HomeMy WebLinkAboutMiscellaneous - 53 WELLINGTON WAY 4/30/2018 (2)PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community and Economic Development Division
CERTIFICATE OF
COMPLIANCE
As of: 12/9/16
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Construction of an
On -Site Sewage Disposal System
By: Dave Maynard
At:
53 Wellington Wav (lot 3)
No
Pich�
uance of this certif ate 1le Grant
Public Health Agent
Map 105C Lot 86.
•th Andover, MA 01845
41 not be construed as a guarantee that the system will function satisfactorily.
120 Main St., North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov
PUBLIC HEALTH DEPARTMENT
RECEIVED
NOV 17 2016
Community Development Division TOWN OF NORTH ANDOVER
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TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System 00 constructed; ( ) repaired;
(Print Name)
Located at: we
(Installation
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
.S�- /�>� and last revised on �/ , with a design flow of
�-
6 640 gallons per day. The materials used were in conformance with those specified on the
approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local
regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on
the As -built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date:
Engineer Representative (Signature)
And – Print Name
Final Construction Inspection Date:
Engineer Representative (Signature)
And – Print Name
Engineer
And – Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.northandoverma.gov
Town of North Andover — Se 'c System - AS -BUILT CHECKLIST
1) /All changes to the design plan have been reflected and noted on the as -built plan
2) /// As -built plan has a suite scale, (1 inch40 feet or fewer for plot plans)
3) Street Address, Assessor's Map and Lot ✓Number
4) JLot Lines and Location of Dwellings served by the system
5) Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable)
6) Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure
Setback distances are shown on the as -built plan from system components to:
subsurface, interceptor & foundation drains
Catch basins
Property lines
Dwellings or other structures
,�`_—rivate water supply or irrigation wells
Watercourses or wetlands
8 V Locations of Wells Drains Wetland Resource Areas within 150 feet of system
> Y
9) JLocation of water, gas, electric lines, cable, control panel (if applicable)
10) nation of Structures within 6 Inches of Finished Grade
11) Original Stamp & Signature
12) Location and holder of any easements which could impact the system
,/
13) v Impervious Areas; Driveways, etc
14) /North Arrow
15) "./Location & Elevation of Benchmark used
16) V STATEMENT ON PLAN (NA 5.3)
Tran �—J6 ,
a. "I 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
breakout elevations, if applicable, have been met."
Signature of Designer
Date
b. "If a STUCTURAL WALL IS PRESENT (NA 4.9) a Letter or statement on the as -built indicating
the wall - was, or was not, constructed in accordance with the intended design and any
manufacturer's specifications."
Signature of Designer
Revised 3/17/15
Date
North Andover Health Department
Community and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 53 Wellington Way lot 3 MAP: 105C LOT: 86
INSTALLER: Dave Maynard
DESIGNER: Phil Christiansen
PLAN DATE: 5/23/16, revised 8/19/16
BOH APPROVAL DATE ON PLAN: 9/20/16
INSPECTIONS
TANK INSPECTION: 10/21/16
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION: 11/1/16
DATE OF FINAL GRADE INSPECTION: C D 1,70 ' LQ -
SITE CONDITIONS
Comments:
SEPTIC TANK
❑x Contractor reports any changes to design plan
N/A Existing septic tank properly abandoned
❑x Internal plumbing all to one building sewer
❑x Topography not appreciably altered
N Building sewer in continuous grade, on
compacted firm base
N/A 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
❑x Water tightness of tank has been achieved by
visual testing
❑x Inlet tee installed, centered under access port
0 Outlet tee installed, centered under access port
(gas baffle)
N inch cover to within 6" of finish grade installed
over one access port
x❑ Neoprene boots around inlet & outlet
Comments: Proposed change — bend in line from tank to d -box to 22 degrees
only (B.L.)
