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HomeMy WebLinkAboutMiscellaneous - 75 STERLING LANE 4/30/2018 (2)(J7 4 rt �, N' LQ t rr a, 1` i TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 4/28/00 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Dave Maynard at Lot 5 Sterling Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector 2-,� 5 -5-�,Y << "7 - ORIGINAL STAMP & SIGNATURE ✓/ IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW �� LOCATION & ELEVATIONS OF BENCHMARK USED AS -BUILT CHECKLIST LOT NUMBER, STREET NAME_ ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS ✓ LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE _1z. TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA L/ LOCATIONS OF DEEP HOLES & PERC TESTS / I/ ELEVATIONS OF DISPOSAL SYSTEM ORIGINAL STAMP & SIGNATURE ✓/ IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW �� LOCATION & ELEVATIONS OF BENCHMARK USED TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF toll TANK & D -BOX ORIGINAL STAMP & SIGNATURE ✓/ IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW �� LOCATION & ELEVATIONS OF BENCHMARK USED Received Apr -27-00 09:54 from 508 688 9542 4 G Apr -27-00 09:46 North Andover Com. Dev. 508 688 9542 TONy`+ OF NORTH lYD(D ER "SEWAGE DISPOS.�Ir SYSTEtiI INSTALLATION CERTIFICATION 7 -He undersized he:eb,, ca:tL*y that the Sewage Disposal Systerr, ( const-,c.ed; ( } repaicec; by MR4NNt,0 located at lAT L�J2Ua & L0IVL, fl -10I I� �iN�)0VV t was installed is ccafcran ance with t_he NcrPI Ando ve- Bcarc of ealth at: craved cl-:.:L Svste:a Desizi co^a- T13 dated o a KI °i0I i,.h an approved desirr. `ow of 441 aLlIc s �cer day. The rat.:ca:s used were in zcn or:.arce .vith these soec:5ed an the acc;cved pia:.; the sy sreni was installed in acccrda-ice wit t.`:e prry Sims of 310 C SR 15.000, Tile 5 And toca:l re`uiawons, and the En -'l 37u^ n2_ a.=ees substantially with &,e approye' plan. All Werk is accurately recrese^ ed or: t-ee -built been s-,:brritted to the Beard cf He:ltz. Bea: nspec:iori date: Fina! ;zzs�eon daze: 2 ' Desi ya2 PHILIP G. CHRISTIANSEN o CIVIL v No.2889'`a�; 4• A�O� �FGISTEL'Sc�\�� er Reor esentatzve Date: 7 — '7 —CSU Date: —.e OC 7000Maj page 1 P.O1 . _ - _W �ti� ��'- �� 'r INSPECTION 1 i INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initials A. Bottom of Bed 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3.. Edge of excavation specified distance from foundation, etc. Comments: B. Retaining Wall 1. Wall height and width as specified 2. Waterproofed 3. Wall minimum 10' to leaching facility 4: Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 2. Schedule 40 pipe 3. Watertight joints 4. Inlet to tank cemented 5. Slope minimum 0.01 or 1/8" per foot minimum 6. Pipe properly set on compact firm base 7. Pipe laid on continuous grade in straight line 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 900 change 10. 10' minimum offset to water line Comments: D. Septic Tank 1. Level _ 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20" manholes 7. Inlet tee minimum 12" under invert 8. Outlet tee minimum 14" under invert 9. Outlet line cemented 10. Air space 3" above tees 11. 2" — 3" drop from inlet to outlet 12. Pipe set 13. Compact base with 6" of 3/4" crushed stone under tank 14. Tank is watertight Comments: Yes NO E. Pump Chamber 1. If separate from tank, compact base with 6" of 1/4" stone underneath 2. Minimum 2" pipe to d -box if gravity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0.1T' (2") drop from inlet to outlet ✓ 3. Minimum 6 sump too* - 4. Outlet pipes show equal distribution ✓` 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe _ Comments: G. Soil Absorption system 1. All stone double -washed ='/a" - 1 '/�" ✓ - pea stone LO -1, Bucket test done? 2. Minimum 2" of pea stone above distribution lines t �.