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HomeMy WebLinkAboutMiscellaneous - 62 WINTERGREEN DRIVE 4/30/2018 (2)I PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/23/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Full Repair/Replacement of an On -Site Sewage Disposal System By: Robert Daigle At: North Andover, MA 01845 Issuance of this clerti%lcat�hall not be construed as a guarantee that the system will function satisfactorily. Michele Grant _r Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com RECEIVED -,w MAY 2. 2016 + ��~ TOWN OF NORTH ANDOVER 'eAM HEALTH DEPARTMENT PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (y constructed; ( ) repaired; ' By: 4 (Print NaQ) Located at: tv v� VV 10 ki_e en Dri V (Installation Ad ess) Was installed in conformance with the North Andover Board of Health approved plan, originally dated / L15_Z�5 and last revised on /��t �/� , with a design flow of T Z� 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: / /Z i`E ineer Representative (Signature) And — Print Name /` J Final Construction Inspection Date: Inger Representative (Signature) —PP /1-(P (fR 2l.s�A V0,ezA/ And — Print Name Installer:T� (Signature) And — Print Name Date: Z� �f � i -Cleo C N 21 S�/C�-A/ S��✓ And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.northandoverma.gov North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 62 Wintergreen Drive MAP: 104B LOT: 194 INSTALLER: Rob Daigle DESIGNER: Philip Christiansen PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS (,� / TANK INSPECTION: 1p DATE OF BED BOTTOM INSPECTION M � � I DATE OF FINAL CONSTRUCTION INSPEt ION: 4/28/16 DATE OF FINAL GRADE INSPECTION: ` /)-11& SITE CONDITIONS Comments: SEPTIC TANK ® Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base ❑ 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) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Neoprene boots around inlet & outlet Comments: 4/28/16 Existing tank was previously examined and reported by Installer to have been deemed watertight. Upon site visit today it was visually watertight as well. Existing building sewer used. Inlet baffle remained. Outlet baffle replaced with tee and effluent filter. Pipe penetration exiting the tank did not appear watertight. Requested Installer to expose the pipe penetration fully and re -cement it, and then leave exposed for a future re -inspection. Requested installer put riser with cover to grade over eftent filter if he is going to keep that optional component in the tank. � � • � �� � (�� DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: 4/28/16. At least one pipe did not have even distribution to it. Installer will return and provide leveling evices and leave open for re -inspection at a later date. D SOIL ABSORPTION SYSTEM (General) V' 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 ❑ 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 Standard Quick 4 Plus Infiltrator Chambers ® Number of chambers per row: 11 ® Number of rows (trenches): 4 Comments: Total Chambers = 44 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED l Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As -Built Plan BM = 130.47 HR= 1.13 HI = 131.60 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Septic Tank OUT 5.34 126.26 126.16 Distribution Box IN 5.52 125.75 125.60 Distribution Box OUT 5.67 125.60 125.43 Lateral Bottom 6.46 125.14 125.12 Lateral INVERT 5.80 125.47 125.37 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Bank3 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Town of North Andover — Septic System - AS -BUILT CHECKLIST 1) I/ All changes to the design plan have been reflected and noted on the as -built plan 2 TAs-built plan has a suitable scale 1 inch = 40 feet or fewer for lotplans) - / p �( p 3) i/ Street Address, Assessor's Map and Lot Number 4) Lot Lines and Location of Dwellings served by the system 5) f Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable) 6) V 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: A�k Subsurface, interceptor & foundation drains Catch basins Property lines 7, Dwellings or other structures Private water supply or irrigation wells Watercourses or wetlands 8) Locations of Wells, Drains, Wetland Resource Areas within 150 feet of system 9) `' Location of water, gas, electric lines, cable, control panel (if applicable) 10) V/ Location of Structures within 6 Inches of Finished Grade 11) V Original Stamp & Signature 12) Location and holder of any easements which could impact the system 13) Impervious Areas; Driveways, etc 14) " North Arrow 15) J Location & Elevation of Benchmark used 16) /STATEMENT ON PLAN (NA 5.3) 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 break out 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 Commonwealth of Massachusetts BOARD OF HEALTH North Andover Map -Block -Lot 104.BO194 -------------------- Permit No BHP -2016-0023 FEE $350.00 ----------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Robert Daigle ------------------ -------------------------------------------------------------------- to (Upgrade) an Individual Sewage Disposal System. at No -62-WINTERGREEN-DRIVE ------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BBp-2016-002 Dated— March 10,2016 --- - ----------- ------------------------------- -------------;H----4---------- Issued On: Mar-22-2016-------------------------------------------------'--BOA-D--OF '-f fiEA •,,r;, Application for Septic Disposal System Construction Permit -TOWN OF NORTH ANDOVER, MA 01845 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ApplicatioUA ereby made fora permit to: Eff Construct a new on-site sewage disposal system* 93/Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component – What? A. Facility Informz & 2- 0s Address or Lot # city r. rb TODA 'S FATE $350.00 - Full Repair $175.00 - Component RECEIVED 2.- *TYPE OF SEPTIC SYSTEM*: MAR 10 2016 ➢ ❑ Pump Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ➢ ❑ onventional System (pipe and stone system) TOWN OF NORTH ANDOVER ➢ @ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install thN5#kW9Fh9ftNT ➢ ❑ 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 --.L"—/ 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) 2. What is the Make? What is the Model. City/Town Email address State Telephone Number Zip Code 3. Installer Information , 1 0� �sr� Vt• ` [ C.O� Name Name of Comp y 14 Lo'�i v► � ��e Address go-420vol City/Town State Zip Code 92V X123 p G /n Telephone Number (Cell Phone # if possible please) 4. Designer Information Wli Name / Name of Company Address 4'�'oarA- City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 •,;�, Application for Septic Disposal Systemi !6 TODA 'S D TE Construction Permit -TOWN OF NORTH ANDOVER MA 01845 $ 00 -Full Repair $1775.5.