DISTRIBUTION -BOX
x❑ Installed on stable stone base
❑x H-20 D -Box
N/A Inlet tee (if pumped or >0.08'/foot)
• Hydraulic cement around inlet & outlets
0 Observed even distribution
N/A Speed levelers provided (not required)
N 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
N/A 40 Mil HDPE barrier installed
❑x Laterals installed and ends connected to
header (and vented if impervious material
above)
x❑ Elevations of laterals and chambers installed as on
approved plan
N/A Retaining wall (boulder / concrete / timber/ block)
❑ Final cover as per plan
Comments:
FINAL GRADE
Loamed
/ Seeded
p Cover per plan
Comments:
DOCUMENTS NEEDED
56 Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
9 As -Built Plan
BM = 131.16
HR = 8.92
H I = 140.08
SYSTEM ELEVATIONS
ROD
ELEVATION
AS -BLT INVERT DESIGN INVERT
ELEV ELEV
Benchmark
Building Sewer OUT
1.90
137.83 137.40
Septic Tank IN
2.78
136.95 137.02
Septic Tank OUT
3.00
136.73 136.77
Distribution Box IN
11.55
128.18 128.19
Distribution Box OUT
11.71
128.02 128.02
Lateral 1 TOP
11.73 /12.00
Lateral 1 INVERT
128.00 / 127.73 128.01 / 127.75
Lateral 2 TOP
11.75 /11.99
Lateral 2 INVERT
127.98 / 127.74 128.01 / 127.75
Lateral 3 TOP
11.75 /11.99
Lateral 3 INVERT
127.98 / 127.74 128.01 / 127.75
Bottom of Bed/Chamber
14.32
125.76 125.75
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
' Suction line 222(2)
z 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
'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
0
Property line
10
10 --
0
Cellar wall
10
20 --
0
Inground pool
10
20 --
N
Slab foundation
10
10 --
N
Deck, on footings, etc
5
10 --
0
Waterline
10
10 10'
0
Private drinking well
75
1002 50
0
Irrigation well
75
100
0
Surface Water
25
50
0
Bordering Vegetated Wetland ,
Salt Marsh, Inland / Coastal Bank'
75
100
0
Wetlands bordering surface
water supply or trib. (in Watershed)
150
150
0
Trib. to surface water supply '
325
325
N
Public well
400
400
N
Interim Wellhead Prot. Area
0
Reservoirs
400
400
N
Drains (wat. supply/trib.)
50
100
0
Drains (intercept g.w.)
25
50
0
Drains (Other) Foundation
10 (5)
20 (10)
N
Drywells
20
25
' Suction line 222(2)
z 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
'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
Commonwealth of Massachusetts
BOARD OF HEALTH
North Andover
Map -Block -Lot
----------------------
Permit No
BHP -2016-0300
-----------------------
FEE
DISPOSAL WORKS CONSTRUCTION PERMIT
$350.00
------------
Permission is hereby granted Dave Maynard
to (Construct) an Individual Sewage Disposal System.
atNo 53 Wellington Way--------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. BHP -20 ate d October 04, 2016
COPY
M-------------------------------------
Issued On: Oct -04-2016 BOARD OF HEALTH
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Aaalication for Seatic Disoosal Svstem
Construction Permit - TOWN OF TODAY'S ®ATE
NORTH ANDOVER, MA 01845 �35000II Repair
.$175.00 -Component
Application is hereby made fora permit to:
Construct a new on-site sewage disposal system*
❑ Repair or replace an existing on-site sewage disposal system*
❑ Repair or replace an existing system component —What?
A. Facility Information
Address or Lot #
City/Town
2.- *TYPE OF SEPTIC SYSTEM*:
> ❑ Pump Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
> conventional System (pipe and stone system)
> ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.)
> ❑ Pressure Distribution S.A.S. (No D -Box)
> ❑ Pressure Dosed (D -Box Present) S.A.S. /
>, ❑ Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES = (no further info. needed)
NO = (installer must specify brand of filter before DWC issuance)
What is the Make? What is the Model.
2. Owner Information
UD
N5me
Address if different from abo
City7%wn State Zip Code
em
Email address Telephone Number
3. Installer Information
JQv�
Name Name lam'
of ompany
a:z ,�vs>� .�<c
Address
reess
reJ
City/Town State Zip Code
92,F --2= 3 75- 72 2F
Telephone Number (Cell Phone # if possible please)
4. Designer Information
/14� .Sz
Name �+ Name of Company
/674
Address
f� 'V— ami ss az �3d
City/Town State Zip Code
97,? - 373 - 03 /D
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
• Application for Septic Disposal System
TODAY'S DATE
Construction Permit -TOWN OF
NORTH ANDOVER$350.00 -Full Repair, MA 01845 $175.00 - component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building:esidential Dwelling or ❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. I understand that until a final Certificate of Compliance has been issued by
this Board of Health, the installed system is not approved.
- /G — !f 20
Name
�
Nae Date
Appli log pr a y: (Board of Health Representative)
(d q 16
Nam Date
Application Disapproved for the following reasons:
For Office Use Only:
1.
