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HomeMy WebLinkAboutMiscellaneous - 66 HAY MEADOW ROAD 4/30/2018 f 66 HAY MEADOW ROAD 2101104.B-0103-0000.0 i ' � Town of 1)iorth Andover Office of the Health Department � p Community Development and Services Division 400 OSGOOD STREET '" •_= -�•��rj' �,'p+�sto�R•C� North Andover,Massachusetts 01845 ss�cNuse Susan Y. Sawyer,REHS/RS 978.688.9540-Phone 978.688.8476-Fax Public Health Director CW RVg7jCA qtF O F COJVI M�r TO jCVCE As of: ,dune 1, 2004 This is to cert that the individua(su6surface disposa[system Repaired 0 — ('uf(System(X� by ,john Soucy .At 66 Yfaymeadow Road North Andover, AVIA 01845 Yfas been installed in accordance with the provisions of Title v of the State Sanitary Code and with the North Andover(Board of ifealth regulations. The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. S an IY. Sawyer, 1RE3fSlgU Public Yfeafth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( j constructed; (%6 repaired; by .�o 1-1 Al S Ov G `� .located at � �Pfl d c� was installed in conformance with the North Andover Board of Health approved plan, System Design Permit.# ,plan dated ,with a design flow of S50 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 re accurately y presented on the As built which has been submitted to the Board of Health. Bed inspection date: - ngin Representative Final inspection date: s�Zo�ay ngin epresentative Installer: GYi Lic.#: Date: Engineer: o`' RICH 9 Date. C. TANGARO m (� --I 13021 NAL : l RICHARD 9y C. TANGARD 13M 90 /STERE � ss/ANAL��'\ i Page 1 of 1 DelleChiaie, Pamela From: Dan Ottenheimer[info@millriverconsulting.com] Sent: Wednesday, May 19, 2004 8:49 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 66 Haymeadow Road Sue and Pam, Attached please find the final construction inspection report for 66 Haymeadow Road. System was built with no problems evident. We could not access the basement to see the control panel and confirm the alarm and pump were on separate circuits, but this has never been a problem before with this installer plus the electrical inspector was slated to arrive this afternoon. Installer also put magnetic marking tape the entire length of the force main so it can be found if needed on some dark and cold winter night. This is a real good thing which I have started encouraging installers to include. It was nice to see someone actually listens to my nasally voice every once in a while. Dan Daniel Ottenheimer,President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester,MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info millriverconsulting.com 5/19/2004 J 0 MILL RIVER CONSULTING Septic System Management Services TOWN OF NORTH ANDOVER SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 66 Haymeadow Rd MAP:104B LOT: 103 INSTALLER: John Soucy DESIGNER: NEES PLAN DATE: 11/17/2003 BOH APPROVAL DATE ON PLAN: 12/3/2003 DATE OF BED BOTTOM INSPECTION:5/6/2004 DATE OF FINAL CONSTRUCTION INSPECTION: 5/18/04 DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE Pressure Dosing COMPONENT SUMMARY FROM PLAN GALLON TANK = 1500 LOADING OF SEPTIC TANK = H-10 GALLON PUMP CHAMBER = 1000 LOADING OF PUMP CHAMBER = H-10 TYPE OF SAS = Infiltrator Trench DIMENSIONS AND DETAILS OF SAS: 62.5'x 15'w/overdig : 2 rows, 10 chambers ea. SITE CONDITIONS ®Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: Could not access house but contractor indicated only one building sewer I 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282.0014 info@millriverccnsulting.com Page 1 of 5 O O MILL RIVER CONSULTING Septic System Management Services SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading 2-Piece construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, over access port ® Outlet tee (gas baffle or effluent