HomeMy WebLinkAboutMiscellaneous - 64 BOSTON STREET 4/30/2018 (2)td
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SEPTIC SYSTEM INSTALLATION
IS THE INSTALLER LICENSED? YES NO
TYPE OF CONSTRUCTION: NEW REPAIR ._
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO
CONDITIONS OF APPROVAL YES NO
(FROM FORM U)
ISSUANCE OF DWC PERMIT jcz;D NO
DWC PERMIT PAID? 4yii) NO
DWC PERMIT NO. �,Z� INSTALLER: M
BEGIN INSPECTION YES NO:
EXCAVATION INSPECTION: NEEDED:
PASSED_ lz4AZ BY
CONSTRUCTION INSPECTION: NEEDED:
7116) w,4. 7y�-D r"I I n 7-14e-4 4G:;X A)C9 5/,-'Q 60
SEEyUZI-
AS BUILT PLAN SATISFACTORY: YES :
APPROVAL TO BACKFILL: DATE: Z.11e 11q7 BY
FINAL GRADING APPROVAL: DATE/6 B
FINAL CONSTRUCTION APPROVAL: DATE:15- BY
.,.�...s..• p�/�Ute'
Boston. St.
APPLICATION FOR SEWAGE DISPOSAL I16TALIATI N
HEALTH DEPARTMNT - NORTH ANDOVER, KSS.
I hereby make application for a permit for a sewage disposal installation at
Br-ston St. I I will install this system in ac-
cordance with all the laws of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1%6 until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of 350 gal. in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of 180 lineal (qMVM) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No past of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE J V U
Signa ure of pplican
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Sig tune of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE 13 Z-
Signature of ZI pecting Officer
Percolation Test 1t min. Soil: Clay
Garbage Grinder No
November 11, 1961
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination was made as requested in order to determine
the suitability of the soil for the subsurface disposal of sewage
on the proposed Boston Street building site of Arthur Hearty.
The land in general is high.
The subsoil in the area was of clay content and a 4-minute
percolation test was conducted.
It is recommended that a 750 gallon concrete septic tank be
installed together with 180 lineal feet of drain pipe.
Very truly yours,
Oi I.Aliam D Isco
WJD:hd
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AS BUILT PLAN
OF
SUBSURFACE DISPOSAL SYSTEM
i
LOCATED IN
AS PREPARED FOR
DATE: .I UL q ( o
SCALE: I '' 4o '
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 or TEL (617) 475-3553. 373-5721
a
107 Forest St. FILE# 3/ 997A RP�a
Middleton, ID
(508)774-2772 9 SE"',vc, G�
TcV,r"
MAR 21 1997
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PROPERTY OWNER'S NAME: Pn LO u S aI O I S
PROPERTY ADDRESS: 4 n d over
ADDRESS OF OWNER: (� O Srt7 Yl �T ti. Y1 d aUQ r
(if different)
DATE OF INSPECTION: l l� �' 19q#7
NAME OF INSPECTOR: :[ Ch I Cr►'�S
•THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY
FILE#
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION , �y,/ ,
Property Address: oSTO SI �/ bWrAddress of Owner: lD 13ot t on `j I N/X&Okl4-�/�
'
Date of Inspection: f g PAC04 1997 (If different)
Name of Inspector:--rho>vqA•S J Cy-/&5:
Company Name, Address and Telephone Number: Currier Septic & Drain Service, Inc.
107 Forest Street, Middleton, MA 01949
(508) 774-2772
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and
experience in the proper function and maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: � cvL Date: l MR�f� 1q�7
The System Inspector shall submit a co y of this i pection report to the Approving Authority within thirty (30)days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector
and the system owner shall submit the report to the appropriate regional office of the Department of Environmental
Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or@D
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in
310 CMR 15.303.Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the
replacement or repair, passes inspection.
Indicate yes, no, or not determined (Y, N,or ND). Describe basis of dtermination in all instances. If"not determined",
explain why not
The septic tank is metal, cracked structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as approved by the Board of Health.
(revised 8/15/95)
ti
FILE#3J9 971q
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (coNTinuEd)
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection
if(with approval of he Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass in �ction if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REOUIRED BY THE BOARD OF HEALTH:
_--1 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply
or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply
well.
ZIL The system has a septic tank and soil absorption system and is within 50 feet of a private water supply
well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more
from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic
compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR
15.303. The basis for this determination is identified below. The Board of Health should be contacted to
determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or-cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
(revised 8/15/95) 2
• FILE#
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
D) SYSTEM FAILS(continued)
Static liquid level in the distribution box above oulet invert due to an overloaded or clogged SAS or
cesspool. 7 -(3ox tS In pdpor' Con�i-�1o►7 .
