78
Lateral 3 TOP 7.15
Lateral 3 INVERT 150.84 150.78
Lateral 4 TOP 7.15
Lateral 4 INVERT 150.84 150.78
Top of Chamber 150.64 151.17
Bottom of Bed/Chamberi 7.77 150.57 150.50
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
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).
s 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
'3l
Town of North Andover — Septic System - AS-BUILT CHEC IST
1) V All changes to the design plan have been reflected on the as-built
2) Is of suitable scale; (one inch =40 feet or fewer for plot plans and one inch = 20 or fewer for details of system
components)
3) Lot number,Street Name,Assessors Map and Parcel Number
4 Lot Lines and Location of Dwellings served b the system
Y Y
5) . Locations,Elevations and Dimensions of system,including reserve (if applicable)
6) _L/
Ties to dwelling or Permanent Structure&Wells
r' a. From Septic Tank&Distribution (D) Box
b. From Leach Area
�L' Ties to Lines from leach area (� L� `✓
8) 4 Lockions of Deep Holes&Peres
9) op of Foundation Elevation ('
10) /Loca
tions of Wells,Drains,Watercourses within 150 feet of system
r
11) of water,gas,electric lines,cable
--"° 12) /Location of Structures within 6 Inches of Finished Grade
13) Original Stamp&Signature
14) Location and holder of any easements which could impact the system
15) Impervious Areas;Driveways,etc
16) North Arrow
1' Location&Elevations of Benchmark used
18) STATEMENT ON PLAN (NA 5.3)
a. "I cert* e ocations, elevations, ties, cover rials exposed component covers etc.,shown on
this rlt substantially agree with the approved plana have determ at the brea o
evations,ifapplicable,have been met."
Signature of Designer Date
b. \ "If_a.STUCTURAI,J4zA��� RESENT(NA 4.9) Letter orstatemen s uiltlndica ' eII
wall- was or was not constructed m accordance wi the intended
design and any maufflacturer's
specifications."
Signature of Designer Date
As of:Friday,February 06,2015
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Commonwealth of Massachusetts Map-Block-Lot
104.60098
-----------------------
BOARD OF HEALTH Permit No
-12
-20
North Andover BHP1486
----P-20-4-12------
P.I. FEE
F.I.IMF $250.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Robert Daigle________
to(Construct)an Individual Sewage Disposal System.
at No 51 HAY MEADOW ROAD c
--------------------------------- --L
"L @as shown on the application for Disposal Works Construction PermitNo. B ----- Dated ----------------------
November 12,_2014
-------------------
Issued On:Nov-12-2014 BOARD OF HEALTH
F
RTx Application for Septic Disposal System
Construction Permit - TOWN OF TODAY'S DAT
ORTH ANDOVER MA 01845 $250.00—Full Repair
�,qwb+wr.o�PSS9 3 $125.00-Component
S$ACHty4B
Important: Apolicationis hereby made fora permit to:
When filling out
forms on the C struct a new on-site sewage disposal system*
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 A. Facility Information
Y
!�1
Vi I ria I t Adcress or Lot#
'"Int 164
I� City/T ',.
2.- *TYPE O SEPTIC SYSTEM*:
❑ Pump M Gravity(choose one)
***If pump system, attach copy of electrical permit to application***
❑ nventional 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 Dosed (D-Box Present)S.A.S.
2. Owner Information
Name
Address(if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information
Name Name of Compa
Iy
Address
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
4. Designer Information
NameamV� a of Company
4� : ZZ ,
Address
J 4 I F!V
City/Town ate Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
- ` ttiao7 Application for Septic Disposal System 1 1614
TOD 'S ATE
FConstruction Permit - TOWN OF
" $250.00-Full Repair
ORTH ANDOVER MA 01845
$125.00 -Component
TS,4C USS
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: �sidential 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 thi arqllhf Health.