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: residential Dwelling or []Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Boar of Healt , the i tailed system is not approved. Z141W14 7 ll Na a Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump Sys tem? If so, Attach copy ofElectrical Permit Yes No Applican t received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed apptovallettet, 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: 6.2 (Address of septic system) L � Relative to the application of dT (Installer's narrio Dated o ay s ate For plans by S-d/n < eto- 3 (Engineer) And dated .2/c�l ri is ate With revisions dated (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@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 cbamher, 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 me of this obligation. Undersigned Licensed Septic Installer: a e —Print) (Name — Signe (Today's Date)�1� 5/2/2016 6 NNORT AN :OVER Massachu %S . Town of North Andover Mail - Construction Inspection - 62 Wintergreen Drive Michele Grant <mgrant@northandoverma.gov> Construction Inspection - 62 Wintergreen Drive 1 message Dan Ottenheimer <dano@millriverconsulting.com> Thu, Apr 28, 2016 at 5:30 PM To: Brian LaGrasse <blagrasse@northandoverma.gov>, Michele Grant <mgrant@northandoverma.gov>, Lisa Hadge <Ihadge@northandoverma. gov> Cc: Isaac Rowe <irowe@milldverconsulting.com>, Pam Lally<plally@millriverconsulting.com> Attached please find the construction inspection report form for 62 Wintergreen Drive. You will note there are three open items which will need to be tended to at a future re -inspection: T. The installer chose to place an effluent filter in the outlet tee. By doing so, he must put a cover at finished grade for ease of access. The effluent filter is not required in this instance, so he either needs to remove it or he needs to have a cover at finished grade over it. 2 The existing tank was re -used and it did not appear the penetration for the pipe exiting the tank was watertight as there was wet soil immediately below the junction of the pipe and the tank. The pipe penetration can be a weak point and lead to effluent leakage, especially on retrofitted older tanks. The installer was requested to expose the entire pipe and to demonstrate its watertightness at a subsequent re -inspection. 3. The pipes exiting the distribution box were not providing even flow. This is likely due to the tight space associated with trying to get 4 pipes coming out of the box into the four headers of the leach field which were in close proximity. The installer was requested to either make the pipes dead even or to install leveling devices, and to demonstrate even flow at a subsequent re -inspection If you would like to have us examine these matters please let us know. If not, you certainly can do so. I will be out of the office tomorrow but glad to help with anything on Monday. Best, Dan >Mill R co nsuI fln 9< Civil € ;.�,a�ec!ari #� l r,k�sr,rnrn4�: #,;I' P.t; i Oting t-.9ums si( rn� itonmviiiit ltr.,irlh �taiYt https:l/m ai l.google.com/mai I/calu/0/?ui=2&ik=d4458df3dg&view= pt&search=inbox&th=1545ee7bae3O4O3c&si m l=1545ec7bae3O4O3c 1/2 North Andover Health Department (ommunity and Economic Development Division January 28, 2016 Frederick Doherty 62 Wintergreen Drive North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 62 Wintergreen Drive (Map 104B, Lot 194) Dear Mr. Doherty: The proposed wastewater system design plan for the above site dated October 15, 2015 with a final revision date of December 4, 2015 and received on December 8, 2015 has been approved. ` The design plan has been approved for use in the construction of an upgrade on-site septic system for a 4 -bedroom (max 9 -room) home utilizing an Infiltrator Chamber system. This design plan approval is valid until January 28, 2018. 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. At a regularly scheduled meeting of the Board of Health, this plan received the following approvals by the members. Local Upgrade Approvals: To reduce the requirement of soil test pits in the area of the proposed leaching facility from 2 test pits,to 1 test pit 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 62 Wintergreen Drive January 27, 2016 This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)) 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation 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, c CLQ� Michele Grant Health Inspector Encl. Installers list cc: Philip Christiansen, Christiansen & Sergi 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 C.S PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 fel: 978-373-0310 www.csi-engr.com fax 978-372-3960 RECEIVED December 11, 2015 DEC 1 1 20 l b North Andover Health Department TOWN OF NORTH ANDOVER 1600 Osgood Street, Suite 2035 HEALTH DEPARTMENT North Andover, MA 01845 RE: Repair Subsurface Sewage Disposal System for 62 Wintergreen Drive Dear Board Members: On behalf of my client Fred Doherty, I request the Board to consider his LUA for his repair of his system at its next available Board Meeting. Commonwealth of Massachusetts City/Town of North Andover kvForm 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 farm 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 16.