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HomeMy WebLinkAboutMiscellaneous - 61 WINDSOR LANE 4/30/2018 (2)e Town of North Andover f NORTH Office of the Health Department o. Community Development and Services Division 400 OSGOOD STREET North Andover, Massachusetts 01845 ��Sa s ACHU Susan Y. Sawver, RENS/RS 978.688.9540 - Phone Public Health Director 978.688.8476 - Fax C�E�I�FICA2E OAF COJK�GIANC�E As of: ,dune 31, 2005 This is to cert that the individua(su6surface disposarsystem was Fully repaired by John Soucy At 6.1 Windsor .Gane North Andover, 9V X 01845 Jfas been instarred in accordance with the provisions of Titre v of the State Sanitary Code and with the North Andover Board of Yfearth regulations. 'The Issuance of this certificate sham not be construed as a guarantee that the system wirr function satisfac ori(y. 4�where E. Grant t Mfic ifearth Inspector 130AR1) OI� :APPI?:V.S 688-95:}1 BUIIBING 688-1)i{ CONSERVATION (i88-9530 FII;ALT11 688-9510 IIL NN(N6 688-9 35 NEW ENGLAND ENGINEERING SERVICES INC May 24, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 61 Windsor Lane, North Andover, MA Septic System As -Built Plan Submittal Dear Ms. Sawyer, RECEIVED MAY 2 4 2005 TOWN OF MGRTH ANDOVER HEALTH DEPARTMENT The following Septic As -Built plans for the above referenced property are being submitted for approval. Enclosed are the following: 1. (3) Copies of the Septic System As -Built Plan. 2. Copy of Designer's/Installer's Certification Form. Please contact this office with any questions or concerns. Sincerely, Thomas Hector Project Engineer cc: Homeowner 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 N TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( )'constructed; 0,0 repaired; by _SDVCY -.5 _Sewer I — located at was installed in conformance with the North Andover Board 9f liealth approved plan, System Design Permit .# , plan dated IA�13 o Rev a c� , with a design flow of qqa 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. Bed inspection date: !' S 0, - Final inspection date: I/O Installer: Engineer: S13 Engineer Representative 0, (0 1Z Engineer Representative Date: Date: 4-�_��o-S RECEI ED MAY 2 4 2005 TOWN OF NORTH ANDOVER O HEALTH DEPARTMENT TOWN OF NORTH ANDOVER ,oRTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan. Y. Sawyer, REHS/RS Public Health Director 1CHU5 978.688.9540 - Phone 978.688.9542 - FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: ,�5` MAP:_ LOT: INSTALLER: rf, Syr DESIGNER:3 S PLAN DATE: ✓/y�p S BOH APPROVAL DATE ON PLAN: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY F130M PLAN GALLON TANK= 45PO, -01,4 LOADING OF SEPTIC TANK GALLON PUMP CHAMBER = / �� D LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: 7"X(2 SITE CONDITIONS Comments: ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Page 1 of 2 TOWN OF NORTH ANDOVER f �aORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT y 27 CHARLES STREET NORTH ANDOVER MASSACHUSETTS 01845+cHUS ,US try se Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK Comments: PUMP CHAMBER Comments: ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Watertightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Page 2 of 2 TOWN OF NORTH ANDOVER tiaORTy H Office of COMMUNITY DEVELOPMENT AND SERVICES aro �, .o ^°`s4,per HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'�ss;;CHUSE<ty Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM ❑ 9 Comments: PRESSURE- DISTRIBUTION El Comments: Installed on stable stone base Inlet tee (if pumped or >0.087foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 '/2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan inch manifold laterals installed with end sweeps size: material: Squirt test ft in height Equal distribution to all laterals orifice size inch as per plan Page 3 of 3 r TOWN OF NORTH ANDOVER f gORTy Office of COMMUNITY DEVELOPMENT AND SERVICES 3r0`�;ieo ay°L HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 1. 845 s�cNuse Susan Y. Sawyer, REHS/RS 978.688.9540 — Plione Public Health Director 978.688.9542 — FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: 11Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D -Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 Map -Block -Lot ap Commonwealth of Massachusetts 106.D- OD66 - ----------------------- Board of Health Permit No BHP -2005-0084 North Andover ------ ---------------- S. FEE P.I. $250.00 F.I.----------------------- Disposal Works Construction Permit Permission is hereby granted JOhn-Soucy------------------------------------ --------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 61 WINDSOR LANE------------------------------ -- as shown on the application for Disposal Works Construction Permit No. BHP --2-005--008--. Datedf-_-April 12,_ 20055 ------- Issued On: Apr -12-2005 ' M`-4 v, .