Name Date
Application A7'T
y: (Board of Health Representativ
Name Dat
Applic , on �i�ap/proYedfor the following reasons:
For Office Use Only: /
1. Fee Attached. Yes v No
2. Project Manager Obligation Form AttacbedP Yes ✓� No
3. Pump Svstem? If so,Attach copy of Electfical Permit Yes No
4. Foundation As-Built?(new construction ronly): Yes Nh,
(Same scale as approved plan)
5. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover
®®licensed installer for the construction for the septic system for the property at:
(Address of sept ystem) For plans by
(Engineer)
Relative to the application of
(Installer' name) And dated
s
rigina ate
Datedtz A;
With revisions dated
oay
(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 (P) 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@townofnorthandover.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, 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 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
approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date) d 1,
ame— rint (Name—Signe
S�T3'�En7�c
North Andover Health Department
(ommunity Development Division
i
October 7, 2014
Ralph and Maureen Enos
51 Hay Meadow Road
North Andover, MA 01845
Re: Subsurface Sewage Disposal System Plan for 51 Hay Meadow,Map 104B,Lot 98
Dear Mr. and Mrs. Enos:
The proposed wastewater system design plan for the above site dated August 18, 2014 with a
final revision date October 1, 2014 received on October 3, 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.
The plan received the following local upgrade approval.
1) To allow only 1 deep hole in the disposal area rather than 2, as required by the code
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.
Per request, the building permit for this project shall be approved prior to the installation of this
system system, so the projects can be completed in the most efficient way, as well as to protect
the integrity of the new subsurface disposal system.
This approval is also subject to the following conditions:
1. Please keep the attached DEP Form 9b for your records (attached)
2. This system utilizes an infiltrator system and the owner has certified the
understanding of this system, as found in the document submitted(see attached)
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
51 Hay Meadow October 7, 2014
3. If site conditions are found in the field to be different from those indicated on the
design plan and/or soil evaluation, the originally issued Disposal System Construction
Permit is void, installation shall stop, and the applicant shall reapply for a new
Disposal Systems Construction Permit(3 10 CMR 15.020(1)).
4. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and
municipal requirements are met. These may include review by the Conservation
Commission,Zoning Board, Planning Board, Building Inspector, Plumbing Inspector
and/or Electrical Inspector. The issuance of a Disposal System Construction Permit
shall not construe and/or imply compliance with any of the aforementioned
requirements.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sincer ,
Su Y. Sa er, /RS
Public Health Dir or
Encl. Form 9B
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
Commonwealth of Massachusetts
City/Town of North Andover
F
Local Upgrade Approval
Form 913
'4M
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
i
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address
on the computer,
use only the tab Ralph and Maureen Enos
key to move your Name
cursor-do not 51 Hay Meadow Road
use the return
key. Street Address
North Andover MA 01845
City/Town State Zip Code
2. -Owner Name-and-Address (if differentfromabove)-:---_.--.- - - - --- -- -- ---- -----
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
x Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
gpd
5. System Designer: Vladimir Nemchenok PE ®RS
Name
66 Park Street Andover MA 01810
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for:
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%:
SAS size,sq.ft. %reduction
51 Hay Meadow Road Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
= w
City/Town of North Andover
a
Local Upgrade Approval
Form 9B
'4M
B. Approval (continued)
® Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft _
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
® Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
North Andover Health Dept
Approving Authority
Susan Sawyer October 7, 2014
Print or Type Name and Title Signature Date
51 Hay Meadow Road Local Upgrade Approval* Page 2 of 2
`� = \ Commonwealth of Massachusetts
f
City/Town of North Andover
Local Upgrade Approval
Form 913
iG^M
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address
on the computer,
use only the tab Ralph and Maureen Enos
key to move your Name
cursor-do not 51 Hay Meadow Road
use the return Street Address
key.
North Andover MA 01845
L City/Town State Zip Code
2. Owner Name and Address (if different from above):
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
x Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
9P
d
5. System Designer: Vladimir Nemchenok PE ®RS
Name
66 Park Street Andover MA 01810
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for:
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
51 Hay Meadow Road Local Upgrade Approval* Page 1 of 2
,Y
Commonwealth of Massachusetts
City/Town of North Andover
o Local Upgrade Approval
Form 9B
B. Approval (continued)
® Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate
min./inch
Depth to groundwater ft
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
® Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
North Andover Health Dept
Approving Authority
Susan Sawyer October 7, 2014
Print or Type Name and Title Signature Date
51 Hay Meadow Road Local Upgrade Approval* Page 2 of 2
ti
Blackburn, Lisa
From: Sawyer, Susan
Sent: Monday, September 22, 2014 2:00 PM
To: 'wrdufresne@comcast.net'
Cc: maural5l@verizon.net; Foster, Bill; Blackburn, Lisa
Subject: RE: 51 Haymeadow
Bill,
Our next BOH meeting is set for 9/29. It is next Monday night.