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
IVO Required pumping more than 4 times in the last year hM due to clogged or obstructed pipe(s).
Number of times pumped
�Q Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
AAny portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply
well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach
copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and
nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead,Protection Area (IWPA)or a mapped
Zone II of a public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater
treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for
further information.
(revised 8/15/95) 3
• FILE#319 7A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the
✓ following have been done:
Pumping information was requested of the owner, occupant, and Board of Health
None of the system components have been pumped for at least two weeks and the system has been receiving
normal flow rates during that period. Large volumes of water have not been introduced into the system
recently or as part of this inspection.
/ AAs built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
�[ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
V All system components, excluding the Soil Absorption System, have been located on the site.
ZThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for
condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of
SCUM.
The size and location of the Soil Absorption System on the site has been determined based on existing
information or approximated by non-intrusive methods.
The facility owner(and occupants, if different from owner)were provided with information on the proper
maintenance of SubSurface Disposal System.
(revised 8/15/95)
4
• FILE#3.1gq�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
Design flow: allons
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no):
Laundry connected to system (yes or no):-No-
Seasonal use(yes or no):_!IQ I
Water meter readings, if available: /VCW7 F, GQ V'. I lab 1
Last date of occupancy:
"MMERCIALZINDUSTRIAL:
e of establishment:
Desi n flow:_gallons/day
Greas rap present: (yes or no
Industria aste Holding Tan present: (yes or no)
Non-sanita waste dischW§ed to the Title 5 system: (yes or no)
Water meter re ings, i vialble:
Last date of oc pancy.
OTHER: escribe)
Last�a a of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
aN - own 61(
System pumped as part of inspection: (yes or no)- j)r)er
If yes, volume pumped:—IDQP gallons
Reason for pumping:) r al UC.�'1 -►- (' —ran }�
TYVOF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known)and source of information:2 yrs 60 -'4fi4-m-r
Sewage odors detected when arriving at the site: (yes or no):
(revised 8/15/95) 5
I_ FILE# 1.3/ /
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SEPTIC TANKAan(locate on site
Depth below gradeAMS 9youil 1 I
�
Material of construction- oncrete_Metal_FRP—other(explain)
Dimensions: ' Baffle Depth Below Outlet Invert: Mo 0
Sludge depth: Z__2
Distance from top of sludge to bottom of outlet tee or baffle:_ AA
Scum thickness: t "
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or,baffle:. M
Comments:
(recommendation for pumping, condition of inlet and o tlet tees or baffle, depth of liquid level in rel 'on to utlet inve ,
structural integrity, evidence of I ak ge,et .)
a
r l '
EASE TRAP:
(lo ite on site pan)
Depth low grade:
Material o construction:_con /etemetal_FRP_other(explain)
Dimensions: Baffle Depth Below Outlet Invert:
Scum thickness.
Distance from top f um to top of outlet tee or baffle:
Distance from bott of scum to bottom of outlet tee.or baffle:
Comments:
(recomme ation for pum 'ng, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,
structur integrity, evidence eaka e
, etc.)
(revised 8/15/95) 6
[FlLEk3/q9q/q
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
TIG T OR HOLDING TANK:
(locat on site plan)
Depth belo grade:
Material of co truction:_conc /emetal_FRP_other(explain)
Dimensions:
Capacity: Aal ns
Design flow: allo \s/day
Alarm level:
Comments
7
(condition f inlet tee, condition of alar and float switches, etc.)
/Z�E
DISTRIBUTION BOX:
(locate on site plan)
Depth below grader
Depth of liquid level above outlet invert:
Dimensions of D-Box• '�o X/ "Depth of Sump: 3 N
Comments.
(not if leve and distribution is equal,evidence of so�6(7
S ryover,,evidence of leakage i to or out of ox, etc.)
IML (�0 / i? i7 s7 P ,n ,
AJ o r / r
not L.e
PULP CHAMBER:
(loca on site plan
Depth belo rade:
Pumps in wor i order:( s or no)
Comments:
(note conditions o ump hamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 7
. 4 FILE#
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM (SAS): /E'S
(locate on site plan, if possible excava ion not required, but may be approximately by non-intrusive methods)
Depth to bottom of SASZL"(�tStone or Pit) '
If not determined to be prenf, explain:
Type:
leaching pits, number: /
leaching chambers, number: y7'L24One'
leaching galleries, number: L�aeh L/ne-
leaching trenches, number, length: //'Pn r� ,Gelzc-4
leaching fields, number, dimensions: 3 y 'Leach C-�n�
Comments- (nQLe condition of soil, signs of hydraulic f Ur , level of p ndin , c ndition of vege ation, etc.)_
/ 1— Ci OtCe
6k
eac Lr
CES POOLS:
(loca on site plan)
Depth elow grade:
Numbe nd configuration:
Depth-to of liquid to inlet invert: /
Depth of so�s layer:
Depth of scun layer:
Dimensions of �sspool:
Materials of const uctio .