Fee Attached.?
Yes
No
Z.
Project Manager Ohligation Form Attached?
Yes
No
3.
Pump System? If so, Attach copV ofElectrical Permit
Yes_
No
Applicantreceived copy of
"Electrical Inspection Notes for Septic Systems"
Yes
No
Handout?
4.
Reviewed approval letter, all paperwork received.
Yes
No
5. Foundation As -Built? (new construction only): Yes No
(Same scale as approved plan)
6. Floor Plans? (new construction only): Yes_ No
Application for Disposal System Construction Permit • Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
loY f '_5_3 ,y>A_;1
(Address of septic system) For plans by //� / -�rt >5 /i�¢ ''� �
(Engineer)
Relative to the application ofj$y /1%/;z yv�g A
(Installer's name) And dated
�(ZTguiaT3ate
Dated �a A L/ - 20 / 61
o ay s ate
With revisions dated S-19-146
(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 (V5 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@northandoverma.gov) 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 ofHealth 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) / b ^ 1/ _ 70 /!1
(Name — print(Name —Signed)
North Andover Health Department
Community and Economic Development Division
September 20, 2016
Messina Development Corp
277 Washington Street
Groveland, MA 01834
Re: Subsurface Sewage Disposal System Plan for 53 Wellington Way — Lot 3
(Map 105C, Lot 86)
To Whom It May Concern:
The proposed wastewater system design plan for the above site dated May 23, 2016 with a final
revision date of August 19, 2016 and received on August 30, 2016 has been approved.
i
The design has been approved for use in the construction of a new on-site septic system for a 6 -
bedroom (max 13 -room) home utilizing a gravity leach field system. This design plan approval is
valid until September 20, 2019.
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.
This approval is also subject to the following conditions:
1. Prior to the issuance of the Disposal Works Construction 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 Construction Permit, the applicant must
submit the floor plans of the proposed dwelling showing no greater than 6 bedrooms
or a total of 13 rooms.
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
53 Wellington Way — Lot 3
September 20, 2016
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�y,
Brian J. LaGrasse, CEHT
Director of Public Health
Encl. Installers list
cc: Philip Christiansen, P.E.
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
CHRISTIANSEN & SERGI. INC
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET, HAVERHILL, MA 01830
"- tel: 978-373-0310 www.csi-engr.com fax 978-372-3960
August 22, 2016
Mr. Brian LaGrasse
Health Director RECEIVED
Board of Health
1600 Osgood Street AUG 3 0 2016
North Andover MA 01845
TOWN OF NORTH ANDOVER
Re: Revision to SSDS plan for 53 Wellington Way HEALTH DEPA MENTr�_
Dear Brian:
Attached is a revised plan for the above referenced property. A septic system design for this lot
has been previously approved.
The revision is to provide for a system at a higher elevation and more fill over the system which
will allow for more fill in the backyard. The system was moved away from the lot line to allow
for the grading requirements to be met.
4Ver rul yours
Ph' - . Christiansen P.E.
r1�SniNeQ
�r�,�,��.�l1 o�� --
h�s;Lv_�u,cc��r✓�
North Andover Health Department
(ommunity and Economic Development Division
June 22, 2016
Messina Development Corp
277 Washington Street
Groveland, MA 01834
Re: Subsurface Sewage Disposal System Plan for 53 Wellington Way — Lot 3
(Map 105C, Lot 86)
To Whom It May Concern:
The proposed wastewater system design plan for the above site dated May 23, 2016 with a final
revision date of June 1, 2016 and received on June 2, 2016.has been approved.
The design has been approved for use in the construction of a new on-site septic system for a 4 -
bedroom (max 9 -room) home utilizing a gravity leach trench system. This design plan approval
is valid until June 22, 2019.
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.
This approval is also subject to the following conditions:
Prior to the issuance of the Disposal Works Construction 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 Construction Permit, the applicant'must
submit the floor plans of the proposed dwelling showing no greater than 4 bedrooms
or a total of 9 rooms.
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
53 Wellington Way — Lot 3
June 22, 2016.
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.
Sincerely,
4
B Zan J. aGrasse, CEHT
Director of Public Health
Encl. Installers list
cc: Philip Christiansen, P.E.
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
June 1, 2016
Mr. Brian LaGrasse
Director of Public Health
CHRISTIANSEN & SERGI, INC.