Our agenda closed on 9/19, however if you submit a request to be on the agenda,today, I will put the matter on. We
are having a hearing on tobacco regulations that starts at 7:15. If this issue gets put on, I can't promise to get it on
before the hearing starts however. Please just send an email requesting to be on the meeting for the purpose to request
a variance to the local regulation regarding the setback. Also, please get me the altered plans, showing the variance
request and the location of the tubes, so that I can get it to the board immediately for review.
I ca not approve this plan until the board has determined if reducing this setback is in the best interest of the septic
system, rather than simply complying.This is an addition to a home, not an existing structure,and therefore the granting
of this is not a given. That is for the members to decide.The good news is that I can tell the board that otherwise the
plan meets the minimum requirements of the code. You may want to add a narrative as to why you suggest the board
should be comfortable with this decision,when there is no need for it if they just change the plans, utilizing some of
your argument listed below. Possibly the homeowner or Bill Foster could represent themselves if you cannot make it.
Susan
From: wrdufresne@comcast.net [mailto:wrdufresne@comcast.net]
Sent: Monday, September 22, 2014 12:43 PM
To: Sawyer, Susan
Cc: maural51@verizon.net; Foster, Bill
Subject: Re: 51 Haymeadow
Susan
My oversight.
I Ithought the SAS had the same set back as a septic tank to a footing of 5 feet.I
9 p 9
I do not understand why the setback would be greater for a SAS than for a tank?
Title 5 has no required setback from a sono tube footing to a SAS or a tank, as it recognizes there is no
significance to maintaining a setback from a solid concrete footing to a septic system component as neither
poses any threat or impact on the other, but 5 feet is implied as the 5 foot clear area around a system would
automatically preclude anything within 5 feet of the SAS, as such, it is an unwritten setback of 5 feet, which is
what I always assumed was the premise for your local setback of 5 feet from a septic tank to a footing.
The only significance to having a setback from a solid concrete footing to a septic tank or SAS is to maintain
the structural integrity of the footing by not disturbing the soil immediately surrounding the footing. This is no
more of a concern for the SAS than it is for a septic tank, so why is the requirement more for a SAS than for a
tank? In fact, the following are the facts, a 1500 gal tank is 5.67 feet deep and requires .75' of cover, and 6" of
stone beneath, as such, the MINIMUM depth of excavation for a tank is approximately 6.9'. The average depth
1
of excavation for a SAS is top and subsoil or on an average, 2-3'. The construction of a SAS poses far less
threat to the structural integrity of a footing than does an SAS.
With this said, I do not understand the reasoning behind your local requirement, but logistically I now
understand that the 10' setback does exist, so for the aforementioned reasons, I would like to request a waiver
or variance from your local regulations to allow a SAS to be T feet from a sono tube footing as Bill Foster from
Cote & Foster has informed me that they can cantilever the deck 2' feet beyond the underlying footing creating
a setback from the footing to the SAS of 7 feet.
I would like to further request that since you stated that the design is FULLY APPROVABLE, with exception to
this matter, that you sign off on the building permit application for the owner so that the may proceed with
Y 9 9p pp Y Y
construction of the porch and deck while the season still permits, with the understanding that the septic system
will be installed prior to them seeking an occupancy permit for the new room.
I appreciate your understanding and help in this matter.
Thank You.
Bill
i
From: "Sawyer, Susan" <ssawyer(cD-townofnorthandover.com>
To: "wrdufresne(a)-comcast.net" <wrdufresne(a�comcast.net>
Sent: Monday, September 22, 2014 7:40:36 AM
Subject: RE: 51 Haymeadow
Yes,that is correct,the leach field distance in our local regulation is 10 feet.On page 6 of the local regulation.
http://www.townofnorthandover.com/pages/nandoverma health/SepticRegs2010.pdf
I totally agree it is good to stay out of the 100, so what would you like to do?