Indication of grouner:
inflow(ce p of must be pumped as part of inspection)
Comm ts: (note condition o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PR b
(loca on site plan)
Materials con ruction: Dimensions:
Depth of so
Comments: o condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95) 8
FILE# 31 9917/
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
on ST
A =�J
o �
T10
O.
6'
� f
DEPTH OF GROUNDWATER
Depth to groundwater: 1,S�eet
method of d termina ion or Oro imatio 11-/ OUT O� l
=S31,5 f,
B 26 ,
(revised 8/15/95) 9
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Date of Pumping: (� O v0 " �`
Quantity Pumped: aahons ``FY
--- g
Cesspool: 1\'0 ❑
Yes Septic Tank: No ❑ Yes El �`<`` '•-'`
SN stem Pumped bv:
' License #: .'
Contents transferred to: a; ,f
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Date Inspector
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' • THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY• ` ';f�' ` rzx ;.:
1 '
.
SUSAN KIERSTEAD 231
MARY LOU SALOIS
10 BOSTON ST.
NORTH ANDOVER, MA 01845 liq-7-19 53-7143/2113
PAY TO b
S ORDER OF E ! W p ` On V'C.J` $ r. {
� 75 OC)
4 T DOLLARS
�\ Lawrence
savings Bank
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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
F '9A
Q �SIED /6 'Y
L 19
APPLICATION FOR SITE TESTING/INSPECTION
�9SSACHUS���y
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
7°
l
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: 5-'_aO CURRENT INSTALLER'S LICENSE#
LOCATION:
LICENSED INSTALLER:
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes J No
Foundation As-Built? Yes NoE�'`3�'�
Approval .// �C2/�� Date:C�
i
Town of North Andover, Massachusetts Form No. 3 •
of No RTN1 BOARD OF HEALTH
° ti0
3? ee'a o
4.
° 0 19—C?
A
t i #
�',S'^'•'^''t�' DISPOSAL WORKS CONSTRUCTION PERMIT
S^CMusE
Applicant
//NAME DURESS TELEPHONE
Site Location to S� ��.--
Permission is hereby granted to Construct ( ) or'Repair an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
�c.HAIKMAN OAI-DOFHEALT! H
Fee D.W.C. No. 2
PLAN REVIEW CHECKLIST
ADDRESS h
1' J--j" 061X QST ENGINEER 5�e-'-
GENERAL
3 COPIESIZ STAMP// LOCUSy/ NORTH ARROW 1,1-/ SCALE L/
CONTOURS_4Z PROFILED SECTION 1/ BENCHMARK SOIL &
PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS
WATERSHED?-Ab- DRIVEWAY /(Elev) WATER LINEy FDN DRAIN
SCH40 TESTS CURRENT? c./ SOIL EVAL
SEPTIC TANK .
MIN 150OGZ/ 17'. INVERT DROP GARB. GRINDER (2 comps +200)
10 ' TO FDN MANHOLE L/ ELEV GW # COMPS . GB L--�
D-BOX
SIZE # LINES . FIRST 2 ' LEVEL STATEMENT
INLET OUTLET97.30 = ' l .:(.2" OR . 17 FT) TEE REQ D?
LEACHING
MIN MO GPD?z RESERVE AREA L/ 4 ' FROM PRIMARY? 2% SLOPE
100 ' TO- WETLANDS. 100 ' TO WELLS4 ' TO. S.H.GW (5 ' >2M/IN)
.20 ' TO FND .& INT.RCPTR _DRAINS 400 ' TO SURFACE H2O SUPP �J
4 ' PERM. SOIL BELOW- FACILITY ✓ MIN 12" COVER FILL? L '
BREAKOUT MET?
TRENCHES dM.
33U
MI40' gpd SLOPE (min .005 or 6"/100 ' ) SIDEWALL DIST. 3X EFF.
