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HomeMy WebLinkAboutMiscellaneous - 79 BEAVER BROOK ROAD 4/30/2018N � V r m W m o ou N W W A O O 0O O;a O O D O 0 0 0 FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:. __._......._..._ ....DY: ,_. . J � � Y • �.� A i J.. j d. . AUI WELL WATER . MAR #wt`s ,;, LOT PERMIT DRILLER._._-.------._.�.___ __.__--.--.__.......... WELL ' PARCEL # STREET .,, _ Ao BAC -TER • - I UA I E (IPPRUVED .QNSTRUCjI_QN_APPROVAL HAS PLAN REVIEW FEE.©EEN PAID? YES NO ' DATE/oZ�/l/� APP. BY-- PLAN APPROVAL: FORM U APPROVAL: DESIGNER: rb9k) 6A PLAN DA"FE. ' CONDITIONS FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:. __._......._..._ ....DY: ,_. . " SUPPLY: TOWN WELL WATER WELL PERMIT DRILLER._._-.------._.�.___ __.__--.--.__.......... WELL TESTS: id MICAL UAJE APPROVED._. BAC -TER • - I UA I E (IPPRUVED BACTERIA II DATE AF'PRUVEll COMMENTS: FORM U APPROVAL: ' "` APPROVAL TO ISSUE" NU BY DATE ISSUED CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:. __._......._..._ ....DY: ,_. . r } -M� NSIfl41.AT� QN ; $EpTL7.1 G�Y-SZ YES NO :,�: ire c•�1 .'•; • -;' -< \x IS THE INSTALLER;SLICENSED? �'• NEW REPAIR' OF. CONSTRUCTIONYES NO NEW CONSTRUCTION:'...... CERTIFIED PLOT PLAN ALVIEW: YES NO ` CONDITIONS OF..APPROV e s FORM U) (FROM •:.�. ;; � E NO ' ISSUANCE ^OF DWC PERMIT _ INSTALLER: N � DWC PERMIT BEGIN INSPECTION YES NO: ' _`- EXCAVATION •INSPECTION: NEEDED: .. .. ,:• •. _ _ •,1..1.1•'_• L.. •.! ! •! .. =; EEDED: --:,',..CONST RUCTION INSPECTION: ,. . _. - •:.:.;:'. • YES -• • � ` ACTOR: AS BUILT PLANSATISF `. �%.. •� . i, BY • `,_ ,'. -• DATE: APPROVAL. TO BACKFILL: 1' FINAL-GRADIN G APPROVAL: DATE ` DATE .. BY •,: • , - '' FINAL CONSTRUCTION APPROVAL: 10. ! �•; ! ''�`: `• ,. ` - :" .• I •• w .t is .. -• '/ - .� t ,• I TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( x ) or repaired ( ) by North Andover Licensed Installer Dave Maynard at Lot #17 (Street #79) Beaver Brook Road, North Andover, MA 01845 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 as described in the Design Approval Site System Permit Number #817 dated March 16, 1998, The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector M y C � O d CA Cl) 10 0 CD n Z y CL CL= C y a� -v o p CD CDCL o cr I CD O CD w ca B•. C CD Caf CD CZC..co) to CD I Z%7J . p- .. ca wtc �. CD ii i O f,- " r • CD O C t CD Z%7J � wtc •f z ►� ii i f,- " r � � � o Y t 4y r='`' Z%7J O, � in t'li O l0 z ►� �'- f,- " r � � � o Y t ri•�6 3 ' C� O, � in t'li O l0 z ►� f,- " r � � � o � � do y O d C� ON 0 0 c Town of North Andover, Massachusetts Form No. 2 f NORTa BOARD OF HEALTH a� •, o r 9- o ti w P DESIGN APPROVAL FOR sAcMusEt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ZIA— Test No. Site Location Reference Plans and Spec ENGINEER DESIGN b DS�A]L Permission is granted for an individual soil absorption sewage disposal system to beins Yalled in accordance with regulations of Board of Health. �� Fee (Po CHAIRMAN, BOARD OF HEALTH Site System Permit No. WI TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (X) constructed;( ) repaired: by located at LOT 17 FERU FP OP -00K ,gipl}D was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of q4O 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 15.00, Title 5, and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As - built plan which has been submitted to the Board of Health. Bed inspection date: Final Inspection date: f �' Installer: Lic# i Design Engin v ector Inspecto Date APPLICATION FOR DISPOSAL WORKS CONSTRUCTION. PERMIT DATE:7A L 3 98 CURRENT INSTALLER'S LICENSE# LOCATION: C—D� / -7 Ic — `` "a r— LICENSED INSTALLER: ��-✓ ��--a•' SIGNATURE N 0 0 0 0 wNa 7�1; NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes o Approval . Date: 4ZA No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH IrAWO OF NoreM A)uhoWL APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (14 Repair ( ) Upgrade ( ) Abandon ( ) - ❑ Complete System ❑ Individual Components Map/Parcel # S 0,601VtS/l31) LD/ VA Lot # Installer's Name Address Telephone # —!C{p0 llQ�EPS OSNameLQWat /VU1 Address Telephone # MuP 0_HkQ71AM5& Designer's Name qT ^373 —o3libss Telephone # Type of Building: WOOD POA 6_ Dwelling — No. of Bedrooms Other — Type of Building No. of persons _ Other fixtures Lot Size 1 , ®Lltt/L2` Garbage Grinder ( ) Showers ( ), Cafeteria Design Flow (mir). required) LID gpd Calculated design flow gpd Design flow provided gpd Plan: Date &Number of sheets Revision Date Description of Soil(s) Fi V ecS v f �r Soil Evaluator Form No. 14 Name of Soil EvaluatorPA, �y d"uation-74 Qlf�s DESCRIPTION OF REPAIRS OR ALTERATIONS 3C� NJ The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er g not place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 1 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Date FORM 2 - DSCP FORM 1255 (REV 5/96) Board of Health DEP APPROVED FORM 5/96 H&W HOBBSB WARREN TM PUBLISHERS - BOSTON Form No. 3 : Town of North Andover, Massachusetts BOARD OF HEALTH of No oT e 19 °oma o " • o ,.� F DISPOSAL WORKS CONSTRUCTION PERMIT • ,SSACHU`'�'S l -� � r �r'y `� jt �� TELEPHONE Applicant AP3DRtS5 • NAME Site Location Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption Y" ' g Approval S.S. No. ! ' Sewage Disposal System as shown on the Design A p CHAIRMAN, BOARD OF HEALTH Fee- 75- ee 7 s D.W.C. No. h.:...e' .Sc':,'t ,:Y�.*".YSt „4'f�'..t{�, a ti....•c ... _. .t ,.;.jw.,,G(,�: ^ st' i .�>>, .+.r, < , .0{fi!?;:xi Memorandum DATE: October 30, 1997 TO: Bob Nicetta, Ken Surrette�� FROM: Sandra Starr, Health 0,Ady RE: Evergreen Estates /� ��' CC: Bill Scott, Susan Ford, Kathleen Colwell, Mike Howard, Phil Christiansen, Al Couliiard Due to the problems recently encountered on multiple lots on Evergreen Estates, the Board of Health at their meeting on October 29, 1997 voted unanimously to require bottom of bed inspections or full septic system installations on each lot in this subdivision before any construction, including foundations, is begun on that specific lot. The majority of lots already have Form U approvals from the Board of Health so it will be up to the Building Department to route all requests for construction approvals at Evergreen Estates to the Health Department for proper action on the septic system issues. I suggest that once a bed bottom has been inspected and approved (or a septic system fully installed), the attached form will be sent to the Building office. I hope this procedure will meet with your approval. If you have any questions or comments or issues, please call me so they can be addressed. The ( ) bottom of bed; ( ) septic system located at , has been inspected and approved on by Board of Health personnel, and the Health Department has no objection to a construction permit being issued for this lot. Inspector Date The �) bottom of bed; ( ) septic system located at Zor /7 5cwyg el&z c XI) , has been inspected and approved on _ MAeCi�v, 1998 by Board of Health personnel and the Health Department has no objection to a construction permit being issued for this lot. Inspector Date PLAN REVIEW CHECKLIST ADDRESS 11-)% / % ENGINEER C"4s GENERAL 3 COPIES / STAMP LLOCUS z_'-- NORTH ARROW SCALE CONTOURS V PROFILE �(SC) SECTION v BENCHMARK tom'— SOIL & PERCSy ELEVATIONS WETS. DISCLAIMER WELLS & WETS f1' WATERSHED? -A/6 DRIVEWAY WATER LINE L/ FDN DRAIN L---" M&P SCH40 TESTS CURRENT? t/ SOIL EVAL *,r(5V� 1lJP SEPTIC TANK MIN 1500G jf .17 INVERT DROP GARB. GRINDERA(2 comps +200 10' TO FDN --' MANHOLE / ELEV GW 6A-- # COMPS . GB L---- D-BO SIZE� # LINES J! FIRST 2' LEVEL STATEMENT INLETI_ay,, - OUTLET /-13, 6� (2" OR .17 FT) TEE REQ' D? _ -f LEACHING 5 l D c 05 -, Z o, v A i MIN 440 GPD? t,� RESERVE AREA �� 4' FROM PRIMARY? 2° SLOPE 100' TO WETLANDS (--� 100' TO WELLS ✓... 4' TO S.H.GW __-- (5'>2M/IN) 20' TO FND & INTRCPTR DRAINS 400' TO SURFACE H2O SUPP L-- 4' PERM. SOIL BELOW FACILITY MIN 12" COVER --� FILL? 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 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT + SIDE = X LDNG = TOT (L x W x #) (DxLx2x##) (G/ft2) Copyright 0 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 c� GW MIN 4' BELOW BOTTOM OF FIELD �,- PIPE ENDS JOINED? -"�"s4" PEA STONE? DIST LINE SLOPE .005? >31COVER-VENT �.--'f SCH 40 cam' MIN 12" COVER RATE z (�p�_ X __/,5 ) X ' c�3 = TOTAL If 416) L W LDG DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY qpm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME Spm MANHOLES TO GRADE ALARM SEP. CIRC. inlet) HWL LWL CHECK VALVE OP. SWITCH ENUF STORAGE? Copyright 0 1996 by S.L. Starr GW (Min. l' below BLEEDER HOLE MANUAL D PLAN REVIEW CHECKLIST ADDRESS,,, ENGINEER 0��1,5,r7A.A SF -'JL) GENERAL 3 COPIES C/ STAMP L/ LOCUS NORTH ARROW L� SCALE L--' CONTOURS L/ PROFILE (/ SECTION �,� BENCHMARK C/ SOIL & PERCS A) �j�j ELEVATIONS WETS. DISCLAIMER CX� WELLS & WETS WATERSHED?