Thanks
Susan
From: wrdufresneC-acomcast.net [mailto:wrdufresne@comcast.netl
Sent: Friday, September 19, 2014 1:41 PM
To: Sawyer, Susan
Subject: Re: 51 Haymeadow
Susan
I do not understand your comment.
Both the proposed porch and the deck are to be supported on sono tubes.
The SAS is proposed to be 5 feet from a deck which is supported on sono tubes.
Are you saying that the leach field has to be 10 feet from a sono tube?
2
The SAS was sited where it is in order to avoid filing with the Conservation Commission. If we move the SAS
further away from the house, work will occur which will require conservation Commission approval, as the
design stands, we are outside the 100 foot buffer zone with all work and therefore a Conservation filing is not
required, having to file would be a large expense and time delay to the owner.
Please advise.
Thanks,
Bill
From: "Sawyer, Susan" <ssawyer(cD-townofnorthandover.com>
To: "Bill Dufresne (wrdufresneCa comcast.net)" <wrdufresne(aD-comcast.net>
Sent: Friday, September 19, 2014 11:08:28 AM
Subject: 51 Haymeadow
Hi Bill,
The plan is fully approvable with one exception.
The field is now less than 10 feet to the footing. NA requires 10 feet to leach area.
You and the owner have options including; move the structure it back to the original footprint 10 feet away,change the
field configuration or move it back and cantilever a few feet as structurally possible. Or other as you may determine.
Didn't think that needed a formal letter.Once you decide;the plan is all set.
Thank you
Susan
Susan Sawyer
Public Health Director
Town of North Andover
1600 Osgood Street
Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email mailto:ssawyer@townofnorthandover.com
Web www.TownofNorthAndover.com
3
ELLEJ (:701 Ply
North Andover Health Department
(ommunity Development Division
July 8, 2014
Ralph Enus
51 Hay Meadow Road
North Andover, MA 01845
Re: Request to be on the Board of Health meeting agenda
Dear Mr. Enus:
This letter is an update on your application. The Health Department received your request. As
written,this request is granted by this department without the attendance of a meeting of the
Board of Health. I am sorry,but I inadvertently used one incorrect word in my previous letter
that led you to believe you needed to see the board. The word installation should be plan
approval.
"Any other request, beyond what is described above, in regards to starting building prior to
plan approval, would require an appearance before the Board of Health and the approval of an
agreement between the BOH and the applicant. "
There is no need for you or your building contractor to come to the July monthly meeting.
I understand the soil tests will takeY
lace on Jul 16''. Once received,the septic plan will be
p
reviewed. Once this plan is approved, the Health Department will sign the Form"U" application.
The Building Department will then contact your contractor to let them know it is ready to move
forward.
Sincerely
Susan Sear,, /RS
Health hecto
Cc: Building Department
Cote and Foster
Page 1 of 1
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
RECEIVED
Jt�� 07 2014
TOWN OF NORTH ANDOVER
Susan Sawyer, Health Director
HEALTH DEPARTMENT
North Andover Department of Health
1600 Osgood Street,Bldg. 20, Suite 2-36
North Andover, MA 01845
Dear Ms. Sawyer,
This purpose of this letter is to request the issuance of a building permit for the
construction of a 3 season room and deck at 51 Hay Meadow Road after the approval of a
septic system design but before the actual installation of said septic system. We (Ralph
R. Enos and Maureen A. Enos)pledge that the septic system will be installed as soon as
possible once the design has been reviewed and approved. Please put this request on the
agenda for your July 24 thmeeting and let me know if my attendance is required.