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOT : 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, Important: When filling out forms on the computer, use only the tab A. Facility Information 1. Facility Name and Address; Fred Doherty key to move your Name _ T cursor- do not 62 WinteMreen Drive use the return key. Street Address North Andover MA 01845 CitylTown State Zip Code 2. Owner Name and Address (if different from above): same _ Name Street Address CItylTown Stat f Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Existing septic system RECEIVED 5. Type of Existing System: DEC O 8 2015 ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (descrR�JRFNORTHANDOVER V RHM 6. Type of soil absorption system (trenches, chambers, leach held, pits, etc): trenches t5€orm9a - rev. 7106 Application far Local Upgrade Approval• Page 1 of 4 Commonwealth of Massachusetts Cityrrown of North Andover 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 sante 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: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 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: replace existing field with new d -box and infiltrator system, 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 Percolation rate Depth to groundwater t5fonm9a • rev. 7106 ft. minfmch Application for Local Upgrade Approval- Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval DEP has provided this form for use by local Hoards of Health. Other forms may be used, but the information must be substantially the some 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 pere 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 most be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name (type or print) Signature G. Explanation Date of evaluation 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: repair system, testing area limited, because of distance from possible wetlands and more favorable depth to GW in TP 2. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: t5farm9a • rev, 7106 Application for beat upgrade Approval- Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover 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. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 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 9 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 "l, 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." 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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 filling out A. Site Information ' on the computer, Frederick Doherty use only the tab__..---._ —. _.... key to move your owner Name cursor - do not 62 Wintergreen Drive_— _ use the return key. Street Address or Lot # North Andover MA 01645 CitylTown State Zip Code Contact Person (If different from Owner) Telephone Number B. Test Results Observation Hole # Depth of Pero Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") 9/2/15 3:55 p.m. Date Time Pere 1 60" 3:55 3:55 4:10 4:13 4:19 6 Mins 2 Mins/Inch Rate (Mln./inch) - -- Test Passed: Test Failed: ❑ Steven Eriksen & Maureen Herald Test Performed Py: Issac Rowe - North Andover Board of Health Board of Neagh Ilvitness Comments: 912/15 _^ 1:29A:M:.__.._ Date Time Perc 2 _...___.__..___...._..--- 4811 1:29 1:29 1:44 2:15 2:54 39 Mins 13 Mins/inch Test Passed: Test Failed: ❑ t6forml1doc- 08/15 Pere Test • Page 1 of i Grant, Michele To: Phil Christiansen Cc: lois@csi-engr.com; Hadge, Lisa Subject: RE: 62 WINTERGREEN DRIVE SSDS REPAIR Attachments: FW: 62 Wintergreen Dr. Dear Phil, Please be advised there is a $75.00 Charge for the second review. All plan reviews and correspondence need to come directly to the Health Dept. for processing before we are able to submit them to Mill River. Please see the attachment. All correspondence that were received on November 16th, 2015 were sent to Mill River on the 16tH. Lois sent additional paperwork on the same day, that was also sent to our consultants on the 161H Sincerely, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com From: Phil Christiansen [mailto:phil@csi-engr.com] Sent: Friday, December 04, 2015 11:04 AM To: Dan Ottenheimer (dano(-amillriverconsulting.com) Cc: Dan O'Connell; Grant, Michele; Lois Christiansen Subject: 62 WINTERGREEN DRIVE SSDS REPAIR Dan As a follow up to our discussion this morning I am forwarding to you a revised Repair Design for 62 Wintergreen Drive North Andover MA. I have made changes as we discussed. I have also attached the letter that I submitted to the North Andover Health Department that I had submitted to them for the second review which had not been forwarded to you for your review. Additionally we were not allowed to submit the LUA form 9A to the Board until the plans were approved I am submitting the Form A to the Board of Health under separate cover. North Andover Health Department (ommunity and Economic Development Division November 25, 2015 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 62 Wintergreen Drive (Map 104B, Lot 194) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated October 15, 2015, revised November 13, 2015 and received on November 16, 2015 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. Each of these matters was raised in our previous communication to you after reviewing the October 15, 2015 design plan and has not been resolved. The original review comments are provided in parenthesis, with additional information based on the November 13 revised plan provided afterwards. 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. "A Local Upgrade Approval is required to be sought for only one test pit in the proposed soil absorption system area (3 10 CMR 15.102). Please also list any LUA or variance being sought on the design plan and on Form 9A". Please provide a completed Form 9A to accompany the submission 2. "Clarify or adjust the terminology of "Remove Top and Subsoil" in the profile to also reference the soil nomenclature used in Title 5 of A & B soil layers." This has not been adjusted 3. "Since the existing septic tank is proposed to be re -used, provide a description of the methodology to be used by the installer to determine the suitability of the existing tank. Provide a method to be used for assuring the watertightness of the tank and any proposed 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 covers" Information about risers and covers needed for compliance with Title 5 has not been provided 4. "The wetlands resource area shown is not labeled as to what it is and who determined its location" This has not been labeled 5. "The Best Feasible Upgrade plan was not labeled" The system which you intend to have constructed was labeled as the Best feasible Upgrade plan, which is not correct. 