filter) installed, over access port ® 24 inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: Building sewer not a straight line to septic tank because of location of exit from house. Contractor put in several 22 and 45 degree bends and a cleanout to grade. PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1000 gallon Pump Chamber installed H-10 loading 2-Piece construction) Inlet tee installed, over access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off float working ® Drain hole in pressure line ® 24 inch cover to within 6" of final grade installed over one access port ® Water tightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282.0014 info@millriverconsulting.com Page 2 of 5 o a MILL RIVER CONSULTING Septic System Management Services ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: n/a D-BOX ❑ Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: No elevations given on plan for D-Box. SOIL ABSORPTION SYSTEM ® 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 ❑ 3/4-1 %" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ! ❑ laterals installed and.ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ® Gravelless disposal systems: type, number and location as per plan ® Elevations of laterals installed as on approved plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Trench from pump chamber to septic tank has magnetic marking tape for ease of i location. Owner also installed electrical conduit to swimming pool in same trench. 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282. 0014 info@millriverconsulting.com Page 3 of 5 a Q MILL RIVER CONSULTING Septic System Management Services PRESSURE DISTRIBUTION ❑ inch manifold ❑ Laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: n/a CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: Inside ❑ Rated for exterior if placed outside Comments: Could not access inside house to check control panel but electrical inspector was slated to check panel later in day. 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1. 800.377.3044 978.282. 0014 info@millriverconsulting.com Page 4 of 5 0 MILL RIVER CONSULTING Septic System Management Services SYSTEM ELEVATIONS Benchmark: 100.00 Rod at Benchmark: 7.60 Height of Instrument: 107.60 INVERT ON DESIGN PLAN ACTUAL INVERT ELEVATION Building Sewer OUT 95.00 95.13 Septic Tank IN 94.55 94.70 Septic Tank OUT 94.30 94.43 Pump Chamber IN 94.25 94.36 Pump Chamber OUT 94.00 94.20 Distribution Box IN 103.50 D-BOX OUT 103.30 Manifold Lateral at Chamber 102.79 102.91 Top of Sand Fill 102.25 102.34 i i 5 Blackburn Center, Gloucester, Massachusetts 01930-2259 toll free 1.800.377.3044 978.282. 0014 info@millriverconsulting.com Page 5 of 5 t { Commonwealth of Massachusetts 1043-Map-B�'`01033- 04.6- - ----------------------- Board Of Health Permit No -20 North Andover BHP-2ooa-o3as ----P ------------- P.I. FEE P I $250.00 Disposal Works Construction Permit Permission is hereby granted John SouCy_______________- ---_----___-________------ to(Repair)an Individual Sewage Disposal System. at No 66 HAY MEADOW ROAD--------------------------- -------------------------------------- -------------- as shown on the application for Disposal Works Construction Permit No. BHP-2004-034_ Dated_ April 06,_2004- _ ------ ----- ----- ------------- ---------------- Issued On:Apr-06-2004 ddrd ealth ............................................................................................................................................................................... z__ APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# l LOCATION: 4, t LICENSED INSTA SIGNATURE: Dv TEL HONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only �OOe Attached? Yes No Foundation As-built? /f/�s No r Floor plans on file? ;� xs No Approval J/1Date: II _ 1 INSTALLER PROJECT MANAGEh;!NT OBLIGATIONS As the North_Andover licensed installer for the construction of the septic system for the property at relative to the application of c dated for plans by X6111&, an( 11-1']-0 dated� a - with revisions dated 'j I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contra( project manger, or any other person not associated with my company schedules an inspec and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicz inspections as indicated below. I understand that requesting an inspection,. with completion of the items in accordance with Tile 5 and the Board of Health Regulations r result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally.first inspection unless there is a retaining wall which should be d first. Instal10--must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-buih verbal OK from engineer must be submitted to Board of Health, after which installer calls inspection time. Installer must be present for this inspection. With pump system all electri work must be ready and able to cause pump to work and alarm to function. c) Final Grade'—Installer must request inspection when all grading is complete. Does not have to on site. j 3. As the installer I understand that persons or companies not associated with.my company m not perform the work required by my company to complete the installation of the syste identified in the attached application for installation. I further understand that work by othc unlicensed to install septic systems in North Andover can constitute reasons for denial of t: suspension of my license in the Town of North Andover pl system, and/or revocation or significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the followil construction steps: elevation of the excavation has been reached. a) Determination that the proper b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wail and oth components. 5. As the installer I understand that I am solely responsible for the installation of the system per the approved plans. No instructions by the homeowner, general contractor, or any,oth( 4Dispal ersons shall absolve me of this obligation. Licensed Sept staller p✓c Date: ks Const tion Pe t # 66 HAYMEADOWROAD JS-2004-0064 Proiect Detail Report Printed On:Wed Jul 20,2005 Project Name: GIS 4: 591.8 Project No: JS-2004-0064 Owner of Record KURKUL, STEPHEN&MARY ,.otta►, , Map: 104.13 Date Submitted: Jun-25-2003 66 HAY MEADOW ROAD °9 Block: 0103 Status: Open NORTH ANDOVER, MA 01.845 a , Lot: Work Category: Work Location: 66 HAY MEADOW ROAD Zoning: Proposed Use: District: ACCU land Use: 101 Proposed Use Detail Subdivision $ wu9 - Description Soil Testing Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Flealth GREEN FLAG BHJ-2003-0068 7/20/05-h/o-Steven Kurkel called for a copy of COC. No Installation Certification Form done,and no Final Grade done. These two items need to be done before it is issued. Spoke with Sean at NEES,and he will generate an original with Ben's signature and stamp,and will send it down. 1 will call John Soucy when received,and have him come in and sign it. Will then schedule a Final Grade Inspection.--p.d. 5/18/04-Final Inspection 5/6/04-Bottom of Bed Inspection 4/5/04-John Soucy applied for a DWC permit. Signed off by Susan Sawyer to use plans approved on 12/3/03 on 4/8/04 with note to John:"The plumbing inspector wants a permit pulled to move the foundation invert and the electrical inispector wants a permit for a pump alarm." Called John to let him know everything is ready for pickup.--p.d. 12/3/03-Septic Plans approved with revised date of 11/17/03. 11/20/03-Septic Plans submitted by NEES. 7/17/03-Soil tests done. 7/10/03-Eng.called looking for Soil Test date. 7/3/03- Received back from Conservation. 