Regards,
Ralph R. Enos Maureen A. Enos
cc: Bill Foster, Cote and Foster
North Andover Building Department
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(a townofnorthandover.com
WEBSITE:htW://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: tj` MZZ,�-1 4
Site Location: E7 �
Engineer: 1
New Plans? Yes U $225/Plan Check# 94- (includes 1St submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? Yes ✓ No
Telephone#: )�J 5'2 C2Z k;?d Fax#: �d������1 y�O
E-mail: (..I r7r0uPaCr✓fiL�l
Homeowner
Name:—
REGENED
OFFICE USE ONLY
hj;v 2 L 1(114
When the submission is complete(including check):
➢ Date stamp plans and letter TOWN OF NORTH ANDOVER
L.HEATH DEPARTMENT
➢ Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
e
t� Commonwealth of Massachusetts
City/Town of
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.
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 REQ VED
Important:
When filling out 1. Facility Name and Address: AUG 2 2 2014
forms on the
computer, use Ralph Enos Residence nrovaq C NORTH0100VER
only the tab key Name HEALTH DEPARTMENT J
to move your 51 Haymeadow Road
cursor-do not
use the return Street Address
key. North Andover MA 01810
City/Town State Zip Code
2. Owner Name and Address(if different from above):
SAME
Name Street Address
CityfTown State
(978)682-7617
Zip Code Telephone Number
3. Type of Facility(check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
3 Bedroom House
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Seepage Pits
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local Upgrade Approval
,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.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: 4 bdrm -600 gpd
gpd
Design flow of proposed upgraded system 440
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:
Total replacement(see plan)
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:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4
Commonwealth of Massachusetts
City/Town of
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
® Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
NA
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
NA
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval, Page 3 of 4
y Commonwealth of Massachusetts
City/Town of
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.
C. continued Explanation P (continued)
3. A shared system is not feasible:
NA
4. Connection to a public sewer is not feasible:
None Available
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
® Complete plans and specifications
® Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
z — 8-21-14
Facility Owner's Signature Date
Ralph Enos
Print Name
Bill Dufresne 8-21-14
Name of Preparer Date
66 Park Street Andover
Preparer's address City/Town
Ma/01810 (978)475-3555
State/ZIP Code Telephone
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 4 of 4
v 1}�
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
PErl5wn l
A. Facility Information
LRA AuG 2 2 2014
Owner Name
5ilTOWN OF NORTH ANQQVEt��.
HEALs
N PE
Street AddressNeap%Lot
Alia EZ HA i1845
City State Zip Code
B. Site Information
1. (Check one) ❑ New Construction grade ❑ Repair
2. Published Soil Survey Available? Yes ❑ No _ If yes: ®F4' 17 * I ' 15,;gap
/^�
l N9 Year Publi hed Publication Scale Soil Map Unit
6A o�
Soil Name Soil Limitations
3. Surficial Geological Report Available? ❑ Yes [ O If yes: Year Published Publication Scale Map Unit
Geologic Material Landform
4. Flood Rate Insurance Map
Above the 500-year flood boundary? Yes ❑ No Within the 100-year flood boundary? ❑ Yes ❑ No
Within the 500-year flood boundary? ❑.Yes ❑ No Within a velocity zone? ❑ Yes ❑ No
5. Wetland Area: National Wetland Inventory Map
Map Unit Name
Wetlands Conservancy Program Map Map Unit Name
7114
6. Current Water Resource Conditions (USGS): o th/Year Range: ElAbove Normal E2f Normal ❑ Below Normal
7. Other references reviewed:
Soil Evaluation Forms.doc-rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8
Commonwealth of Massachusetts
CityiTown of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
7t -
C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area)
Deep Observation Hole Number: Da 1(,,—
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 5�— Location (identify on plan): !�E L)
)
2. Land Use Gil P�,00rLA L.-,,' I Lo t
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones (
%)
b. HopAIky
r ` e
Vegetation Landform Position on Landscape(attach sheet)
9
3. Distances from: Open Water Body ee�� Drainage Way feet Possible Wet Area fee
Property Line feet Drinking Water Well feet Other feet
4. Parent Material: Unsuitable Materials Present: Yes ❑ No
If Yes: ❑ Disturbed Soil Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes If yes:
(6 � 5; Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: "' ;
inches elevation
Soil Evaluation Forms.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
r
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number:
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil
Depth(in.) Layer Moist(Munsell) (USDA) Structure 8 Structure Consistence Other
Cobbles Depth Color Percent Gravel (Moist)
Stones
7,-5 9;—I0 F**tv9
Additional Notes:
Soil Evaluation Forms.doc-rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used:
❑ Depth observed standing water in observation hole A. B.
inches inches
❑ pth weeping from side of observation hole A. B.
inches inches
B.