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET, HAVERHILL, MA 01830
tel: 978-373-0310 www.csi-engr.com fax 978-372-3960
North Andover Health Dept.
1600 Osgood Street, Suite 2035
RECEIVED
JUN 0 Z 2016
North Andover, MA 01845 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Re: Subsurface Sewage Disposal System Design Plan for (Lot 3) #53 Wellington Way
(Map 105C, Lot 86)
Dear Mr. LaGrasse:
We have received your May 31, 2016 comments on the above referenced plan, and we offer the
following response. To facilitate the review of this information we have reproduced your comments, and
our responses follow each comment in blue italics.
l 1. The soil logs are not shown on the design plan (310 CMR 15.220(h)).
The drawing layer that the test pits logs were on had been inadvertently turned off on the
originally submitted plan. The logs are shown on the attached revised plan.
l 2. The lot area is not shown on the design plan (NA 3.2).
The drawing layer that the lot area and dimensions were on had been inadvertently turned off on
the originally submitted plan. The area and dimensions are shown on the attached revised plan.
3. On sheet 1 of 2, the loading rate of 0.74 gpd/sf is incorrect for the Class II soil. The design
calculations and trenches need to be revised.
Rather than make the leaching area larger to reflect the loading rate for the Class 11 soil in the B
Horizon we have specified on the revised plan that the subsoil is to be removed and replaced
with Title 5 sand. The leaching trenches are properly designed for the Class I soil in the C
horizon.
d 4. The breakout elevations (high and low) for the leaching trenches are not depicted on the design
plan.
The breakout elevations (the top of stone elevations) at the beginning and ends of the trenches
have been added to the profile view on the revised plan.
/ 5. The proposed grading on sheet 1 does not match the proposed grading in the profile view
around the septic tank and leaching trenches. Clearly label the proposed grading contour lines.
The proposed contour lines around the septic tank and over the leaching trenches have been
corrected on the revised site plan. All of the proposed grading contours have been labeled.
1 6. On sheet 2 of 2 the trench inlet elevation is not shown in the system elevation table.
The System Elevations table has been revised to include the trench inlet elevation.
[ 7. On sheet 2 of 2, the system elevation table indicates test pit 8B.
The System Elevations table has been corrected to properly refer to Test Pit 58.
8. On sheet 2 of 2, the profile view and cross-section view indicate "removal of top soil is not
/ required". This appears to be a typo and should indicate the subsoil not to be removed.
The labels have been removed (see response to Comment 3, above).
I trust that these responses fully address all of your comments.
Please contact me if you have any questions.
Very truly yours,
Christiansen & Sergi, Inc.
Philip G. Christiansen
Cc Messina Development Company
0 Page 2
North Andover Health Department
Community and Economic Development Division
May 31, 2016
Philip Christiansen, P.E.
Christiansen and Sergi, Inc.
160 Summer Street
Haverhill, MA 01830
Re: (Lot 3) 53 Wellington Way (Map 105C, Lot 86)
Dear Mr. Christiansen,
The proposed wastewater system design plan for the above site dated May 23, 2016 and received
on May 24, 2016 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 where applicable.
1. The soil logs are not shown on the design plan (3 10 CMR 15.220(h)).
2. The lot area is not shown on the design plan (NA 3.2).
3. On sheet 1 of 2, the loading rate of 0.74 gpd/sf is incorrect for the Class II soil. The
design calculations and leaching trenches need to be revised.
4. The breakout elevations (high and low) for the leach trenches are not depicted on the
design plan.
5. The proposed grading on sheet. l does not match the proposed grading in the profile view
around the septic tank and leach trenches. Clearly label the. proposed grading contour
lines.
6. On sheet 2 of 2, the trench inlet elevation is not shown in the system elevation table.
7. On sheet 2 of 2, the system elevation table indicates test pit 8B.
8. On sheet 2 of 2, the profile view and cross-section view indicate "removal of top soil is
not required". This appears to be a typo and should indicate the subsoil not to be
removed.