- 3. Minimum 6" stone beneath pipe 4. Distribution lines capped or connected together_ 5. Grading meets 3:1 slope 6. Minimum of 9" of fill graded over system 7. Toe of slope stops minimum 5' from edge of property; if not, then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches ✓' 2. Length of trenches agree with plan. (Max. length 100') 3. Width of trenches agree with plan - Minimum 2'; maximum - 4'. 4. Vent present if 150 feet or specified 5. Distance between trenches minimum 4' and maximum of 6' q_ 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' ,r 8. Depth of trenches below outlet invert minimum of 6". Yes NO 9. Pipes set on stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipe 6' maximum 4. Pipes connected at end 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond f7 W C O Z Z 1 \\! = ar E a a W •� !\ LL y� W .D QZ �' N J Q '� y W 2 1 b �� \ LL Q z t•� V\ > \ �� o U Ln C Q Z Lu Z a� a } rd F- U , � a Q �•..� , L: W LLJQ = N > LL O Q \ CO U Q Y =3 a� Q o C Q Q C 3 O i ) CL n Ln Eui bA _y Q N Z W C rz *�• C 'N en Il O.JER Q r v 2 •t !o y —� '� rz o Moi ..• Q in a V) li V� APPLICATION FOR DISPOSAL WORKS CONSTRtiCTION PER1tiIIT DATE: _ 6d CURRENT I~iSTALLER'S LICEi`iSEm Z� LOCATION: 7L# ic% LICENSED INSTALLER: z2%14_�_4_-vrl 603 SIGNATURE:az2_TELEPHONE;� CHECK ONE: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Date: -5=11vD Administrative Use Only 575.00 Fee Attached? Yes V/ No Foundation As -Built? Yes �/' No Floor Plans? Yes ✓ No Approval Date: -5=11vD INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at relative to the application of z,�' dated 9—®r_for plans by.��sl�;� Yom, 'and dated ? —e6 with revisions dated I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. 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 my company. a) Bottom of Bed — generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. .f 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me -of this obligation. Undersigned Licensed Septic Installer -� Date: MAR - 9 Received Jul -08-99 13:51 from 508 688 9542 - G page 1 • Jul -08-99 01:26P North Andover Corn. Dev. 508 688 9542 P.01 Town of North Andover OFFICE OF °4 •"' ° ' ^ ��< COMMUNITY DEVELOPMENT AND SERVICES 30 School Street North Andover, Massachusetts 01835 ��� t WILLIAM J. SCOTT North Director February 3, t998 Mr. Steven D'Urso 22 Lilly Pond Dr. Boxford. MA 01921 Re: Lot #5 Sterling Lane, Dear Mr. D'Urso: This is to inform you that the above referenced plans have been disapproved for the following reasons: I. Septic system is located under gravel driveway to open space access (3IOCMR 15.240(7)). 2. Soil tests out of date (N.A. 7.05). 3. No benchmark within 75' of system (3I OCMR 15.220(q)).. 4. Missing map and Parcel (N.A. 8.02a).. 5. All pipe to be Sch4O (N.A. 14.04). 6. Alarm for pump shall be on separate circuit. Manual operating switch required. 7. If tanks in GW, buoyancy calculations must be done. 8. Please provide calculations for emergency storage. If you have any questions. please do not hesitate to call the number below. Sincerely. j /. Sandra Starr Health Administrator SS/rel c.c.: George Farr William Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 686.9540 PLANNING 688-9535 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 (978) 373-0310 FAX: (978) 372-3960 August 2, 1999 Ms. Sandra Starr: North Andover Board of Health 27 Charles Street North Andover, Ma 01845 Re: Lot 5 Sterling Lane Dear Ms. Starr: On behalf