Depth to soil redoximorphic features (mottles) A. G�
inches inches
❑ Groundwater adjustment(USGS methodology) A. B.
inches inches
2.
Index Well Number Reading Date Index Well Level
Adjustment Factor Adjusted Groundwater Level
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. /Doesleast four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
on system?
❑ No 22
b. If yes, at what depth was it observed? Upper boundary: —'J� Lower boundary:
inches inches
Soil Evaluation Forms.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. 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.
IJ9,�/.,,z Q.-M X6 �� 197—
Signature o Soil Evaluator Date q
Typed or Prin ed Name of Soil Evaluator/License# Date of Soil Evaluator Exam
l o'I"-c tri" lH'tij,04vm) AUx/ePM
Name of Board of Health Witness Board of Heal
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.
Soil Evaluation Forms.doc•rev. 1/10 Form 11 –Soil Suitability Assessment for On-Site Sewage Disposal -Page 7 of 8
Commonwealth of Massachusetts
City/Town of
= Percolation Test
Form 12
GN
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: A. Site Information
When filling out
forms to the p q � p t`
computer, use [�#T�'f #T
only the tab key Owner Name
to move your r7171
cursor- not use Street Address or Lot#
key. urn ret
urn LN A o_ , HAI
City/Town 9'V)
Zip ode
0Z -7617
Contact Person(if different from Owner) Telep ohoh ne Number
B. Test Results
Date Time Date Time
Observation Hole# p�2
Depth of Perc rr
Start Pre-Soak (�I L
End Pre-Soak ( 2
Time at 12"
Time at 9"
Time at 6" r' d?2
Time(9"-6")
Rate(Min./Inch) I
Test Passed: Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Test Performed By:
0 fl, /'
Witnessed y:
Comments:
t5form12.doc•06/03 Perc Test•Page 1 of 1
X r
S�TTLED 7
EEcclp
North Andover Health Department
(ommunity Development Division
June 19, 2014
Ralph Enus
51 Hay Meadow Road
North Andover, MA 01845
Re: Application for 3 season vaulted room and deck
Dear Mr. Enus:
Your application for an addition at the above address has been reviewed by the Health
Department. Unfortunately, the application cannot be approved at this time for the following
reasons as notes with an"X":
1. X Missing information
2. Passing Title 5 inspection of septic system required
3. X Location of structure not acceptable with current information in the Health File
4. Undersized septic system (project has no increase I flow as proposed)
To address the problem(s):
If#1 is checked, please supply:
Certified scaled plot plan showing house, septic system in relation to the proposed addition.
If#3 is checked:
No permanent structures shall be placed on any part of the leaching area or over the septic tank.
The As-built in the file shows that the tank and one of the leaching pits may be too close to the
addition. The tank must be greater than five feet to any sono-tube. The leach pit must be greater
than ten feet to any sono-tube.
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
If there is doubt that the As-built as found in the Health Department is accurate, each component
of the septic system should be located. To properly locate the components you may hire a locally
licensed septic inspector.
For more information regarding the regulations regarding subsurface disposal systems, please
feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerel ,
an S er, S/RS
-Health Dire r
Cc: Building Department
Cote and Foster
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
1.
4 I
• SF,'f'1��76y6,
' .. rte.,•
• 1� FILE COPY
North Andover Health Department
(ommunity Development Division
July 1, 2014
Ralph Enus
51 Hay Meadow Road
North Andover, MA 01845
Re: update; Application for 3 season vaulted room and deck
Dear Mr. Enus:
This letter is an update on your application. I understand that Bill Dufresne of Merrimack
Engineering Services was at the property to identify the location of all the components of the
subsurface disposal system. I assume that he found your system in failure and in need of
replacement, as your contractor dropped off an application for a soil test. This will begin the
process to replace the full septic system.