///) DRIVEWAY L. (Eley) WATER LINE 4.,-' FDN DRAIN v" SCH4 0 L,-' TESTS CURRENT? C/ SOIL EVAL -D,qN C)�- SEPTIC TANK MIN 150OG .17 INVERT DROP / Z, GARB. GRINDER (+200% EDF) 25' TO CELLAR G--' MANHOLE ELEV GW # COMPS. D -BOX SIZE # LINES !o FIRST 2' LEVEL STATEMENT INLET Ii�3�Jf�J - OUTLET j33,,37 (2" OR .17 FT) TEE REQ'D?/(/0 LEACHING MIN 660 GPD? tl RESERVE AREAL,--' 4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS 100' TO WELLS f.,-' 4' TO S.H.GW r!r (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS 7/ 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY V/" MIN 12" COVER x FILL? 61 (15' if above natural elev; 101if below) BREAKOUT MET? 1-11 TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100') SIDEWALL DIST. 3X EFF. W OR D (MIN 61) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >50') BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright © 1995 by S.L. Surr PITS MIN 660 LEACHING MIN 1 (13'x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE + SIDE x LOAD = TOTAL BOT (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 60') MIN 13' X 16' PIT BOT + SIDE X LOAD —= TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS �C" GW MIN 4' BELOW BOTTOM OF FIELD MIN 660 GPI7�/ 900 ft2 BED PIPE ENDS JOINED? 4" PEA STONE? L-"' DIST LINE SLOPE .005? >31COVER-VENT SCH 40 ✓ MIN 12" COVER `� RATE I�� LDG �—� X 660 - le ',( X = TOTAL G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright 0 1995 by S.L. Starr Co 0 0 0 fY9 G4q �J C� �z d a w 3 7 c- Form No. 3 Town of North.Andover, Massachusetts BOARD OF HEALTH pRTH p tt�.o ,,• hp OL O " . A •moo `•+ ,,,;.��� DISPOSAL WORKS CONSTRUCTION PERMIT AC OU Applicant a/ 14 Vv 149 l�ep TELEPHONE NAME ADDRESS Site Location �fJT 17—;1/C�B/,� Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. AIRMAW,BRD OF HEALTH D.W.C. No. Fee Appl Town of North Andover, Massachusetts BOARD OF HEALTH �.#.It_. /_A_ APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 Site LocationOr'111.2/1/l �pkj& - Engineer�dj �,c , NAME / ADDRESS %� /TELEPHONE Test/Inspection Date and Time �1,4 96 7/�,7��� CHAIRMAN-, BOARD OF HEALTH Fee Test No. 6ss— S.S. Permit No./D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts NORT1� A BOARD OF HEALTH U APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer • NAME ADDRESS TELEPHONE r Test/Inspection Date and Time F - - /• CHAIRMAN, BOARD OF HEALTH S.S. Permit No.. -�"/ 7 D.W.C. No. C.C. Date Test No. Plbg. Permit No. FORM U —VERIFICATION 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 local or state law, regulations or requirements. *************A***Applicant fills out this section****************** APPLICANT: Phone0E?,-_3/ LOCATION: Assessor's Map Number Parcel Subdivision P Lots) /� Street 3=22 U St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved 0<�,/� 9� Date Rejected Received by Building Inspector Date SEPTIC PLAN SUBMITTALS LOCATION: GOT hl � 0�o NEW PLANS: YES -$Plan REVISED PLANS: YES DATE: �' DESIGN ENGINEER: (" In n 1P, $25.00/Plan__f. CJS 10 When the submission is all in place, route to the Health Secretary 1 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 August 6, 1996 Ms. Sandra Starr North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 17 Beaver Brook Road (Evergreen Estates Subdivision Dear Ms. Starr: (508) 373-0310 FAX: (508) 372.3960 On behalf of Messina Development Corporation, I submit to you the enclosed modified septic system design for the above referenced lot. The modifications made to the plan are as follows: 1. Test Pit 96-10, which we performed to verify that the required 4' of parent material existed throughout the leaching area, has been added to the plan. 2. The location of the proposed garage, and therefore the alignment of the proposed driveway, have been revised. No changes to the any of the proposed septic system components have been made. Enclosed are 3 copies of the revised Septic System Design for Lot 17. Please contact me if you have any questions regarding these modifications. Ve Truly You , Daniel J. O' nnell M No. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: 3 ZS q(o Commonwealth of Massachusetts A/ofzrH jtNoouo�2. , Massachusetts Soil Suitability Assessment for On-site Sewage Diss osal EVA ZJ'�1�25 (� Date: 41 +1 ?IS PerformedBy :........5 T...................................................................... Witnessed By :......... S. .N.I ......... ST. I. jZ................................................................................ ................................................... Or (,(� ! 7 UF%Z%K � Omer', None, N1F&S1N19 OCVE LDPIWeNT GO/2P, Lo=*n Address Address, ud '' La 1 rf� I (Gv Telephone 1 44 t / �45AT Pon1 lJ 0121 Ue ew Construction KRepair ❑ 867 - 31 OZ Office Review ' Published Soil Survey Available: No ❑ Yes :.���..8.`.� Soil Map Unit. Cr.L............. Year Published 19.8.1..... Publication Scale oGC Drainage Class WE" Uiz1.y.?.. Soil Limitations jW-65 sibV",....4.�r1'1......................................................... Surficial Geologic Report Available: No [� Yes ❑ Year Published Publication Scale ..... Unit ........................ .................................................................. Geologic Material (Map )......................................................... Landform........................................................................................................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes ❑'� Within 500 year flood boundary No El Yes ❑ Within 100 year flood boundary No []Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ............ ................... ............... ............................................................... p (map Ma ma unit ......................................................... ....................................... Wetlands Conservancy Program Current Water Resource Conditions (USGS): Month Range :Above Normal []Normal ❑Be1c,.v Normal ❑ Other References Reviewed: iiDEP APPROVED FORM - 12/07/95 FORIM 11 - SOIL. EVALUATOR FORM Page 2of3 Location Address or Lot No. LOT- 1 l >F VEkee P E�&U F S 1?i-lYS On-site Review naao Hole Number /77 t. Date:..::Q•.J+j'?S Time:.: Weather Location (identify on site plan) Land Use Slope Surface Stones Vegetation :....:::::.:: . . ::.:::.:..:.:...::...., ._........ Landform_::..:.......... .... ............. ... .. Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area . %.S� .. feet Property lane .... ... feet Drinking Water Well :::. feet Other DEEP OBSERVATION HOLE =0G' Depth from Surface (Inches! Soil Horizon Soil Texture (USDA) Soil Color (Munseil) Soil Mottling Other - (Structure, Stones: Boulders, Consistency, % Z4-�Z EGt C5 L 215y414 P-evu MFe( �`'►�i� 13Ft�ow -- L - l Crz mMAIt NAG. - MIIVIIVIUM yr L . ,v- . ... _- _..- �Qi t Parent Material (9e010gic) --n-(A - 8e Depthtodrock: Ii V Depth to Groundwater. Standing Water in the Hole: "CA/f. Weeping from Pit Face: AI(We— Estimated Seasonal High Ground Water: DEP APPROVED FORM - 1210719S 14 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot ivo. (,yT 17 On-site Review Deep Hole Number I:.�_.-Z ¢ Time: Weather Date:. /SS Location (identify on site plan) Land Use WOUPL44'09 Slope M S--tO Surface Stones Vegetation ....:...:. Landform.... .... .. Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way _ feet feet Possible Wet Area 140.. feet Property Line Drinking Water Well feet Other DEEP OBSERVATION HOLE -LOGt Depth from Soil Horizon Soil Texture (USDA) . Soil Color Soil Other (Munsell) Mottling ;Structure, Stones, Boulders, Consistency, % Surface (Inches)Gravel) Lb ; 4, S 1, Z.5' 51(0 �4 Parent Material (geologic) n L' (-- DepthtoBedrock: 1j [- Depth to Groundwater: Standing Water in the Hole: �1/ON�F Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 11107195 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot into. LOT C7 EV€YLC;tZ. Determination ,dor Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole ............ ... inches 12iDepth to soil mottles 64.:`. inches ❑ Ground water adjustment ................... feet Index Well. Number .................. Reading Date ................... Index well level .................. Adjustment factor ................... Adjusted ground water level ...................... Depth 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? YDS If not, what is the depth of naturally occurring pervious material? Certification I certify that on It L (date) I have passed the soil evaluator 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. Signature Q �-� Date 312 - DEP APPROVED FORM - 12107/95 f FORM 12 - PERCOLATION TEST Location Address or Lot No. W -r V7 Oyotc tzggy f.cT14-19S COMMONWEALTH OF MASSACHUSETTS /VOYLN 64AJbth,+gie, Massachusetts Percolation Test* Date:...... Observation Hole # 11 -2 - 1,2..Depth Depth of Perc 5-0 ti 51 / Start Pre-soak WL 43 End Pre-soak I ,` ' ; SB Time at 12" Time at 9 I Z' Ob Time at 6" Time. (9"-6") Rate Min./Inch -7 * Minimum of 1 percolation test must be performed in both the primary area AND reserve are . Site Passed Site Failed ❑. Performed By: Cj1 P&[ST(1wi&y - ii -t26(, /A/C" Witnessed By: S i9nvbY S i -w" i sa&'y F-Ogz Comments:v......:................................................................:........... ............ ............ ..................... iiDEP APPROVED FORM - 12/07/95 DATE 17 1 /96 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW � FEE >46,n PERMIT # 817 DATE RECEIVED APPLICANT `866 ME-SS1191 - ASSESSOR'S MAP ADDRESS PARCEL # LOT # 17 ENGINEER �� S STREET --75,,.5WV&,e 70 ooK IeA ADDRESS S6)A- Al4!6'�e PLAN DATE/�/ 9� REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED X p2or�c� AlET/ 76G'U U� M 5 5 �.v � Q <SD�� T-�sTs &7?- A-) ,tJDs o� s y�rEM, 3, LEAD/�iNG /32c=A Nar /9 M11v1muM O /- 7-19 e �3/6 eM2 ISS a7�)J vee OIL Notice to APYLI( AM/'I V CLERK and Certification of A .on or Planning Board on Definitive Subdivj,,ion Plan entitled: Evergreen Estates By: Christiansen s Sergi dated Dprpmhar aa_., 19 94 The North Andover Planning Board has voted to APPROVE said plan, subject to the following conditions: 1. That the record owners of the subject land forthwith execute and record a "covenant running with the land", or otherwise provide security for the con- struction of ways and the installation of municipal services within said sub- division, all as provided by G.L. c. 41., S. 81-U. 2. That all such construction and installations shall in all respects conform to the goverui g rules and regulations of this Board. 3. That, as required by the North Andover Board of Health in its report to this Board, no building or other structure shall be built or placed upon Lots No. as shown on said Plan without the prior consent of said Board of Health. 4. 'Other .conditions: In the event that no appeal shall have been taken from said approval within twenty days from this date, the North Andover Planning Board will forthwith thereafter endorse its formal approval upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: Date: Augus c 15, i.995 NORTH ANDOVER PLANNING BOARD Kir By: A Josepi, V. Mahoney, chaiiman M See attached -70rioC">m c r -y S r c , C-7 z � L.r In the event that no appeal shall have been taken from said approval within twenty days from this date, the North Andover Planning Board will forthwith thereafter endorse its formal approval upon said plan. The North Andover Planning Board has DISAPPROVED said plan, for the following reasons: Date: Augus c 15, i.995 NORTH ANDOVER PLANNING BOARD Kir By: A Josepi, V. Mahoney, chaiiman M FORM C r APPLICATION FOR APPROVAL OF DEFINITIVE PLC` Z"A`'-" N OW`t NORTEi ANDOVER January, 17 ^ , 4�9 95 :tt, To the Planning Board of the Town of North Andover: The undersigned, being the applicant as defined under Chapter 41., Section 81—L, for approval of a proposed subdivision shown on a plan entitled Definitive Subdivision Plan "Evergreen Estates" located in North Andover by Christiansen & Sergi, Inc. dated December 28. 1294 being land bounded as follows: Northerly bt Com of MA, land of Steer and Fried; easterly by land of Fried, Badder, Rough, Green, Galeassi, Yourre, Mateja, Farr and Com of MA; westerly by Com of MA.. hereby submits said plan as a DEFINITIVE plan in accordance with the Rules and Regulations of the North Andover Planning Board and makes application to -the Board for approval of said plan. 1087 314 Title Reference: North Essex Deeds, Book 2901 , Page 13 ; or Certificate of Title No. , Registration Book , page ; or Other: Said plan has(x) has not( ) evolved from a preliminary plan submitted to the Board of Aug 24 19 94 and approved (with modifications) ( ) disapproved (X on Oct 4 e 1994 The undersigned hereby applies for the approval of said DEFINITIVE plan by the Board, and in furtherance thereof hereby agrees to abide by the Board's ,Rules and Regulations. The undersigned hereby further covenants and agrees with the Town of North Andover, upon approval of