of our client, Coolidge Construction Co. Inc., we have prepared a revised septic system design for the above referenced lot. Enclosed are three copies of the plans. The septic system design previously submitted for this lot was prepared by Steven D'Urso. We have taken Mr. D'Urso's plan and revised it to incorporate the comments that you made in your February 3, 1998 letter of disapproval. The following is a list of our responses to each of your reasons for disapproval. In order to facilitate your review of this information, we have reproduced each of your comments in Italics, and our response to each of your comments immediately follows. 1. Septic system is located under gravel driveway to open space access (310 CMR 15.240(7)). Coolidge Construction has reached an agreement with the Massachusetts Department of Environmental Management whereby they will construct the gravel access drive within a newly created easement along the Lot 4/Lot 5 property line. The proposed leaching facility will lie outside of the new easement. The original easement will be eliminated. The new easement plan has been recorded in the North Essex Registry of Deeds as Plan #13516. 2. Soil tests out of date (N.A., 7.05). According to Mr. D'Urso, you agreed at the time of the testing in 1995 that the only one confirmatory test was required in this location. This requirement would be consistent with the testing provided for the septic system designs for Lots 2 and 3, which you have approved. 3. No benchmark within 75' of system (310 CMR 15.220(q)). An appropriate benchmark has been added to the plan. 4. Missing map and Parcel (N.A. 8.02a). The Assessors Map and Parcel numbers have been added to the title block. S. All pipe to be Sch 40 (N.A. 14.04). The system profile and construction details indicate the required Schedule 40 PVC pipe. 6. Alarm for pump shall be on separate circuit. Manual operating switch required. The new plan includes a different house footprint that has been specified at a higher elevation. This higher elevation enables the construction of the septic system without any pumping. 7. If tanks in GW, buoyancy calculations must be done. The new design includes the raising of the septic tank to an elevation above the groundwater level. 8. Please provide calculations for emergency storage. This comment is not applicable since the pump has been eliminated. I trust that the new design plan, along with my responses to your reasons for disapproval, fully address all of the your comments. Please contact me if you have any questions regarding this matter. 4Veryyly yours, Vnsen CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 September 29, 1999 Ms. Sandra Starr: North Andover Board of Health 27 Charles Street North Andover, Ma 01845 Re: Lot 5 Sterling Lane Dear Ms. Starr: (978) 373-0310 FAX: (978) 372-3960 On behalf of our client, Coolidge Construction Co. Inc., we have revised the septic system design for the above referenced lot. Enclosed are three copies of the plans. The revised plans include the location and results of the additional test pit that you requested in the leaching area. Also attached is a copy of the soil evaluation form for the test pit. Please contact me if you have any questions regarding this matter. Li] t; SES' 3 01999 LOCATIO NEW PLANS: REVISED PLANS: YES SEPTIC PLAN SUBMITTALS $60.00/Plan� , $25.00/Plan DATE:_/la DESIGN ENGINEER:�jc�.on .1�yYSo When the submission is all in place, route to the Health Secretary SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES REVISED PLANS: YES SITE EVALUATION FORMS INCLUDED: $125.00/Plan $ 60.00/Plan YES NO DATE: DESIGN ENGINEER:46 tl " DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port.,.,\;.. Engineering. Y i? 0, ; � 6lLTH i When the submission is all in place, route to the Health Secretary. SEPTIC PLAN SUBMITTAL FORM LOCATION:... -- NEW PLANS: YES REVISED PLANS: YES $125.00/Plan $ 60.00/Plan L--' SITE EVALUATION FORMS INCLUDED: YES NO DATE: -7 a1 r T%keYNGF fj1ORTH ANQ0!