I wanted to inform you that the protocol for our office is to not sign off on a building permit on a
until we are certain the site where the designer is testing, can sustain the proposed
property � g g� P P
septic system. This is in the best interest of all parties, so that all aspects of the installation,
including the costs, will be known.
Unfortunately, the location of the system was not identified at an earlier stage of the project
where it would have less impact on your building addition plans. The procedure for septic
replacement begins with soil testing, which takes place as soon as the parties are available;then a
plan is drawn by the designer and submitted for review. The review comes back usually within
14 days; but can by law take up to 45 days. Once the plan is approved a letter stating such will be
sent out.
You then would hire a locally licensed septic installer to do the system and after installation is
over the Health Department would sign the building application and the building could begin. If
the applicant wishes to request the construction of the addition, after the plan is approved, but
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
owl'
prior to the septic installation, you would submit in writing your agreed intentions of when you
promise to complete the septic system.
Any other request, beyond what is described above, in regards to starting building prior to
installation, would require an appearance before the Board of Health and the approval of an
agreement between the BOH and the applicant. The Board meets monthly and the next meeting
is July 24, 2014. To get on the agenda, the request must be put in writing and submitted by July
14tH
For more information regarding the regulations regarding subsurface disposal systems, please
feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerel
usana er, S/RS
ealth Director
Cc: Building Department
Cote and Foster
File
N
Page 2 of 2
North An -
36,
ort dower Health Department, 1600 Osgood Street, Building 20, Suite 2
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
51 Hay Meadow
September 29, 2014 BOH Meeting
This is a home addition; neither the addition nor the septic system, are currently built.
Please read explanation of request by Bill Dufresne of Merrimack Engineering
Recommendations and facts from the Health Director
- The homeowner is removing an existing deck and addition. (as shown in the blue)
-the homeowner wishes to replace it with another deck and porch addition (as shown in orange).
This would have been a simple issue except the old septic system failure during the course of
approving this addition.
- The septic designer is determined to keep the septic system out of the 100 foot mark from the
wetland. The designer was not aware of our local regulation requiring a 10 foot distance from the
footing of a deck to the leach field(see the new tank and field in pink)
- The designer put the tube in at 7 feet away from the field and is requesting a variance of 3 fee
Public Health Concerns
1) why should the BOH grant a variance to the regulation when the project could be easily
changed to comply
2) what is the hardship that the owner will experience by either moving the field location?
Reducingthe size of the deck b 3 feet? Or other architectural opportunities
Y Pp
3 if the owner creates a hardship, is that reason to rant a local regulation
P g g
Note that the building addition is proposed to be constructed first; the sono-tubes will be put in
the ground and then the excavation of the field will be done. The excavation of the field will be
to the outer pink dotted line. The purpose of the 10 foot distance is to protect the structure in case
of excavation which could undermine the structure.
The applicant is creating a self-induced hardship. They are asking for a variance instead of
changing the deck or the leach field location.
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION uJ f� D
Print
PROPERTY OW ER ✓� Fl L.i0 A�/ IV,&r6
A,� 100 Year Old Structure yes o
MAP NO:AY-
�°ARCEL: ZONING DISTRICT: - Historic District yes no
Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 0 One family
`Addition 0 Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ Watershed District
❑Water/Sewer
ESCRIPTION OF WORK TO BE PERFORMED:
oiv' r-ALtL 7-E2--> 20 0 h'I
Identification Please Type or Print Clearly) �'
OWNER: Name: T��}Lp/J eh/US Phone:
Address: �l )4i)-C/MF-4'>° (-(j R D
CONTRACTOR Name:( 'D 7-EyPhone:
Address: D
Supervisor's Construction License: �J� 7 Exp. Date: 7A/
Home Improvement License: d `� d Exp. Date: 'Jl-
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � 19 - FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/owner Signature of contracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑
..-TYPE-OF=:SEWERAGEDISPOSAL
Public Sewer ❑ Swimming Pools ❑
Tanning/MassageBody Art ❑
Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc.. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
��evLe
DATE REJECTED DATE-APPR{VEft
PLANNING & DEVELOPMENT ❑
COMMENTS
.CONSERVATION Reviewed on Si nature
r �
! 1
COMMENTS (� �`� ��� tem
✓6.-e-d
i i t l y A- b2
HEALTH Reviewed on Nignature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlrecei t submitted Yes .