said DEFINITIVE plan by the Board: 1. To install utilities in accordance with the rules and regulatioas of the Planning Board, the Public Works Department, the Highway Surveyor, the Board of Health, and all general as well as zoning by—lags of said Town, as are applicable to the installation of utilities within the limits of Kays and streets; 2. To complete and construct the streets or ways and other improvements shown thereon in accordance with Sections Iv and V of the Rules and Regulations of the Planning Board and the approved DEFINITIVE plan, profiles and cross sections of the same. Said plan, profiles, cross sections and construction specifications are specifically, by.reference, incorporated herein and made a part of this application. This application and the covenants and agree— ments herein shall, be binding upon all heirs, executors, administrators, successors, grantees of the whole or part of said land, and assigns of the undersigned; and 3. To complete the aforesaid installations and construction within two (2) years from the date hereof. ,\ Received by Town Clerk: Date: Time: Signature: Signature of Applicant Messina Development Corp., 805 Winter St. Sort ndover, MA 01845 Address P1 a. A complete set of signed plans, a, copy of the Planning Board decision, and a copy of the Conservation Commission Order of Condition must be on file at the Division of Public Works prior to issuance of permits for connections to utilities. The subdivision construction and installation shall in all respects conform to the rules and regulations and specifications of the Division of Public Works. b. All site erosion control measures required to protect off site properties from the effects of work on the lot proposed to be released must be in place. The Town Planning Staff shall determine whether the applicant has satisfied the requirements of this provision prior to each lot release and shall report to the Planning Board prior to a vote to release said lot. C. The applicant must submit a lot release FORM J to the Planning Board for signature. d. A Performance Security (Roadway Bond) in an amount to be determined by the Planning Board, upon the recommendation of the Department of Public Works, shall be posted to ensure completion of the work in accordance with the Plans approved as part of this conditional approval. The bond must be in the form of a check made out to the Town of North Andover. This check will then be placed in an interest bearing escrow account held by the Town. Items covered by the Bond may include, but shall not be limited to: i. as -built drawings ii. sewers and utilities iii. roadway construction and maintenance iv. lot and site erosion control V. site screening and street trees vi. drainage facilities vii. site restoration viii.final site cleanup e. Three (3) complete copies of the endorsed and recorded plans and two (2) certified copies of the recorded subdivision approval, Covenant (FORM I), Right of Way easements, and FORM M must be submitted to the Town Planner as proof of filing. 4. Prior to a FORM U verification for an individual lot, the following information is required by the Planning Department: a. All lots must be approved by the Board of Health. The Board of Health has determined that sots 6, 9, 12, 13, and 21 cannot be used for building sites without injury 4 5. to the public health without further testing. No building or structure shall be placed upon these lots without consent by the Board of Health. b. Due to the large amount of rock on the site which may interfere with the amount of parent material available for leaching, the Board of Health will require that the leaching area for each lot be completely excavated to insure that there is the requisite four feet of parent material present throughout the. entire location proposed for the leaching area. . C. The applicant must submit to the Town Planner proof that the FORM J referred to in Condition 3 (c) above, was filed with the Registry of Deeds office. d. A plot plan for the lot in question must be submitted, which includes all of the following: i. location of the structure, ii. location of the driveways, iii. location of the septic systems if applicable, iv. location of All water and sewer lines, V. location of wetlands and any site improvements required under a NACC order of condition, vi. any grading called for on the lot, vii. all required zoning setbacks, viii. location of any drainage, utility and other easements. e. All appropriate erosion control measures for the lot shall be in place. Final determination of appropriate measures shall be made by the Planning Board or Staff. f. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. g. The lot in question shall be staked in the field. The location of any major departures from the plan must be shown. The Town Planner shall verify this information. h. Lot numbers, visible from the roadways must be posted on all lots. Prior to a Certificate of Occupancy being requested for an individual lot, the following shall be required: a. A stop sign must be placed at end of Pheasant Brook Road where it intersects with Salem Street. b. A driveway easement across Lot 22 must be granted to Ian 5 ti y CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 March 25, 1996 Ms. Sandra Starr North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: Lot 17 Pheasant Brook Road (Evergreen Estates Subdivision) Dear Ms. Starr: (508)373-0310 FAX: (508) 372-3960 Thank you for your March 6, 1996 comments regarding the Septic System Design for the above referenced lot. I have the following responses to your reasons for disapproval. The required Soil Evaluator forms are enclosed. 2. The location of a proposed test pit in the proposed leaching area has been added to the site plan. We can perform this test pit when we are at the project doing the other remaining testing for Messina Development Corp. 3. The size of the proposed garage has been reduced, resulting in a separation of 12 feet between the garage foundation and the proposed leaching field. 4. The required note regarding the gas baffle has been added to the septic tank detail. 5. No vent is proposed for the leaching field. The note on the Longitudinal Section detail for the leaching field has been changed so that it no longer specifies a vent. Although the total length of the proposed leaching field is 84 feet, the placement of the d -box in the center of the field results in a length of 42 feet for the distribution pipes. Since this is less than the 50 foot length at which vents are required, no vents are proposed. 6. The plan has been revised to include the slopes of the pipes on the profile of `.he system. Enclosed are 3 copies of the revised Septic System Design for Lot 17. Please contact me if you have any other comments regarding this design. Ve ly Yours, Phil' G. Christainsen Town of North Andover40RTM OFFICE OF 3?�,�'"� ',��oL COMMUNITY DEVELOPMENT AND SERVICES 6. . p 146 Main Street x` r oq�10 North Andover, Massachusetts 01845 9SSACHUs�t (508) 688-9533 March 6, 1996 Christiansen & Sergi 160 Summer Street Haverhill, MA 01930 Re: Lot 917 Beaver Brook Road Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Soil profile documents missing (3 10 CMR 15.100 (2)). 2. Soil tests needed at western ends of system. 3. Leaching area not a minimum of 10 feet from slab foundation (3 10 CMR 15.211). 4. Gas baffle required on outlet of tank (3 10 CMR 15.227 (4)). 5. Please show vent on site plan & profile. 6. Please indicate slope of distribution pipe. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, �Z Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell No................ _....... k'>c$.............................. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDD VEiZ BOARD OF HEALTH BOARD OF HEALTH .......... v. w..r �.............. O F.....JV .9. 1.74 .....11./.4 4.o V6�� ........---- - J�V.) 8 Appliration for Oftipowd Warko C�antitr urtidil ernttt Application is hereby made for a Permit to Construct ()() or Repair ( ) an ndividual Sewage Disposal System at: -------------------------- ---- - - Location - Address or Lot No. 1��ss!_j✓A. 17.!P..!t�l: C�?? 4�4�..h'47�?.'1v�_....�,�o....!u9o��/ w Owner Address Installer Address �p� Type of Building 1 I Size Lot ......... : �tlp7.'_:_C..3q t Dwelling —No. of Bedrooms ......... ................................Expansion Attic ( ) Garbage Grinder ( ) pa Other — Type of Building ............................ No. of ,persons..................__._...... Showers ( ) — Cafeteria ( ) a'I Other fixtures ........................... Design Flow............................................gallons per person per day. Total daily flow... ....... _lo..'.6,..