W OR D (MIN" 6 '') L=-/— RESERVE BETWEEN TRENCHES? y IN FILL?lc__—MUST
BE 10 ' MIN 4 PEA STONE?_&�ENT? (>3 ' COVER; LINES >50 ' )
BOT �D�C� + SIDE 0 X LDNG 'Z = TOT
(L x W x #) (DxLx2x#) (G/ft2)
7I& -,�g ,prod / 5� vvab z/
Copyright 0 1996 by S.L. Starr / ✓z o
May 23, 1997
William Dufresne
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: 64 Boston Street
Dear Bill:
This is to inform you that the proposed plans for the site referenced above have been
disapproved for the following reasons:
If new plans satisfactorily addressing all the following issues are submitted to the Health
Department by ` L)N , then approval for the plans should be given by
JuAJ9- i/
01�1. Soil evaluation forms missing. (310 CMR 15.018)
v, 2. Insufficient leaching for a three (3)bedroom dwelling and no request for any variance.
(3 10 CMR 15.203 &N.A. 2.14(4))
V �3. Additional soil testing needed at western end of system. (3 10 CMR 15.102 & 15.104)
If you have any questions, please do not hesitate to call the Board of Health Office at the
number below.
Sincerely,
Sandra Starr, R.S.
Health Administrator
SS/cjp
cc: Mary Ann Salois
File
Town of North Andover t NORTH° ,
OFFICE OF �? ry`ttlD ,,, yo°L
COMMUNITY DEVELOPMENT AND SERVICES °
F A
30 School Street `►o' ` '`
North Andover Massachusetts 01845 ��
WILLIAM J. SCOTT 9ss'4 U
Director
May 27, 1997
William Dufresne
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: 64 Boston Street
Dear Bill:
This is to inform you that the proposed plans for the site referenced above have been
disapproved for the following reasons:
If new plans satisfactorily addressing all the following issues are submitted to the Health
Department by June 4, 1997, then approval for the plans should be given by June 11,
1997.
1. Soil evaluation forms missing. (3 10 CMR 15.018)
2. Insufficient leaching for a three (3) bedroom dwelling and no request for any variance.
(3 10 CMR 15.203 & N.A. 2.14(4))
3. Additional soil testing needed at western end of system. (3 10 CMR 15.102 & 15.104)
If you have any questions, please do not hesitate to call the Board of Health Office at the
number below.
Sincerely,
Sandra Starr, R.S.
Health Administrator
S S/cjp
CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
NORTH ANDOVER BOARD OF HEALTH
DESIGN REVIEW REPORT
/ n iia/97
FEE: �O � PERMIT # '7 1DATE RECEIVED
APPLICANT M,'g )/ C.DU SALa/S MAP PARCEL
ADDRESS Oce e;&2Sy"7>10 57- LOT # CO
ENG. tom • ST.ADD. lr>6 ,7-
PLAN
-
PLAN DATE REV. DATE
CONDITIONSOFAPPROVAL
APPROVED DISAPPROVED
REASONS FOR DISAPPROVAL:
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Town of North Andover, Massachusetts Form No.2
BOARD OF HEALTH
3:•�` ' °� 19�
o —
.
---�•* DESIGN APPROVAL FOR
C""5``� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant LAA0A ,(� Test No.
Site Location GLA
Reference Plans and Specs.
• ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
: CHA AN,BOA HEALTH
LFeV Site System Permit No.131
MAP AND PARCEL
ADDRESS
OWNER
SIZE OF LOT IN SQUARE FEET I I
#BEDROOMS
SEPTIC SYSTEM LOCATION
(For example,FRONT YARD SOUTHEAST CO R)
FINAL GRADING DATE f J cj
AS BUILT PLAN IN FILE?
INSTALLER
DWC PERMIT DATE (0 r G 7
CERTIFICATE OF COMPLIANCE DATE 1
ENGINEER ���C.CiCidy
Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
July 15, 19 97
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X)
by Mike Reify
INSTALLER
at 64 Boston Road, North And n�Ter� MA 01845
SI TE LOCA I IUN
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. 917 dated May 2 , 19 97
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
L
FORM 11 - SOIL EVALUATOR FOR-NJ
Page 1
No. JUN - L 199
Date ............... ......
COmmonwealth of Massachusetts
` assachusetts
Soil Suitabili Assess ent orn- ite
Performed By: .......... .,...��..� ��' �
_. ........................
Witnessed By: _ ...............
...............
l�lan Address« 3 .........._
Owner's Home. p..
Te ,na;
lepho
1Y 2-
- / N
New Construction ❑ Ropair
O.ffibe Review I E
j
Published Soil Survey Available:' No ❑ Yes
Year Published ../�1P�f �'ublication Scale �....
Soil Map Unit .....l. > :
Drainage, Class Soil Limitations
........:..........