`a""- — - — - — - JI ----------------------------------------------------------------- .................................................................,................ TOWN OF NORTH ANDOVER koRTH Office of COMMUNITY DEVELOPMENT AND SERVICES 3a R, °O� HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 '�,S •,r� Eta S�COU 978.688.9540 — Phone Susan Y. Sawyer, REHSIRS 978.688.9542 — FAX Public Health Director healthdept@townofnorthandover.com - e-mail www.townofnorthandover.com - website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: — r -- LOCATION: (Q I f/l1"i A So 2 �► . LICENSED INSTALLER NAME: c�- G K PLEASE PRIN dl SIGNATURE: TELEPHONE Coo � CHECK ONE: Y FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. $250.00 or $125 Fee Attached? Project Manager Obligation From Attached? Foundation As -Built? Floor Plans? Yes, ' _ No Yes No Yes No Yes No ($125) Approval of Health Agent Date: ! 6f INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 6 1 1/y-1 i1CC62 L relative to the application of 0IS o S dated 4--- /;)^ 0 for plans by IV, 45. n and dated -0 fwith revisions dated — t-t—e S_ 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 manger, 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 Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work 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. UndersignXL)6ensed Septic DisposajJWorks Construction hermit # Date: '^P ZI ^USS TOWN OF NORTH ANDOVER Ot NORTFF ,,t.to 10 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET '+ 'gra 'r' NORTH ANDOVER, MASSACHUSETTS 01845 CHUg Susan Y. Sawyer, REHS/RS Public Health Director February 8, 2005 Richard Glover 61 Windsor Lane North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX RE: Subsurface Sewage Disposal System Plan for 61 Windsor Lane, Map 106D, Lot 66 Dear Mr. Glover, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated December 23, 2004; Final Revision dated February 4, 2005, and received by this office on February 4, 2005. The design has been approved for use in the construction of an upgrade onsite septic system. This approval is valid. for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2.. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 3. The plan does not call for installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use, if you choose to install one. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director encl: List of licensed septic system installers cc: New England. Engineering Services file TOWN OF NORTH ANDOVER Of NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES or •'r '�°°� HEALTH DEPARTMENT 27 CHARLES STREET ",• 4r+ NORTH ANDOVER, MASSACHUSETTS 01845 'Ss�cHuSEt Susan Y. Sawyer, REHS/RS Public .Health Director January 28, 2005 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 978.688.9540 — Phone 978.688.9542 — FAX Re: Subsurface Sewage Disposal System Plan for 61 Windsor Lane, Map 106D, Lot 66 Dear Mr. Osgood: The proposed septic system design plans for the above site dated December 23, 2004 and received on December 28, 2004 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. The soils shown do not specify that the C -horizon was a gravelly Sandy Loam. Field notes show 50% aggregate, of which — 10% were boulders. -220(4)(h) 2. Please specify that the septic tank shall be tested for watertightness — both for infiltration and leaking. If tank cannot be made watertight, it must be replaced. Also, if the tank is not 1,500 gallon, it will have to be either replaced or a variance requested. Additionally, you might wish to consider using an effluent filter in the septic tank. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere .f r san Y. Sawyer, RE 'S/RS Public Health Director cc: Owner File Page 1 of 1 Dellechiaie, Pamela From: Andrew McBrearty [amcbrearty@millriverconsulting.com] Sent: Friday, January 28, 2005 2:20 PM To: info@millriverconsulting.com; 'Susan Sawyer'; Pamela Dellechiaie Cc: 'Lisa LeVasseur (E-mail)'; mgrant@townofnorthandover.com Subject: 61 Windsor Lane Sue & Pam, Here is the plan review for 61 Windsor Lane. I am including both an approval and disapproval letter. The soil test data on the plan does not show the large amount of aggregate found during testing, and this would be an important piece of information for an installer to know when preparing bids. I'd rather have a home owner know ahead of time that excavation will (could) be more expensive because of the number of stones that will be encountered, and will have to be removed if found during preparation of the bed bottom. There is no specific note about verification of