6/25/03 Received application for Soil Testing. Copy to Conservation. Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: DWC-System Repair BHP-2004-0349 Apr-06-2004 SIGNED OFF JS-2004-0064 Plan Review BHP-2004-0348 Dec-05-2003 SIGNED OFF JS-2004-0064 New Repair Soil Tests BHP-2003-0161 Jul-08-2003 SIGNED OFF JS-2004-0064 Soil Testing Inspection History GeoTMS®2005 Des Lauriers Municipal Solutions,Inc. Page 1 of 2 66 HAYMEADOW ROAD JS-2004-0064 Project Detail Report Printed On:Wed Jul 20,2005 Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Final Inspection DWC-System Repair BHP-2004-0349 May-18-2004 FULL COMPLY Dan Ottenheimer JS-2004-0064 Bottom of Bed Inspection DWC-System Repair BHP-2004-0349 May-06-2004 SIGNED OFF Dan Ottenheimer JS-2004-0064 GeoTMS®2005 Des Lauriers Municipal Solutions,Inc. Page 2 of 2 Page 1 of 1 0 0 DelleChiaie, Pamela From: Dan Ottenheimer[info@milldverconsulbng.com] Sent: Thursday, December 04,2003 9:09 AM To: Heidi Griffin; Brian LaGrasse; Pamela Dellechiaie Subject: 66 Haymeadow Road Heidi, Brian and Pam, Attached please find the plan approval letter for the septic system design at #66 Haymeadow Road. Dan Daniel Otfenheimer, President Mill River Consulting Septic System Management Services 5 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com .com info@millriverconsuIting.com .com 12/4/2003 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES o? `.'•° HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Heidi Griffin 978.688.9540—Phone Acting Health Director 978.688.9542—FAX December 3,2003 Stephen Kurkel 66 Haymeadow Road North Andover,MA 01845 RE: Subsurface Sewage Disposal System Plan for 66 Haymeadow Road,Map 104B,Lot 103,North Andover, Massachusetts Dear Mr.Kurkel, The North Andover Board of Health has completed review of the septic system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated November 17,2003. The design has been approved for use in the construction of a replacement onsite septic system.This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection which did not meet the acceptable criteria in the state regulations. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer,septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board,Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Since ly, Hei Griffin, Acting Health Director encl: List of licensed septic system installers cc: file New England Engineering Services OI42 Town of North Andover HEALTH DEPARTMENT 27.Charles Street North Andover,MA 01845 978.688.9540 healthdevirYownofnorthandover cpm SEPTIC PLAN SUBMITTAL FOR -- ���'�' a DATE OF SUBMISSION: %/f lq`e3 NOV 2 00 20 SITE LOCATION: 1� ✓ w► p ENGINEER- w Fn3 NEW PLANS• YES_ S225.00/Plan Check#• (Includes IWNEwP and one Re-Review Only) REVISED PLANS: YES $75.00/Plan Check#: SITE EVALUATION FORMS IN CLUDED: YES NO LOCAL UPGRADE FORINT INCLUDED: YES O . Telephone#:_q7S 1768 Fax#:��7�-�gv=�oqq E-mail: S E N`G—60 AC)1.- Ccs A/1 HOMEOWNER NAME: OFFICE USE ONLY When the submission is complete(Including check). r/ 1• Date stamp plans and letter 2 Complete and attach Receipt 3 Copy Fide; Forward to Consultant d. Enter on Log Sheet and Database © 0 NEW ENGLAND ENGINEERING SERVICES INC November 19, 2003 TOWN OF NORTH ANIOU Brian LeGrasse OF_ s North Andover Board of Health 27 Charles Street Nov 2;0 2003 North Andover, MA 01845 F f Y Re: 66 Haymeadow Road,North Andover, Septic system design Dear Brian: Enclosed are the following documents concerning the above referenced property. 1. 5 sets of septic system design plans. 2. Application for plan approval. 3. Soil evaluator sheets. 4. Check to cover the approval fee. These plans are being submitted for approval. If you have any comments or questions please do not hesitate to contact this office. Sincerely, 9'. C (9 Benjamin C. Osgood, r.,EIT President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 .. 