.............................................
Surficial Geologic Report Available: No L� ❑
' hes
Year Published ............
Publication Scale .......:........
..
Geologic Material (Map Unit) .
.................................................'.
Landform ... � ............ ... :.
Flood Insurance Rate Map: ....... .. ..................................... . ... ..... ..
Above 500 year flood boundary , No
❑ Yes Ly'
Within 500 year flood boundary. No L Yes ❑
a
Within 100 year flood boundary No
Yes ❑
Wetland Area:
: National Wetland Inventor .Ma '
Y P (map unit) ......: .................. ..................................
Wetlands Conservancy Program <Ma
.................
P (map unit)..................................................:.
Current Water Resource Conditions (USG; S): Month ...........:......
Range : Above Normal ❑ Normal ❑
Below Normal ❑
Other References Reviewed: (,(�(2 f (���
FORM 11 - SOIL EVALUATOR FORA
Page 2
O11-Site Review
Deep Hole Number Date: y-l6 Time: �`/fd�'� Weather fic-w.,
Location (identify on site plan) - :��� �
.............. ...................................................
Land Use ....................... .. Slope l°'oi �dlia Surface Stones ....-...
Vegetation ....... .......I...............
Landform .........0 ............. ........
Position on landscape (sketch on the back) . _ .. .... . ........ .... ................... ......
Distances from:
Open Water BodY7iOO feet Drainage way 7���.� feet
Possible Wet Area 7t6wt feet Property Line f' .. feet
Drinking Water Well>too' feet Other
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(Inches) (USDA) (Munsell) (Structure, Stones, Boulders,
Consistencv. % Gravel)
[r
PSL /oYK.
--w 6Ge
1 2e� �� C�•S L. ZP 57'r It f i1k✓,�ez 41 is•, s5 f'v[�h
c
/0/&
Parent Material (geologic) a. . . .................................................. Depth to Bedrock:
Depth to Groundwater: Standing Ws;e: in the Hole: .... ...... . Weeping from Pit Face: .
Estimated Seasonal Hign Ground Water: f& ��
FORM 11 • SOEL EVALUATOR FORM
Page 2
On-site Review
!� --_7 Time: �o
�' �� o'� Weather tJUI �OB
Deep Hole Number .�4i. ..... Date: Y-1(o
Location (identify on site plan) . .. . ... .............................................................................. l..
Land Use / . ...................... ... Slope ft Surface Stones ......-,' .. ................................. ..
Vegetation ......(A.-I �-;Y1f//�,�'Ud . ........ I .......... ... .. .. ........... .1 1
Landform ........... .. I................................................... .... . ...._
Position on landscape (sketch on the back) ..............................................-........ . ...........--
Distances from:
Open Water Body feet Drainage way >Acl 0 feet
Possible Wet Area j.-�1 feet Property Line ���... feet
Drinking Water Well 7( feet Other
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(Inches) (USDA) (Munsell) (Structure,Stones, Boulders,
Consistencv, % Gravel)
14
Parent Material (geologic) _. Depth to Bedrock:
Depth to Groundwater: Standing Wave. in the Hole: __" .._ Weeping from Pit Face: .l
Estimated Seasonal High Ground Water: 7 ���
FORM 11 - SOIL EVALUATOR FOPM
Page 3
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole.................. inches
epth weeping from side of observation hole .................. inches
f/
Depth to soil mottles ec.. .A�,inches,
❑ Ground water adjustment feet
t
Index Well Number .............. Reading Dade .... ............. Index well level .................. r
;Adjustment factor ........ Adjusted ground water level ........................................................
Deoth�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? .
If not what is the
depth'
of naturally oocurrin9Pervious
material?
Certification
i
I certify that ons:. :!C (date) I have passed:the examination 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.
a
bUtteu:*wQDate �Z
T
l
� ao'^c=--•o
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICA-NT fiLLS OUT THIS SECTION***********************
T
APPLICANT Ed-L-ItzUe- 6-z� r L`l PHONE
LOCATION: Assessors Map NumberO l� PARCEL_
SUBDIVISION LOT (S)
STREET ��5�"-� S ST. NUMBER--G—
***************************************OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS:
/
v CONSERVATION ADMINISTRATOR DATE A��ROVED ���b `�`�
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOLTH DATE APPROVED
R-H DATE REJECTED
SEPTIC IN�3PECTOR-HEALTH DATE APPROVED
' DATE REJECTED
COMMENTS
—424Z 14--
s . X,�
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
,17'S�1
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I �A151 '1<.iX3 I
0100
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