the watertightness of the existing septic tank. I have included this in both letters, as it is crucial to the system. We have had issues with re -used tanks being undersized, so I also have a note for this as well (replace or variance request required). thanks, -andy Andrew McBrearty, Project Manager Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 ph: 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com amcbrearty_ gmillriverconsulting.com 2/2/2005 NEW ENGLAND ENGINEERING SERVICES INC December 27, 2004 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 _---- Re: 61 Windsor Lane, North Andover DEC 2 8 2.004 Septic System Design uvER Dear Susan, The following plans and enclosures for the above referenced property are being submitted for approval. 1. (3) Copies of the Septic System Design Plans. 2. (1) Copy of the Form 11 Soil Evaluator Sheets. 3. (1) Copy of the Form 12 Percolation Test. 4. (1) Check for payment of the Town approval fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 SEPTIC PLAN SUB DATE OF SUBMISSION:/2 7 /0 SITE LOCATION: & / wllvosde- ENGINEER_ AOL,) 61V��/fi11/� AL FORM DEC 2 8 2004 v +r, :aV _R NEW PLANS: YES V $225.00/Plan Check #: (Includes 1 w and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan Check #: SITE EVALUATION FORMS INCLUDED: � �l[ L , NO LOCAL UPGRADE FORM INCLUDED: YES NO' Telephone #: 9 -� $ (gig (o - F7 (o 6 Fax #: 9-7 E-mail: AOL -0061 HOMEOWNERNAME:_ /316rt.,-T-�D � /al_'Y✓t�A! 4—L ..(I v 1 - OFFICE USE ONLY When the submission is complete including check): 1. Date stamp plans and letter Z Complete and attach Receipt 3. Copy File; Forward to Consultant 4. Enter on Log Sheet and Database NEW ENGLAND ENGINEERING SERVICES INC February 4, 2005 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 RECEIVED Re: 61 Windsor Lane, North Andover Septic System Plan Re -Submittal I FEB 0.4 2005 Dear Susan: TOWN OF NORTH ER HEALTH DEPARTMENT The following plans for the above referenced property are being re -submitted for review and approval. The new septic design plans have been revised to reflect the comments in your letter dated January 28, 2005. The following changes have been addressed: 1. The soils shown do not specify the Glayer being a gravelly sandy loam. The plans now reflect the appropriate soil texture. Existing tank should specify being tested for water tightness, or being replaced. Existing septic tank to be replaced by a new 1500 gallon septic tank. Enclosed are (3) copies of the revised septic design plans. Please contact this office with any questions or concerns. Sincerely, Thomas Hector Project Engineer 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 BOARD OF HEALTH���'® NORTH ANDOVER, MASS. 01845 978-688-9540 pE� p 2 2004 APPLICATION FOR SOIL TESTS DP r vrcln �1\00VER j TONEALTH DEPARTMENT DATE: i- MAP & PARCEL: I7�� LOCATION OF SOIL TESTS: V7/0- d Ab f g'e!�f 6w:�k OWNER: 1C -K C-L=WF TEL. NO.: � ' 9 40 70 ADDRESS:_- - W l llGfi�Jl� G�1V�DOd n ENGINEER: u �Cf l) de (��fjyl D 4td I(�rllY ,elm TEL. NO.: q 7b -6.96 r / 769 CERTIFIED SOIL EVALUATOR: LE(VA MN c, p r>! �o 'I' 1elabtsto .1 Intended use of land: Residential Subdivision Sin a Family Home Commercial` Is This: Repair testing Undeveloped lot testing In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WrM THIS FORM: Upgrade for addition No�__ 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. 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 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: _ Check Amount: Check Date: W \N v> s�) 2 L-_vqt\j '�-- Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Monday, December 20, 2004 9:01 AM To: amcbrearty@millriverconsulting.com; Lisa Kozel LeVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: 61 Windsor Lane soils Folks, Attached are soil test results from 61 Windsor Lane. Dan 0 Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultin .corn dano@millriverconsulting.com 12/21/2004 V I at tr t,1, to ^�-: ' �•�°- _f._,� �.--CL.. —. co, Ifok ir .01 Oil Vol h h ct+ 3 � � �f �' CJ►� �J �� � t DEC 2 8 2004 No., Date: Commonwealth of Massachusetts Massachusetts A -Jt i:.� n-- _ !t ;� • --- ---- - ����.,��„�,,.�� �. �.�-JD6G ►�Grvu�r ,vcs usac ..... By: Performed B B ¢�, gin. •........ .. QS�.Q.P..�....i�%f.:....... Date: A c Witnessed By: .... TSC A.C.f�w..�,.......B1."ar+'7..3,AA.j1...&JOU .:..C,rvlt' !1 ' ................... ............... ...... -_ at (01 Wi+nc{s�r L.ctr►e °'_ Ham. ��G l�►taver %v��•h A A6*4erl MA . C,1 W��sor I,.ane /V°r4ti Arjwar� JHA .. ot8�s pew Construction ❑ Repair X78 �8g� 0 Office Review Published Soil Survey Available: No ❑ Yes Year Published �.i.$.�..... Publication Scale i iSoil Map Unit Drainage Class Well..... Soil Limitations .