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. erely, ichele Grant Health Inspector cc: Fred Doherty 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& SER GI INC PROFESSIONAL ENGINEERSANDLAND SUR YEYORS %MZI 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 wwwr.csi-erw.com fax 978-372-3960 RECEIVED NOV 16 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Owner's Certification for 62 Wintergreen Drive I, Fred Doherty, the owner of record of 62 Wintergreen Drive, hereby certify to the following 1. I have been provided a copy of the Title 5 Innovative Alternative Technology Approval for General use dated 6/12/2015, the Owner's Manual with maintenance, and I agree to comply with all terms and conditions; 2. The design does not provide for the use of garbage grinders. This restriction is understood and accepted; 3. Whether or not covered by warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the North Andover Board of Health (NABOH) , if the Department or the NABOH determines the system to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Acknowledged: Fred Doherty o Commonwealth of Massachusetts Executive Office of Energy & Environmental Affairs K Department of Environmental Protection One Winger Street Boston, MA 02108.617-292-5500 Charles D. Baker Matthew A. Beaton Governor Secretary Karyn E. Polito Martin Suuberg Lieutenant Governor RECEIVED Commissioner APPROVAL FOR GENERAL USE NOV 16 2015 Pursuant to Title 5, 310 CMR 15.000 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Name and Address of Applicant: Infiltrator Water Technologies, LLC. P.O. Box 768 6 Business Park Road Old Saybrook, CT 06475 Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber', Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8 - inch invert), Quick4 Plus High Capacity chamber (13 -inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3 -inch invert), Quick4 Plus Standard chamber (8.0 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8 -inch invert), Infiltrator 3050 (Storm Tech SC -740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile) chamber (6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber (2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19, 2015, modified June 12, 2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Water Technologies, LLC., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. David Ferris, Director Wastewater Management Program Bureau of Water Resources June 12, 2015 Date This information is available in alternate format. Call Michelle Waters-Ekanem, Diversity Director, at 617-292-5751. TTY# MassRelay Service 1-800.439-2370 MassDEP Website: www.mass.gov/dep Printed on Recycled Paper Infiltrator Chamber, Infiltrator Water Technologies. Approval for General Use — June 12, 2015 I. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1: Chamber Dimensions Page 2 of 6 Model Dimensions W x L x H Inches Invert Height Inches Equalizer 24 15 x 100 x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6 -inch invert) 16 x 48 x 8 62 Quick4 Equalizer 24 LP 2 -inch invert) 16 x 48 x 8 2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 Quick4 Plus Standard (5.3 -inch invert) 34 x 48 x 12 5.3 Quick4 Plus Standard (8 -inch invert) 34 x 48 x 12 8 Quick4 Plus Standard LP (3.3 -inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP (8 -inch invert) 34 x 48 x 8 83 Infiltrator 3050 or StormTech SC -740 51 x 85.4 x 30 22.254 High Capacity Chamber 34 x 75 x 16 11 High Capacity H-20' Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 Quick4 Plus High Capacity (8 -inch invert) 34 x 48 x 14 8 Quick4 Plus High Capacity (13 -inch invert) 34 x 48 x 14 135 ' This approval allows the use of the high capacity H-20 chambers but makes no determination as to the chambers meeting the H-20 loading requirements. 2 Includes Infiltrator MultiportTM invert adapter attached to the side of the end cap. 3 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in -One 8 Endcap. 4 Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2. 5 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in -One 12 Endcap. 2. The System is an open -bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. Infiltrator Chamber, Infiltrator Water Technologies. Approval for General Use - June 12, 2015 Page 3 of 6 3. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 4. For new construction or upgrades, the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. Table 2: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites" Model Effective Leaching Area SF/LF Effective Leaching$ Area SF/LF Equalizer 24 3.76 N/A Quick4 Equalizer 24 3.90 N/A Quick4 Equalizer 24 LP (6 -inch invert) 3.90 N/A Quick4 Equalizer 24 LP (2 -inch invert) 2.78 N/A Equalizer 36 4.73 N/A Quick4 Equalizer 36 4.73 N/A Standard Chamber 6.53 N/A Quick4 Standard 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard (5.3 -inch invert) 6.20 N/A Quick4 Plus Standard (8 -inch invert) 6.96 N/A Quick4 Plus Standard LP (3.3 -inch invert) 5.65 N/A Quick4 Plus Standard LP (8 -inch invert) 6.96 N/A Infiltrator 3050 or StormTech SC -740 N/A 6.71 High Capacity Chamber 7.79 N/A High Capacity H-20' Chamber' 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity (8 -inch invert) 6.96 N/A Quick4 Plus High Capacity (13 -inch invert) 7.93 N/A 6. Effective April 21, 2006, 310 CMR 15.251(1)(b) maximum trench width is 3 feet. '. Effective leaching area is equal to 1.67 (bottom width + (2x invert height)) for Systems 3 feet or less in width. g. Effective leaching area is equal to 1.0 (3 + (2x invert Height)) for Systems with a width greater than 3 feet. 9. The maximum trench width allowed to calculate effective leaching area is 3 feet. 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. Infiltrator Chamber, Infiltrator Water Technologies. Approval for General Use — June 12, 2015 Page 4 of 6 6. For new construction or an upgrade, the applicant can size the System in bed or field configuration, using the effective leaching areas presented in Table 3. Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Model Effective Leaching'" Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP (6 -inch invert) 2.23 Quick4 Equalizer 24 LP (2 -inch invert) 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard (5.3 -inch invert) 4.73 Quick4 Plus Standard 8 -inch invert) 4.73 Quick4 Plus Standard LP (3.3 -inch invert) 4.73 Quick4 Plus Standard LP (8 -inch invert) 4.73 Infiltrator 3050 or StormTech SC -740 7.10 High Capacity Chamber 4.73 High Capacity H-20' Chamber 4.73 Quick4 High Capacity 4.73 Quick4 High Capacity HD 4.73 Quick4 Plus High Capacity (8 -inch invert) 4.73 Quick4 Plus High Capacity (13 -inch invert) 4.73 10 Effective Leaching area is equal to 1.67 times bottom width only. 7. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. II. Special Conditions The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with the "Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use" (the Infiltrator Chamber, Infiltrator Water Technologies. Approval for General Use — June 12, 2015 Page 5 of 6 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve new construction or an existing facility with a proposed increase in flow, for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section II Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4. The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration, then the system shall comply with these requirements: a) Length (each trench) 100 feet maximum (3 10 CMR 15.251(1)(a)); b) Width (each trench) 2 feet minimum to 3 feet maximum (3 10 CMR 15.251(1)(b)). - Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater (3 10 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet (per side) of side wall area for each trench (3 10 CMR 15.251(1)(e)); e) Trenches shall be situated, where possible, with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (3 10 CMR 15.251(2)); f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es) flowing into the lower trench(es) (3 10 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater (3 10 CMR 15.251(4)) - Chambers greater than 3 feet Infiltrator Chamber, Infiltrator Water Technologies. Approval for General Use — June 12, 2015 Page 6 of 6 wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (3 10 CMR 15.251(11)). 7. When installed in trench configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration, the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field (3 10 CMR 15.252(1)); b) the maximum length of chambers in series shall be 100 feet (3 10 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet (310 CMR 15.252(2)(f)); and d) the effective leaching area shall include only the bottom area, not the sidewalls (3 10 CMR 15.252(2)(i)). 9. For Systems constructed in fill and installed, the System shall be installed as specified in 310 CMR 15.255 Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5) requiring written notification of alternative system prior to property transfer, (6) need for a certified operator, (9) need for an operation and maintenance contract with an operator and (10) deed notice requirement. CHRISTIANSEN & SERGI INC csil PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 www.csi-engr.com fax 978-372-3960 11 November 13, 2015 North Andover Board of Health Michele Grant Health Agent 1600 Osgood Street Suite 2035 North Andover, MA 01845 Re: 62 Wintergreen Drive, Subsurface Sewage Disposal System Plan Dear Ms. Grant: We are in receipt of your letter of November 12, 2015 on the above referenced project. I have prepared a revised plan and respond to your comments below. For ease of reference, I have printed your comments, and then my response in blue. RECEIVED NOV 16 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 1. The finish grade on the site plan does not match the finish grade on the profile view. Finish contour 126 and/or spot grades need to be added to the site plan view to assure proper cover is provided The 126 contour and spot elevations have been added to the site plan The location of the water line is not shown (310 CMR 15.220(4)(m)) A water line has been added to the plan A Local Upgrade Approval is required to be sought for only one test pit in the proposed soil absorption system area (310 CMR 15.102). Please also list any LUA or variance being sought on the design plan and on Form 9A Form 9A is attached and a note has been added to the plan 4. Clarify distribution box construction requirements to include all outlets pipes needing to be level for the first 2' upon exiting the box (310 CMR 15.232(3)(c) A note has been added to the profile that all pipes from the dbox outlet to be level for 2 feet 5. Surface elevations are missing on the soil logs on the design plan (310 CMR 15.220(4)(h)) Surface elevations have been added to the soil logs 6. The chamber i n v e rt height in the design parameters does not match the invert in the chamber detail. Confirm the correct model unit to be used is allowed in Massachusetts and is labeled consistently on the plan The invert height has been corrected 7. Reference and provide a copy of the most recent approval letter for the alternative disposal system you have selected. The one provided has been supplanted with a newer version The Alternative system was approved 6/12/15. Attached is a copy of that approval. 8. Provide the required designer celification when using a Alternative Soil Absorption System (DEP Policy Section II(18)(c)) The certification which was on sheet 2 in the original submittal has been moved to sheet 1 and modified to reflect the date of 6/12/15 9. Clarify or adjust the telninology of "Remove Top and Subsoil" in the profile to also reference the soil nomenclature used in Title 5 of A & B soil layers. The use of the phrase "Top and Subsoil" when describing what is to be removed for proper installation of a system is appropriate and need not be changed because it is the terminology used by the installers. Installers are not soil evaluators and do not refer to soils by horizon nomenclature. Additionally an A horizon is defined in Title 5 as "topsoil" (see unsuitable materials 310CMR15.002). The B horizon or subsoil is not referred to at all within Title 5. 10. Since the existing septic tank is proposed to be re -used, provide a description of the methodology to be used by the installer to detelnine the suitability of the existing tank. Provide a method to be used for assuring the watertightness of the tank and any proposed covers Notes have been added to the plan concerning use of the existing tank. 11. A benchmark was not provided (310 CMR 15.220(4)(q)) The top of the house foundation and the top of the tank have been referenced as bench marks 12. Soil data provided on Form 11 and the design plan does not match that of the Board of Health 's representative's field book notes. A copy of the notes are attached for reference. The soil evaluator on site was Steve Erikson a certified soil evaluator. His information differs from the Board of Health representative in only the depth of the C horizon on test pit 1. (Steve lists 80" while the BOH representative lists 82"). Since Steve is the evaluator and the BOH representative is the witness I have maintained Steve's 80". This difference does not have any bearing on the design. 