�' L Lj?n4 DESIGNENGINEER: hVfS f e114 ,°`.' ....._"�..n.'....._ f DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a'stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. s Town of North Andover, Massachusetts Form No. 2 e f NOR7q BOARD OF HEALTH O'w y hyo 194— A DESIGN APPROVAL FOR ss"CHUSSOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Appli Site Location Reference Plans and Spec Test No. , q3 �­ Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee t,4 Site System Permit No. ✓1 NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATEllo! q8 FEE: PERMIT # 4o DATE RECEIVED V �/ APPLICANT C5�&dQ GG- MAP PARCEL ADDRESS LOT # STREET # ENG. �% �� ll-, 2e (n STREET ',5-TeSeG/X-)G ,i,9 - ENGINEER'S ADD. PLAN DATE CONDITIONS OF APPROV REV. DATE APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: 6 y57 -&-M / c7), o &7- D ,9- L ,1V-14: 7,6 �0&AJ6N/� ���! Z,01142 7�"' G ysrcAs, @-�//j CMe Gill fq/-o 9�- /2191eC C. (1/, /q . �>. 0 a C. J %b ate. 6G// (A),4 14. b4J tae -PoR o s --8 67 G A) S U1 r. MA�VUA-G 6P&��/9-r/ 4_)4 SZZ) i rcf-/ QU/���. 7, .s em 7-dO Au /4-s IA-) ccs, —3�6 Yl'9w'f / y v 5 r- To/e1-Gc--, PLAN REVIEW CHECKLIST ADDRESS 2- - [5— 5,7-9;rZ1,Qr, ENGINEER GENERAL 3 COPIES L---'' STAMP LOCUS L---- NORTH ARROW L ---SCALE �! CONTOURS`-� PROFILE !fL--'(Sc) SECTION L--- BENCHMARKS SOIL & PERCS ELEVATIONS WETS. DISCLAIMER `�� WELLS & WETS WATERSHED? Q DRIVEWAY --' WATER LINE FDN DRAIN M&P SCH40 TESTS CURRENT? Ah) SOIL EVAL SEPTIC TANK MIN 150OG .17 INVERT DROP �� GARB. GRINDERJ�_(2 comps +200) 10' TO FDN Lf"*� MANHOLE C/ ELEV GW ## COMPS. GB C-� D -BOX SIZE ## LINES ;2— FIRST 2' LEVEL STATEMENT INLET %%J`�4-3 - OUTLET _l/'c _7 ( 2" OR .17 FT) TEE REQ' D?0 LEACHING / MIN 440 GPD? i/ RESERVE AREAy 4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS __---100' TO WELLS -- 4' TO S.H.GW Li (51>2M/IN) 20' TO FND & INTRCPTR DRAINS 400' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER 6---' FILL? `x(15') BREAKOUT MET? TRENCHES MIN 440 gpd SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN 61) RESERVE BETWEEN TRENCHES?--'�-'IN FILL?MUST BE 101 MIN. (/' t " PEA STONE? L ---VENT? C�� (>3' COVER; LINES >50' ) BOT r Q� + SIDE A4 O = 744 X LDNG _ = TOT 4,,� 7 446 ( L x W x #) ( DxLx2x## ) ( G/ f t2 ) Copyright (9 1996 by S.L. Starr PITS MIN 440 LEACHING MIN 1 (13'x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 440 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 440 GPD 900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >31COVER-VENT SCH 40 MIN 12" COVER RATE ( X ) X = TOTAL L W LDG DOSING TANKS AND PUMPS DIMENSIONS X X = 166b PUMP CAPACITY gpm L W D Vol. DISCHARGE SIZE Uf C DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE �-/ ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL fib(-// LWL /G j,S-/ CHECK VALVE BLEEDER HOLE t�— MANUAL OP. SWITCHA-' ENUF STORAGE?� Copyright © 1996 by S.L. Starr 1646 Applica Site Loc Enginee Town of North Andover, Massachusetts BOARD OF HEALTH 4 19 99 Form No. 1 APPLICATION FOR SITE TESTING/INSPECTION Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Test No. Fee S.S. Permit No.1/16 D.W.C. No.-C.C. Date Plbg. Permit No.__ MOA7hr r: /7 4- 1 BOARD OF HEALTH M11 4 R l/6v f 30 SCHOOL STREET TvEla. 