11/Ubi/ZUai:.,; gib;5J 1181 ia4U1_ IANUAHDR PAGE 01 FORM 11 - SOIL EV'AIXATOR 1;ORNM Page 1 of 3 No. / -z Date: / 03 Commonwealth of Massachusetts ,AN-volz- , Massachusetts Sail Suitability Assessment,f0 0n-site Sewage Disposal Performed By: .. .. =. .. . '........ rei�� .. Date; Witnessed By: Loaumn A6&m aAddrem, P4 A,Y�l f]'/�j/y/yl/ Owisr'F Wme. '►� � C�� La a ,)Ve ,tFl vr���/T J�-V/i" Te tOnoneA/ i /Yo. New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published Publication Scale �'� �, Soil Map Unit Drainage Class XO� z ................. Soil Limitations Surficial Geologic Report Available: No Q Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) .......................................... ............. .... .... ......... . . ... Landform ................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes N Within 500 year flood boundary No ❑Yes 7 Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map un-it) ................ ... ... ...... .......... . .. Wetlands Conservancy Program Map (map unit) ...... Current Water Resource �/� es urce Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belc,.V Normal ❑ Other References Reviewed: DEF APFROVED FORM-12/07/9S 11 bbl�bkl L17 .5y'.:. T(�i'1334►�1'1 :TANGARDR O PAGE-:.;:02 FORM 11 - SOIL EVALUATOR 1,*0121M Page 2 of 3 ol Location Address or Lot Iqo, On-site Review 7 r Deep Hole Number Date: ./ ..��/a3 Time- Location ime Location (identify on site plan) Land Use UseSlope (°r6y - Surface Stones Vegetation Landform' Position on landsoape Distances from: Open Water Body feet Drainage way �� feet Possible Wet Area feet Property Line feet Drinking Water Well> /SZ�' feet Other DEEP OBSERVATION HOLE LOG Depth trom Soil Horizon Soil Texture Soil Color Soil other Surface (Inches) 1USDA) (Munsell) Mottling (Structi.ire, Stones, Boulders, Consistency, % Gravel) -37 dye% - t 5 Eo, Parent Material{geologic) GrG �.��7^ 7-7e-e— DepthtoSedrock: Deo;h to_Groundwater; Srandinq Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: ki D1::P APPROVED F0 PM- 12;07/95 FORM 11 - SOIL EVALUATOR FORNI Page 2 of 3 Location Address or Lot :Jo. J96tA" On-site Review Deep Hole Number Date: /�'/ Time / Weather -41 4 �f Location aide ify on site plant Land Use Slope (%1 "' Surface Stones J Vegetation Landform Position on landscape d . 7. Distances from: Open Water Body C��°'� feet Drainage way ' feet Possible Wet Area 4,'° feet Property Line' feet Drinking Water Well,? feet Other DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil atnor Surface(Inches) (USDA) (Munsell) Mottling (Structure.Stones, Boulders, Consistencv, 0* Gravel V,416 fid/ ` 1�401,01 Parert Material(geologic) Dopthtoeedrock: Depth to roar water: Standing Water in the Hole: �-_ weeping from Plt Face: r� Estimated Seasonal High Ground Water,` DEP APPROVED FORM, e2/0i/95 ., +-, `111;`@Of LGG;.3•r":'G C�:..�:7 1.F+3'b.�.34G110 . : ::";_^`I.F1N17�5KL1K. �.: ..'. .- :'f";Al7t'='1�4-- FORM II - SOIL LVALUATOR FORM Page 3of3 Location Address or Lot No. 2i'�y���?/.��/ Determination for Seasonal High Water Fable Method Used: ❑ Depth observed standing in observation hole.......... ..... inches ❑ Depth weeping from side of observation hole......... inches ® Depth to soil mottles ✓inches 4'-' /- ❑ Ground water adjustment ..................I feet /;&2 — 317 Index Well Number .................. Reading Date ................... Index well level ........... ... Adjustment factor ................ Adjusted ground water level ..................... ...... ,................ I Demth of Naturally Occurrin_q_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 occurring pervious material? Certification I certify that on ��(date) I have passed the soil evaluator examination approved by the De0aIrtment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date / /?,P/, i DEP APPROVED FORT!