13. Miscellaneous wording is shown above the site plan view I didn't see any miscellaneous wording on our copy of the plans 14. The wetlands resource area shown is not labeled as to what it is and who detelnined its location Steve Erikson, who is also a wetland scientist located the pocket of wetlands in an effort to be complete in preparing the repair plan. It is an area with wetland plants and soils. 15. The Best Feasible Upgrade plan was not labeled The plan has been labeled Please Do not hesitate to call me if you any additional questions. Regards, Philip G. Christiansen North Andover Health Department (ommunity and Economic Development Division November 12, 2015 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 62 Wintergreen Drive (Map 104B, Lot 194) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated October 15, 2015 and received on October 21, 2015 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 finish grade on the site plan does not match the finish grade on the profile view. Finish contour 126 and/or spot grades need to be added to the site plan view to assure proper cover is provided 2. The location of the water line is not shown (3 10 CMR 15.220(4)(m)) 3. A Local Upgrade Approval is required to be sought for only one test pit in the proposed soil absorption system area (3 10 CMR 15.102). Please also list any LUA or variance being sought on the design plan and on Form 9A 4. Clarify distribution box construction requirements to include all outlets pipes needing to be level for the first 2' upon exiting the box (3 10 CMR 15.232(3)(c) 5. Surface elevations are missing on the soil logs on the design plan (3 10 CMR 15.220(4)(h)) 6. The chamber invert height in the design parameters does not match the invert in the chamber detail. Confirm the correct model unit to be used is allowed in Massachusetts and is labeled consistently on the plan 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 7. Reference and provide a copy of the most recent approval letter for the alternative disposal system you have selected. The one provided has been supplanted with a newer version 8. Provide the required designer certification when using a Alternative Soil Absorption System (DEP Policy Section 11(l 8)(c)) 9. Clarify or adjust the terminology of "Remove Top and Subsoil" in the profile to also reference the soil nomenclature used in Title 5 of A & B soil layers. 10. Since the existing septic tank is proposed to be re -used, provide a description of the methodology to be used by the installer to determine the suitability of the existing tank. Provide a method to be used for assuring the watertightness of the tank and any proposed covers 11. A benchmark was not provided (3 10 CMR 15.220(4)(q)) 12. Soil data provided on Form 11 and the design plan does not match that of the Board of Health's representative's field book notes. A copy of the notes are attached for reference. 13. Miscellaneous wording is shown above the site plan view 14. The wetlands resource area shown is not labeled as to what it is and who determined its location 15. The Best Feasible Upgrade plan was not labeled 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. IC'e' ely, le Grant Health Inspector cc: Fred Doherty 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 Hadge, Lisa From: Hadge, Lisa Sent: Thursday, October 22, 2015 4:20 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 62 Wintergreen Dr. Attachments: 201510221550.pdf Attached are septic plans and paperwork for 62 Wintergreen Drive. -----Original Message ----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Thursday, October 22, 2015 3:50 PM To: Hadge, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 10.22.201515:50:08 (-0400) Queries to: noreply@townofnorthandover.com rl-,MWI-�- H0011 (M ( TOWN OF NORT11, A\DOVER Ofrice of CONI N1L'S ITl' 1)E\'ELO1'NIENT AND SER\'IC FS HE,aLTH DEPARTMENT 1600 OSGOOD STREET'; SUI -1-11-121035 NOR 11i ANDOVER. N•I.�SSACHUSETTS 1)1.8=13 ��.95 4r) — Phone Susan Y. Sa\` er, RFF1S!RS 978.68\, 8476—FAX Public Health Director E-%tA.it.: l,_a1t11�1u cr:tu«nufnurtiiandu� r.cum WERSITE: httta:.`,%ww.tuAnofnurthanduver.coin SEPTIC PLAN SUBMITTAL FORM RECEIVED OCT 20,2015 40 Date of Submission: � V � CT O � TOWN OF NORTH ANDOVER Site Location: (p V1! I N 7-f7Z, GP EEN L) 1< I k/—L- HEALTH DEPARTMENT Engineer: PA ri shwnS e,Y1 New Plans? Yes ' v $225/Plan Check # (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes t/ No Local Upgrade Form Included? 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Z m w O O :. • 0 IN a 4' > �m N U N ENC 0 E E�ci > a oS V- L Wa— O 4)O O E N C (DO =o t: c N lfj fl.O+L' 4) dcoa�iU L«, L Ucn O >+ M 0 C1 >�3 opt -0 O_ O ^ U ❑. >O c L O ,0 C O `- V t t M U L U •- E"a M j � CI C . � N = 4) 1 .r- o a U W -0 N co O N 0 M N� t0 N'. y oil o CD In c7 W T 0 c at T f6 co W I � tN I Y_ I � I W i O I (D n a: i co 0 -0 N E�N O _ <LI E An L U� v >i� o� o� a� 0 U oo `') a 0 L a U Cc c Co 0 c C � 'd Z0 co w 0 n d a LL In Z 0 0 4'v co 0 w d 0) (a CL to zz go 0 0 Commonwealth of Massachusetts - City/Town of North Andover, MA Y _r= Percolation Test -- 3 Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When A. Site Information filling out forms on the computer, Frederick Doherty use only the tab key to move your Owner Name cursor - do not 62 Wintergreen Drive use the return Street Address or Lot # key. North Andover MA 0 r� City/Town State Zipp Code Contact Person (if different from Owner) Telephone Number B. Test Results 9/2/15 3:55 p.m. 9/2/15 1:29 p.m. Date Time Date Time Observation Hole # Perc 1 Perc 2 Depth of Perc 60" 48" Start Pre -Soak 3:55 1:29 End Pre -Soak 3:55 1:29 Time at 12" 4:10 1:44 Time at 9" 4:13 2:15 Time at 6" 4:19 _ _ 2:54 — Time (9"-6") 6 Mins 39 Mins Rate (Min./inch) 2 Mins/Inch 13 Mins/Inch Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ Steven Eriksen & Maureen Herald Test Performed By: - - - — - - - - - Issac Rowe - North Andover Board of Health Board of Health Witness Comments: t5form12.dorr 09M5 Perc Test - Page 1 of 1 CHRISTIANSEN & SERGI, INC ROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 Owner's Certification for 62 Wintergreen Drive RECEIVED OCT 21 2015 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I, Fred Doherty, the owner of record of 62 Wintergreen Drive, hereby certify to the following: 1. I have been provided a copy of the Title 5 Innovative Alternative Technology Approval for General use dated 2/19/2015 , the Owner's Manual with maintenance, and I agree to comply with all terms and conditions; 2. The design