( (O .ef441� ...RapI... Pa.flkt......_ ........ .... Surficial Geologic Report Available: No Rl” Yes ❑ Year Published _ , Publication Scale Geologic Material (Map Unit) ...................................................... _�_.._.........__--- Landform. ............................................................ Flood Insurance Rate Map: Above 500 year flood boundary No []Yes Within 500 year flood boundary No []Yes ❑ -- Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ............... ................ ..................................... _- ...... ........... _ _.. ;.. Wetlands Conservancy Program Map (map unit) -Current Water Resource Conditions (USGS): Month k0 ovlk ,'.kaDa'� Range :Above Normal El Normal P�Belcw Normal ❑ Other References Reviewed: ' DEP APPROVED FORM - 12/07/95 ;FORM - SOIL F;VALUATOR FORM Page 2 Of 3 Location Address or Lot No. �% t On.-site Review Deep Hole Number .Date:J.a. a y Time :-1.11,00— .Qp:::. Weather fr p ° (identifyon site Ac' ;te plan) .:...::.F.,,��-::,. �ero►r,..: n__ Land Use :.,131...1a (/o) • o. x, H ce Ston. .� ... ,.w :��............:..:......:.........: D -N..::.:... .:.. Slop ° :�...i Surfa ones Vegetation ....f, S Landform ......:....... . Position'on landscape (sketch on the back)..�r!!4►!''.:..,...,-,:.-..,:.r,::.,.,.: Distances from: Open Water Body :6:..., feet Drainage way—SPP...:- feet ' Possible:Wet Area >G: ....., feet Property Line .......fa)-.....,, feet Deinking Water Well ISa feet Other DEEP OBSE RVATION HOLE LOG- pts (Structure, Stones, Boulders, Consistency, % Depth from Surface. (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Gravel) c 4Y5. 3 IOYR lb . �3y'i, manes 5'q — 107 G 5 �. asY 313 5 10% 6-mg. �sga Cobb, 10% 8ovilGtS QUIRED AT 9VERY PRO A t f Parent Material (geologic) ol\ 1;i DepthtoBedrock: —Ai6 Depth to Groundwater: -'Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 12/07/95 Location Address or Lot No.o('-�c�nytdp.ret- On.-site Review Deep Hole Number .::mfg.. „,. Date:,. a a•. q o _ Time•.... Weather ..�Aaa✓ �O° Location (identify on sitg plan) ...M04--mo,. (/o °Stones. Land Use ...���.��a.��..:.,....,..:. Slope �) ,.�:.:l.P..... Surface VegetationsGxm.SS,:_,a.. Y.,...:.,v.:...w:..r ..:.v::.w:._.:,.....,..::...�...,....-. Landform Position on landscape (sketch on the back)f!►�'.. Distances from: Open Water Body :..(P ' -'feet Drainage way. .:,p feet PossibleMet'Area 4M.— feet' Property Line .31_ feet 'Drinking Water Well >IV-- feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil color Soil Other Surfacellnches) . (USDA) _ (Munsdiq Mottling (Structure, Stones, Boulders, Consistency, "/o ©' 1h A11 Ft a(0 QW. 10Y 4 Y. y�b JOYA Parent Material (geologic) tt� DepthtoBedrock: �-'• .Depth to Groundwater: -'Standing Water in the Hole: "" Weeping from Pit Face: Estimated Seasonal High Ground Water:__ DEP APPROVED FORM - 12/07/95 Determination_ for Seasonal High Water Table Method Used: Depth observed standing iri observation hole ................... inches ❑ Depth weeping from side of observation hole ................... inches Depth.to soil mottles,51.-- . inches(TPl) ❑ Ground -Mater adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level :.................. .Adjustment factor ................... Adjusted ground water level ........................................................ Death of Naturally Occurring Pervious Material Does at least four- feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? s_ If not, what is the depth of naturally. occurring pervious material? ^ Certification certify that on Alto P7 q-5 (date) 1 have: passed the soil evaluator . examinatio.n approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date /2 0? 7 d Commonwealth of Massachusetts City/Town of Percolation Test Form 12 t5form12.doc• 06/03 Perc Test • Page 1 of 1 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 on the computer, use Rick Glover only the tab key Owner Name to move your 61 Windsor Lane cursor - do not Street Address or Lot # use the return key. North Andover _ MA 01845 City/Town State Zip Code (978) 691-0070 Contact Person (if different from Owner) Telephone Number B. Test Results 12/15/04 1:13 12/16/04 8:08 Date Time Date Time PTI PT1 Observation Hole # 71 "/20" 71" /20" Depth of Perc 1:13 8:08 Start Pre -Soak 1:28 8:23 End Pre -Soak 1:28 8:23 Time at 12" 1:58 @ 10" 9:21 Time at 9" - 10:21 Time at 6" - 60 MIN. Time (9"-6") - 20 MIN./INCH Rate (Min./Inch) Test Passed: ❑ Test Passed: Test Failed: ® Test Failed: ❑ Thomas Hector New England Engineering Services Inc. Test Performed By: Andrew McBrearty, Mill River Consulting Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 >s F PGS 13,4n Acrd a /_ i*n/.t l I 'i , tfENN/FER R097D