•f2lo/9s FORM 12 -PERCOLATION TEST Location Address or Lot No. �o� ? ✓►�✓vl e�o� (� COMMONWEALTH OF MASSACHUSETTS �jb P-MI AN flcoe2. Massachusetts Percolation Test` Date: .xw. .7 f j/�7: :�Zdv?� Time:. .� c> Observation Hole # Depth of Pero 36 Start-Pre-soak �7 , Da End Pre-soak Time at 12" Time at 9" Time at 6" Time W-61 Rate Min./Inch LL,, _7 M(AI r Aj C'q * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ _.............................................._............................................................................-.....___......_....... Performed By: ,�- Witnessed By: :�-2 n A j 13 0-41- Comments: v.........r.. �.. ._. ._ _ ....k..v..... ...........:.......... ...w�. w.... k. .....v�.. ....,......_..v.�........ M._ _.wk...�.- .._ ...... DEP APPROVED FORM-12/07/95 of NOHTH Vti / OFFICES OF: o�„ 0Town of 120 Main street APPEALS � � » NORTH ANDOVER North Andover, BUILDING Massachusetts O 1845 CONSERVATION 96sACHUS DIVISION OF (h 17)685-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR Building Inspector 3-17-88 re: proposed pool 66 Haymeadow The Health Dept. has no objection to the proposed pool location at this site. Sincerely, Mike Graf cc: R. Stockard 66 Haymeadow 3 s G- l� CA ar - S SYS /ks Ee R-ji" � T Sc�4rtw) z 7 3 - QCs Zk � L PERMANENT Permanent Civil Service Employees as of January 2, 1988. Seniority Date is ranking ha.sed on City Town length of ser"rice as a. permanent employee after certification as defined in MGT,, Chapter 31, Section 33. Department Division Muni- Name of Employee Social Sey lEthnicSeniorit Permanent Mill-time Appointment Prov.Prom Class SecurityM,F Code Date Title After (FT) Date to TitleCode Title Number Certification Part-time Current & Effec r,ode (PT) Position Date Return to: Dept. of Personnel Administration, One Ashburton P1ace,. Room 307 Boston, MA 02108 Signature of Appointing Authority Town of North Andover, Massachusetts Form No. 1 NaRrM BOARD OF HEALTH / 1646 0 1 * rD 10 APPLICATION FOR SITE TESTING/INSPECTION * 7 ADRA TED PPI" .CEJ �SSAC14USE� i Applicant ������ NAME ADDRESS TELEPHONE Site Location /� /�C • Engineer ` Z /��— 4 ` —1/4� NAME ADDRESS TELEPHONE Test/Inspection Date and Time w CHAIRMAN,BOARD OF HEALTH Feel' GKJ Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH ., NORTH ANDOVER, MA 01845 978-688-9540 JUIN ° 3 APPLICATION FOR SOIL TESTS DATE: fr 1 MAP &PARCEL: log l " g LOCATION OF SOIL TESTS: L, f- !ajv,,e-e,(ao,.," P,,C> OWNER: 5q-e-eK E W 1"o 9,K 0 L- TEL. NO.: ADDRESS: a , �. ��n V-D ENGINEER: c, e TEL. NO.: q7 CERTIFIED SOIL EVALUATORS Intended Use of Land: Residential Subdivision Sin le Family Home Commercial Is This: Repair Testing: _ ^� Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No �Q THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or up rg ades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). TOWN o qRj` 7. Within 60 days of testing soil evaluation forms shall be submitted. Sr�,) ME!-.2 Please Do Not Write Below This Line — 32003 N.A. Conservation Commission Approval: + t Date Received: S � Check Amount: Check Date: 7 tJETTI- �. "JF Ja J F. - Mdrz�r a. Moot2.>✓ 43c�-d� '- SI" E -�- ... 15.1 1 ^ 5TH w >�at L ti P EXIS`f. I=EtJCE-TO sr-- I tl] O I J \y I 11 t J Oil dio_ oJ I = I to x C� S� l %- co d'I Q In V Lo 4c) LO 4-4,1435.1✓.} :�� �;� l X3,5 O 5.G_ sT AI L .w 11 ., '�S�T) IVE Y �} reo -- klTd A TOTA.L P COKITA GE- SZ O o Z 1 p w - 1� EtiSO.�IDE, �Z 0412 WOTES : I I2ECOCD OWIJ Et2 Or- L-0-T-45 ,CACL Ivt. 5t4EZ LA J. POL L 2. tZECOt [2 OWIJEI2 OF LOT 50 ,CzLV-L M-� >WCZLA, J .POLL 3. A13UTTOYLS UAME.5 -r&v V-P-1 PeOM T-IE IJOeTH AUDOV OGGICE MOST. 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