does not provide for the use of garbage grinders. This restriction is understood and accepted; 3. Whether or not covered by warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the North Andover Board of Health )NABOH) , if the Department or the NAB OH determines the system to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Acknowledged: ,::� 16Y Fred Doherty MassDEP Charles D. Baker Governor Karyn E. Polito Lieutenant Governor Commonwealth of Massachusetts Executive Office of Energy & Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-550© APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems, Inc. P.O. Box 768 6 Business Park Road Old Saybrook, CT 06475 Matthew A. Beaton Secretary Martin Suuberg Commissioner Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber', Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8 - inch invert), Quick4 Plus High Capacity chamber (13 -inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3 -inch invert), Quick4 Plus Standard chamber (8.0 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8 -inch invert), Infiltrator 3050 (Storm Tech SC -740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile) chamber (6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber (2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19, 2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. David Ferris, Director Wastewater Management Program Bureau of Water Resources February 19, 2015 Date This Information Is available in alternate format. Call Michelle Waters•Ekanem, Diversity Director, at 617-292.575'1. TTY# MassRelay Service 1.800439-2370 MassDEP Website: www.mass.flovldep Printed on Recycled Paper Lim Ow4 f )1- a. E m ji K Q W � � t E Tu N N N N } E C w mF o S! L ++ C C W N (a 7 r .;. r oa;�� a E 3a }moi C L L y 7 N N L d 'p W N to ID = a O NLAJ j• N ; C j'R aE trot Q b L O a. E m E y C � � t E t N v c E mF o S! 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N d ai L E N j. lU y y c m 3 °Coo v>ic m'3Ega N oy y o n CNa m m 70 >` 3 L C N U O 7 CO N N U y a d NN (0 y 'C 0 y Cc: o C N U N N O G> CO y '5 T m y O. N E L> E Q m a 3 o.T ooa o_g c o o)cco E o m g a 7a', aLLN C N C NC F 0 O Y r V R ttl N =c• 0>O -6 c ;� 'O d d 3s N N O w G> O C r O` -=r H U U C 3 y UC y U h 7W` N U W 0 T V -'O C in 3 N 30 Tl ZYo y« p., O o. y r o =_ r H E N> CO a `° m o' m W y a> Y d W «o $ c h a m E N co CL o N R C C 0 c > E 0 o E 0-- 0 L d 7 U C a a> 010 a>> N m m 0) O b o � - N y N N N ° Z •> N N C i0 41 O rn cw.- m lU y C X 7 Q U o y E ad'CI- CLC X d d H c n dV ) U E d N � O C p O N N N U O co = 7d'7 'co > Q Q ! Qj a 13 0 Ir 0 E Charles D. Baker Governor Karyn E. Polito Lieutenant Governor Commonwealth of Massachusetts Executive Office of Energy & Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems, Inc. P.O. Box 768 6 Business Park Road Old Saybrook, CT 06475 Matthew A. Beaton Secretary Martin Suuberg Commissioner Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber', Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8 - inch invert), Quick4 Plus High Capacity chamber (13 -inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3 -inch invert), Quick4 Plus Standard chamber (8.0 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3 -inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8 -inch invert), Infiltrator 3050 (Storm Tech SC -740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile) chamber (6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber (2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19, 2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. David Ferris, Director Wastewater Management Program Bureau of Water Resources February 19, 2015 Date This Information is available In alternate format. Call Michelle Waters-Ekanem, Diversity Director, at 617-292.5751. TTYtf MassRelay Service 1.6001179-2370 MassDEP Website: www.mass.gov/dep Printed on Recycled Paper Infiltrator Chamber, Infiltrator Inc. Approval for General Use — February 19, 2015 I. Design Standards Page 2 of 6 The models listed in Table 1 are covered under this Certification. Table 2: Chamber Dimensions Model Dimensions W x L x H Inches Invert Height Inches Equalizer 24 15 x 100 x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6 -inch invert) 16 x 48 x 8 62 Quick4 Equalizer 24 LP 2 -inch invert) 16 x 48 x 8 2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 Quick4 Plus Standard (5.3 -inch invert) 34 x 48 x 12 5.3 Quick4 Plus Standard 8 -inch invert 34 x 48 x 12 8 Quick4 Plus Standard LP (3.3 -inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP (8 -inch invert) 34 x 48 x 8 83 Infiltrator 3050 or StormTech SC -740 51 x 85.4 x 30 22.25' High Capacity Chamber 34 x 75 x 16 11 High Capacity H-20' Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 ick4 Plus High Capacity (8 -inch invert) 34 x 48 x 14 1 8 Quick4 Plus High Capacity (13 -inch invert) 34 x 48 x 14 135 ' This approval allows the use of the high capacity H-20 chambers but makes no determination as to the chambers meeting the H-20 loading requirements. 3 Includes Infiltrator MultiporJm invert adapter attached to the side of the end cap. Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in -One 8 Endcap. ' Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2. 5 Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All -in -One 12 Endcap, 2. The System is an open -bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. V; s Infiltrator Chamber, Infiltrator Inc. Approval for General Use - February 19, 2015 Page 3 of 6 3. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 4. For new construction or upgrades, the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. Table 2: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites' Model Effective Leaching? Area SF/LF Effective Leaching$ Area SF/LF Equalizer 24 3.76 N/A uick4 Equalizer 24 3.90 N/A Quick4 Equalizer 24 LP 6 -inch invert) 3.90 N/A Quick4 Equalizer 24 LP (2 -inch invert) 2.78 N/A Equalizer 36 4.73 N/A Quick4.Equalizer 36 4.73 N/A Standard Chamber 6.53 N/A Quick4 Standard 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard 5.3 -inch invert 6.20 N/A Quick4 Plus Standard (8 -inch invert) 6.96 N/A Quick4 Plus Standard LP (3.3 -inch invert) 5.65 N/A Quick4 Plus Standard LP (8 -inch invert) 6.96 N/A Infiltrator 3050 or StormTech SC -740 N/A 6.71 High Capacity Chamber 7.79 N/A High Capacity H-20 Chamber' 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity (8 -inch invert) 6.96 N/A Quick4 Plus High Capacity (13 -inch invert) 7.93 N/A Effective April 21, 2006, 310 CMR 15.251(1)(b) maximum trench width is 3 feet. '. Effective leaching area is equal to 1.67 (bottom width + (2x invert height)) for Systems 3 feet or less in width. $. Effective leaching area is equal to 1.0 (3 + (2x invert Height)) for Systems with a width greater than 3 feet. 9. The maximum trench width allowed to calculate effective leaching area is 3 feet. 