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Tovv : Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTML-*NT - Temp Dumpster on site yes no
Located at'l24 Mair Street
Fire Departmerii-sigriatu"re/date
COMMENTS_
TOWN OF NORTH ANDOVER "'' ,•.
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSETTS 01845
Susan Y.Sawyer,RENS,RS 978.688.9540–Phone
Public Health Director 978.688.8476–FAX
healthdeptng:townofnorthandover.com
www.townofnorthandover.com
APPLICATION FOR SOIL TESTS
DATE: MAP&PARCEL:
AP&PARCEL: �O
LOCATION OF SOIL TESTS:
OWNER:. i���_ /l Contact#:�4� r
OZ
7
APPLICANT: y �/ Contact#:
ADDRESS:
ENGINEER: Contact
CERTIFIED SOIL EVALUATOR: .1-v O'li`'r'o A
Intended Use of Land: Resident' Subdivision S' a amil ome Commercial
Is This: Repair Testing: Undeveloped Lot Te Upgra71-AXdd i t i o n:
RECEIVED
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM jUll 22014
TOWN OF NORTH ANDOVER
➢ Proof of land ownership(Tax bill,or letter from ower permitting test) DEARTH DEPARTMENT
➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) -
➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date. (D
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Signature of Conservation Agent. — (� t -6 �•- X
Date back to Health Department: (stamp in):
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Blackburn, Lisa
From: Dan Ottenheimer <dano@millriverconsulting.com>
Sent: Wednesday,July 16, 2014 4:55 PM
To: Sawyer, Susan; Grant, Michele; Blackburn, Lisa
Cc: 'Isaac Rowe'; Pam Lally
Subject: Soil testing witnessing - 51 Hay Meadow Road
Attachments: Soil Log - 51 Hay Meadow Road.PDF
Folks,
Attached please find my notes from the soil and percolation testing which was performed at this site.
Please note that the soil evaluator for the owner excavated deep observation holes and performed a percolation test in
the front yard first. When he could not achieve my concurrence that the water table needed for the design was where
he alleged,versus the 25" below grade which I indicated, he decided to also dig a test hole and a percolation test in the
backyard. I am comfortable and confident in my attached findings, though he was not happy with them.
I am telling you this because we essentially did two soil tests at this property and I would like to send an invoice to the
Town for the two. I arrived at the usual time to watch them dig test holes and percolation tests in the front yard, and
only when the percolation test was half over did they decide to scrap the front yard and move their work to the
backyard, at which time I waited while the holes were excavated,the percolation test hole dug, and the second
percolation test was run. Not that I minded any of it, but it did take twice the amount of time which it should have and I
think it fair to be compensated for that. Concur?
Please let me know if you have any questions.
Thanks,
Dan
�I1� l River
consulting
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Daniel Ottenheimer, President
Mill River Consulting, Inc.
6 Sargent Street
Gloucester, MA 01930-2719
978-282-0014 x 802
www.millriverconsulting.com
dano@millriverconsultine.com
Member: Massachusetts Association of Onsite Wastewater Professionals, Massachusetts Environmental Health
Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association
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SUMMARY OF INVERTS ► BUILDING TIES
SEWER ® FDTN. 151.90 BLDG. CORNER A I B C D � • THIS PLAN & CERTIFICATION 1S NOT
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SEPTIC TANK OUT 151.27 1 DIST. BOX _ 35.5129.0 — — j SYSTEM. IT IS A RECORD OF THE LOCATION
DIST. BOX IN 151.10 AND ELEVATION OF THEEXISTING EXISTING SYSTEM
DIST. BOX OUT 150.91 COMPONENTS.
INV. IN CHAMBER 150.82
BOTT. CHAMBER 150.53 "1 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.
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MARTHA MACINNIS COTE 4 FOSTER CONTRACTING Inc., PROPOSED NEW 3 SEASON ROOT"I
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