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any
questions you may have. We look forward to working with you to obtain a wastewater treatment
and dispersal system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
Sincerely,
frianI LaGrasse, CEHT
Director of Public Health
cc: Messina Development Company
File
i
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
TOWN OF NORTHANDOVER
Office of CO11NIUNITY DEVELOPMENT AND SERVICES
HEALTH. DEPARTMENT
1600 OSCOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 - Phone
978.688.8476— FAX
E-MAIL: healthdept@7northandovenna.gov
WEBSITE: http:Hww-Nv.northandoverma.Lyov
SEPTIC PLAN SUBMITTAL
FORM
RECEIVED
MAY 2 4 2016
Date of Submission: S Z Z � 3 � o 1 OVYN OF NORTH ANDOVER
Site Location: . well l P15 hv- yVGL.y HEALTH DEPARTMENT4 '_ ) 6� e�l
Engineer:
Chk^rs7)4/K
�75
�
New Plans? Yes $2Z/Plan Check
review only)
Revised Plans?Yes $75/Plan Check #
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? It, Yes No
Telephone #: q 7 g ' 3 73 -0 3 16 Fax #:
E-mail: es
Homeowner
Name:
OFFICE USE ONLY
When the submission is complete (including check):
➢ Date stamp plans and letter
➢ _Complete and attach Receipt
A L/"'- Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
(includes 1St submission and one re-
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOAR® OF HEAL'T'H
TOW 41 OF IV 04TH 1q NP6 V& 1( -
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct (Repair ( ) Upgrade ( ) Abandon ( ) - Complete System ❑ Individual Components
We- 1 � � n r /�-rt. UVB,'
LocalMn
r6 f 3 lap/Parcel #
Lot #
Installer's Name
Address
Telephone #
E � ,3 j/ 6,ress
7
J1Telephone #
J0,10 J -A
67, ,37J --e.3 /d3
Telephone #
Type of Building: WWW Fi2Av*iA Lot Size -5--5',.0 79 S feet
Dwelling — No. of Bedrooms Garbage Grinder ( IV
Other — Type of Building No. of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow (min. required) 0 gpd Calculated design flow gpd Design flow provided4 O gpd
Plan: Date v Number of sheets —9 — Revision Date
Title
Descrip ion of Soils)
Soil Evaluator Form No Name of Soil EvaluatorPDate of Evaluation /
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
JITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
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
r
Commonwealth of Massachusetts
City/Town of North Andover
w Percolation Test
Form 12
�M
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal, DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important: When
A. Site Information
Time
filling out forms
5-A
on the computer,
use only the tab
Gordon Family Trust
10:17
key to move your
Owner Name
cursor - do not
53 WELLINGTON WAY (602 Boxford Street
LOT 5)
use the return
key.
Street Address or Lot #
Time at 9"
North Andover
MA 01845
�
10:27
City/Town
State Zip Code
10
Philip Christiansen
978.373.0310
4 MIN/INCH
Contact Person (if different from Owner)
Telephone Number
'
B. Test Results
Test Failed:
Witnessed By:
Comments:
Date
5-B
Date
Time
Observation Hole #
5-A
Depth of Perc
30"
10:17
Start Pre -Soak
9:54
End Pre -Soak
10:09
11
Time at 12"
10:09
Time at 9"
10:17
Time at 6"
10:27
Time (9"-6")
10
Rate (Min./Inch)
4 MIN/INCH
Test Passed:
Test Failed:
❑
Philip Christiansen
Test Performed By:
Isaac Rowe
Witnessed By:
Comments:
Date
5-B
Time
26"
9:59
10:17
10:17
10:25
10:36
11
4 MIN/INCH
Test Passed:
Test Failed:
❑
t5form 12.doc• 06/03 Pere Test • Page 1 of 1
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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(a,townofnorthandover. com
www.townofhorthandover.com
APPLICATION FOR SOIL TESTS
DATE: 11/24/2014 MAP & PARCEL: 105C.22
RCEii'ro"
602 Boxford St, NA Lot L N'
LOCATION OF SOIL TESTS:
Z'6 2014
Gorton F . HEN.THDEPARTNIENT
Oami Trust WNER: Y Contact #: —
APPLICANT:Messina Development Contact #:978-837-95 g
ADDRESS: 277 Washington St,-Groveland, MA 01834
ENGINEER: Christiansen-&-Sergi,-Inc --.- Con -tact#: 978-373-0310
CERTIFIED SOIL EVALUATOR`. Philip Christiansen
Intended Use of Land: Residential Subdivision Single Family Home Commercial
X
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition;
In the Lake Cochichewick Watershed? Yes
No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.5"x 11 "Plot plan & Location of Testing (please indicate test 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 Approva Date: �J
Signature of Conservation Agent:�
Date back to Health Department: (stamp in): �� �` ' e.As
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