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. Infiltrator Chamber, Infiltrator Inc, Approval for General Use — February 19, 2015 Page 4 of 6 6. For new construction or an upgrade, the applicant can size the System in bed or field configuration, using the effective leaching areas presented in Table 3. Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Model Effective Leaching" Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP 6 -inch invert 2.23 Quic1c4 Equalizer 24 LP 2 -inch invert 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard (5.3 -inch invert) 4.73 Quick4 Plus Standard (8 -inch invert) 4.73 Quick4 Plus Standard LP 3.3 -inch invert 4.73 Quick4 Plus Standard LP (8 -inch invert) 4.73 Infiltrator 3050 or StormTech SC -740 7.10 High Capacity Chamber 4.73 High Capacity H-20 Chamber' 4.73 Quick4 High Capacity 4.73 Quick4 High Capacity HD 4.73 Quick4 Plus High Capacity (8 -inch invert) 4.73 Quick4 Plus High Capacity (13 -inch invert) 4.73 "o. Effective Leaching area is equal to 1.67 times bottom width only. 7. When the System is used with a secondary treatment unit approved in accordance with 310 CMR 15.284 or 15.288, additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. H. Special Conditions The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval, the System shall comply with the "Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use" (the Infiltrator Chamber, Infiltrator Inc. Approval for General Use — February 19, 2015 Page 5 of 6 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This Certification is for the installation of a System to serve new construction or an existing facility with a proposed increase in flow, for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section H Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General Use Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4, The System shall be exempt from the minimum inlet spacing requirements of 310 CMR15.253. 5. The System shall have a minimum of one inspection port through the top of one of the chambers. The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is installed in trench configuration, then the system shall comply with these requirements: a) Length (each trench) 100 feet maximum (310 CMR 15.251(1)(a)); b) Width (each trench) 2 feet minimum to 3 feet maximum (3 10 CMR 15.251(1)(b)). - Chambers greater than 3 feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area, three times the effective width or depth of each trench, whichever is greater (3 10 CMR 15.251(1)(d)); d) The effective leaching area shall be calculated using the bottom area and a maximum of two feet (per side) of side wall area for each trench (3 10 CMR 15.251(1)(e)); e) Trenches shall be situated, where possible, with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (3 10 CMR 15.251(2)); f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es) flowing into the lower trench(es) (3 10 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater (3 10 CMR 15.251(4)) - Chambers greater than 3 feet Infiltrator Chamber, Infiltrator Inc. Approval for General Use — February 19, 2015 Page 6 of 6 wide, when specifically approved, shall be separated by three times the actual width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241(310 CMR 15.251(11)). 7. When installed in trench configuration, approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration, the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field (3 10 CMR 15.252(1)); b) the maximum length of chambers in series shall be 100 feet (3 10 CMR 15.252(2)(b)); c) separation distance between adjacent beds/fields shall be ten feet (3 10 CMR 15.252(2)(f)); and d) the effective leaching area shall include only the bottom area, not the sidewalls (3 10 CMR 15.252(2)(i)). 9. For Systems constructed in fill and installed, the System shall be installed as specified in 310 CMR 15.255 Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber. 10. The System is exempt from 310 CMR 15.287, specifically items: (5) requiring written notification of alternative system prior to property transfer, (6) need for a certified operator, (9) need for an operation and maintenance contract with an operator and (10) deed notice requirement. 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 healthdept(a,townofnorthandover.com www.townofnorthandov er. comREC:VD APPLICATION FOR SOIL TESTS AUG 2 4 2015 DATE: August 24, 2015 MAP & PARCEL: N��A�iN1EN o LOCATION OF SOIL TESTS: 62 Wintergreen Drive, North Andover, MA� _kr � OWNER: Frederick J & Linda Doherty Contaet #: (617) 839-3509 APPLICANT: Frederick J Doherty Contact #: (617) 839-3509 ADDRESS: 38 Farrwood Drive, Bradford MA -01835 ENGINEER: Christiansen & Sergio Inc. Contact#: (978) 373 0310 CERTIFIED SOIL EVALUATOR: Steven Erikson, Norse Environmental Services, Inc. Intended Use of Land: Residemial Subdivision Single Family Home Is This: Repair Testing: X 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 ]]"Plot plan & Location ofTesdn,- (please indicate test pit 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 $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission ADvroval Date: Signature of Conservation Agent:_ Date back to Health Department: (slump in): so Loi Z -i �5 Iip, 6tL L iic$ t 5r - .a, i ST pq %OCSGO t EX /,57-//v& I AP, pc�,—PN 47 BR R-1 LIor z i LOT WIIYTE��h�,kr.tMft/' Df�lYt= SLOPE /ZfQU//��it�1F/VT (/50) X = /50 - DES/GN 6ZEV4T/ON AT .... . ....(TOP OF STONE) _ EX/5T/N:F ELEVW-ION qT ........ . 2EQU/2E0 F/�L = .............. z�L Fv..dT/O/t/,5 ...... I.... " Y ,Y- circ- iiv i ii i l n iv IVV. i/rf- ///// /-) L- TAA/Ii v v. I-lt-l" riiir n,C n o 4 v cic qC? STONE )EPTA/ ,47- P,PnR c lc -.-)T /q i z 47 AJ SUB-SUPF,4CE D/SPO ;d, - SYSTEM /N AOR FR DOHER- i Y 04TE.• 1013187 -. J1'ST/.4NSEN ENS/NE"F�P/N / y/ E- T -1//S PI -AN /5 A107-,4 W41e1e4NTY NC. OF T//E SYSTEM BUT ,4 11E2/F/C 4T/On/ //¢ KENOZ,4 �J �/E� ,yq yE�N/L L, /Y1q• OF Tf/E LOC.4T/ON OF T, -/E ST�(/CTU2ES. .k L EXIst•�NA�• AS 3�x� L