688-9540 .NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 110.4 LOCA ION OF SOIL TESTS: r/�, Assessor's map & parcel number: OWNER:n�j l zr ��y TEL. NO.: / ADDRESS: ENGINEER: TEL. NO.:352 -- Y�Y_'� CERTIFIED SOIL EVALUATOR: � �� ' acib Intended use of land: residential subdivision, single family home, commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted. tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: % MAP & PARCEL: LOCATION OF SOIL TESTS: D' OWNER: is TEL. NO.: ADDRESS: �4/ p. ENGINEER: TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Repair Testing: Undeveloped lot testing: THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership �Tak bill, or letter from owner permitting test) 2. Plot plan } 3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: ✓ Date Received: ell a 99 Check Amount: �'%�v Check Date: PARCEL B 3 PARCEL B i EASEMENT N jar T.O. f ams 19.49' . Er1srox fnl/NAATIOW 9 FASEMENT N� L= 88. t' ow- J STERLING LANE ENT REFERENCE PLAN: N0. 13033 FOUNDATION LOCATION PLAN Jir M gla amuscammcwN co., imc. 0 or""�' TW aWrMYXW IS Off AM car am,T t M. �y �, MWTU L, g� La�M'/aW. MWTN �floi=R MA iii �d��s AMl SCALE: 1!-- 60' DATE. I V19/00 CHR/ST/ANSEN 8. SERG! mI" suffW"m `"s" ,.o auo.ior st.Yey,ui.w aa=o m. ,A-ars.�a.ro / o i!M ar p ! =a ac MAR r 9 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. t oT 6' -S/fa/86- 1, rl IYE- On-site Review Deep Hole Number Date: .-/Zb/" Time:.. / 1'00 Weather S:u^y✓`1. 6. Location (identify on site plan) Land Use 1 005-0 -1cJ90,A� Slope (%) .O".-3 Surface Stones MANY - Ui2_ wHtl- i31/ZCLi Vegetation v4K;:M�p4.; lWWIfl.GCPIN�.;:.J... �. Landform ....: ,.....:.. . Position on landscape (sketch on the back) Distances from: Open Water Body. - feet Drainage way feet Possible Wet Area ::.:. feet Property Line feet Drinking Water Well .:.:.:::..:.:. feet Other ._:.::. DEEP OBSERVATION HOLE LOG" Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Grav6-5 Depth from Surface (inches) A �5`�Ny )O`1943 6" Wi GiffL, vm'i S�Lr M�h`� 12nC�TS Z7 �rcy I��tU�(2-`l �OYIr75��i MASS IU�f �f2f�f�f� .�— S. L• (!OA4 wN n oo�S VE2yM jqSSf OF l (&e+ r'U'I6GE Z7- �1S G, �Ouwal Z,SYS)4 M3D f-E(.j poo -(s 7b 7Z- L,S, P'C&O:-) MINIMUM OF Y HOLES REQUIRED A7 -EV EA f L rr DepthtoBedrock: Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: NO Weeping from Pit Face: NOiY+s — r�=TM3',. .-. • Estimated Seasonal High Ground Water: `f r--T-C—°r-rVf� (� fuDRTI I " ND- Ok'ER/ P �(?i3 CSN HEADN °-f SOI C i<'f+-'0if'iYCGn�vnl�t.L. DEP APRROVEI8R1�1J/07/95 k a .•> xLi l (NlY SS GG4h,l.�'v "Z JOY e3R.o W� ��„x��' pbYi� �G(NF�iZ/rt1Cr ti V, FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: Commonwealth of Massachusetts A110 00W , Massachusetts Performed By: Date Witnessed By: itlon Address or Owner's Name # Address and •J Telephone # 1iz �2- z New Construction f Repair Office Review Published Soil Survey Available: No Yes a Year Published Publication Scale Soil Map Unit 6� Drainage Class Soil Limitations Surficial Geologic Report Available: No ® Yes Year Published Publication Scale Geologic Material (Map Unit) Landfonm Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year flood boundary No y Yes Within 100 year flood boundary No 7C Yes Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range: Above NormalNormal Below Normal Other References Reviewed: DFP APPROVED FORM - 17/07/95 0 soilevd."M Location Address or Lot No. FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 /1 Deep Hole Number ` Date .5136119;—_Time 1/0 . 6-r) Weather Location (identify on site plan). Ate( Land Use Slope (%) Surface Stones Vegetation ��� dok Landform Position on landscape (sketch on the back) Distances from: Open Water Body 21,00 feet Drainage way '?/Q O feet Possible Wet Area. feet. Property Line .50 feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) ��_� Depth to Bedrock: 9Z D=th to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water t f DFP APPROVED FORM -17107195 soil".Um ' 4 J0 M Location Address or Lot No._ FORM I 1 -SOIL EVALUATOR FORM Page T of T aDepth observed standing in observation hole Depth weeping from side ofobservation hole A Dep th.to soil mottles � 2 inches. Ground water adjustment feet Index. Well. Number. Reading Date Index well level Adjustment factor Adjusted ground waterlevel inches 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 occuring pervious material? • " • inches I certify that. on lq�4(date) I have passed. the soil evaluator examination approved by the Department of Environmental Protection and thatthe above analysis was performed by me consistent with the. required training, expertise and- experience ndexperience described in 310 CMR. 15.017. Signature Date. lq: K 4IT611Vdt$)M,�, �rz .. d WE 7/_� 7 soii"."M FORM 12 - PERCOLATION TEST r Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS %"a ag , Massachusetts Percolation Test* Date: Time: /f(9 O Observation Hole# Depth of Perc4trt Start Pre-soak End Pre. -.soak P34 Time at 12" Time at 9" 2Z ( f Time at 6" / 3 Time (9"-6") Rate Min./Inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site PassedSite Failed Performed By: Witnessed By: Comments: DEP APPROVED FORM - 12/07/95 Pei, tSAM 2 c� --------------------------- VI III........... --------------------------- III........... al I I I I! I i!!��!i�islll i IIIi1 Ie- o k.. S i {V'd�vl� r ���-; III I i 17. j4) I ► i i I � .. i ! i �_ i. � I _ � I�111 1!I�I IIlli I11�i�jl�l li �1! � iII III llli� ;II I ,�'Sj I I I. II ►yd�.li' i'iil I��d�;jlll 1. lid {-i llllli�l►iIIIiI(�lil i � AJ ' �✓� )��. ���1 i t 1, ; l l l l l l l I i � l Ij 1I �71 l i i I► I i I I i i i f-�,,-!��o�s != y9, x 7160' = Illy �� A F= II vecfs i t �' it .l i1;7s fl(I! i e" Ijll III LIII Ifi II I I i llll IIl11►{l��jl i illilllii'i!i!i- I1!►fllll!i��11�I flllilll�l'�1►1i1 l�ll� iI MEMBER FORK! U - LOT RELEASE FORM lySiFclICT10NS. This form is used to verify that all nec: scary approvals/permits from' Beards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicabie or requirements. APPLICANT FILLS OUT THIS SECTION - 7 APPLIcAvT�OCLi/'Y'� �.�si P'iCNE LOCA T ICN: Assessors iiYaD Nur tef SUEDIVISICNJ.�'i�- LOT (S) STFE-72-29k'Li-l"67 4214 .5 T NUMEEF OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: /yXaO (- 6 Mcg o PFN IiFCX5,e-4"�1 CCNSERA VTICN ADMINISTRATOR DATE APPRGVED I� DATE REJECTED CCMMEN TIS— TOWN S TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FdOD IN&?E ORDATEAPPROVED /4 DATE REJECTS:] OR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUELIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DE=AR T v1EIT RECEIVED EY EUILDING ii ISPECTCR nevi:ed 9197 im DATE o1'- �)u--e11rtiy t PARCEL B PARCEL B STERLING LANE REFERENCE PLAN: N0. 13035 FOUNDATION LOCATION PLAN "W 00MUMM SEAMCK MEW-MMM07415 OF MV LOCA za a xw er-uMs w EtFELT M1 7V aors mX= CLIENT: COOLIDGE CONSTRUCTION CO., INC.0AWIM or D�arrs M� L° i°�'P �`"'� o» THIS CERAMTlOM /S MADE AMD UNITED "m mww N"u MOT Jr USED or nE alW FOR ANr ABOWn WN 7W TO THE ABOVE CL/EM. w O MASH OF pAf WUMSEN t SERB Or- AMD ANr GWM//l 0NMV USS /S PRGMMMCA405714MM V t SM TA42S MD RESPOAMEWTr RW 17#' UMAUTMWED USE OF 7W OM/MM OR ANY MFW -- LOCATION: NORTH ANDOVER MVA. AMWN CONTANW" "nw " SCALE: 1'= 60' DATE: 11/19/99 CHRISTIANSEN & SERGI 5MVEnM " 160 SUMM Sr. /Uvt7afAt.1." 01=-* ,;,< W- 876.373-010 p 11M. er CH M1UN501 Jt SDW sr_