®........__......_....gallons. Septic I r J iBuid capacity./..gallons Length/.Q_% ...... "Tidth C. Y-4.._ Diameter. ............... Depth -S'.`-5_ x Dispo..................... Width ..... 14i......... Total Length .... _22.4------ Total leaching area-]_-Z� C?.....s q• � , Seepage Pit No ...................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft. Z Other Distribution box ( i4 Dosm5tank ( ) aPercolation Test Results Performed by.../ !!fi.+.ej...0 `cer..�j�.t_ 5..%� ................... Date. 4j 1// ?J ..1...711.y 17,1L Test Pit No. 1.. /.?....___minutes per Inch Depth of. Test Plt.....% � ...____. Depth to ground water.../_�P-.--�5.� 14"4 44 /7'3 ...... per inch, Depth of Test, Pit ------ (. /c)_l'..... Depth to ground water .._.fid ESS iwT R4 9 -----------------------------------------------------------------------------------------••........•--•------•-•-----------•------••-•--•---•--•-•-•--•----- D Description of Soil ......... .00.1: y._....C.O.a.'m...... j .... n-7— kS5_1.t/c�___...... x U...........--•-------------••--••---•-----•-------•--•--•-------•-••--•••----•..._...-----•........--••-----------••-----•-------------------•....----•-••-----------••---...........----•-----••-----•-- w U Nature of Repairs or Alterations — Answer when applicable................................................................................................ ----------------------------------------------•--•---....----------•-••--•----•-•--••--•----------•• •-•-•--------• ••••--------------••••-------•--......---......._...----------------••-•-••------••--- Agreement : The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 'ITLL 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe:d....................................................................................... ................................ Date ApplicationApproved By --------------------- --- ---------------------------------------------------•--•--------•---•---.................................. Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------- ------ -•--•-•---•-----••-•-----------• •---------------•--•-•... •--...--•-•• • ••-------••••--••-----.....--------'------•----•---•-------•-•-------------------------•-----•-----...... •---------• •• •-•-...--•--- Date Permit No ................... Issued ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... OF ..................................................................................... Tatifinde of Tantphattrr, , . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------------- ------------------------------------------------------ ...------...--------------•--------------------------------------- Installer at--• •-------••---------•--------•----......-•......---••----•--•---••-.... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ......................................... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•--------------------------........-----••--....--••-•------.. II'ispector................... ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................. I ........... OF .................................................._.. _..................... _......... No......................... FEE---......--------....... Ropowd Varb (9vautrurtiart Vrrntit Permissionis hereby granted .................... -,:....................................... ..................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo .......................................................... - Street as shown on the application for Disposal NVorlcs Construction Permit No ..................... Dated .......................................... --------------------------------------------------------------------------------......................... DATE ................................................................................ Board of health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4{`�/ ,� 4 , k .S � .�� a 0 a 0 (D w I 0 03 a 0 (D rr 1 v t31 co 0 I C) 0 U) (D 0 0 3 3 o' I m 21: 0 (D ni 3 C7 flJ N (D n O 0 (D CL r p t r -t (D O h �f z n Q o c 0 n O 1 3 a o' fD P,> e+ A rt O C (D O 3 0 O rr 1 {� O n -n m c 3o (D KQ O � rt O C 'O 0 m 0 c 0 n c 3 (D rt a o" 0 a 0 9 fD l C7 flJ N (D n O 0 (D CL r p t r -t (D O h �f •-tV � 7ra vtY.hee provided 1hl# (Olin Icr 0 Uy IQ,ol 6 pe +ubmlrrod Ro the local Bcalc or;,ojIn Or cR 51�Vty� RTHANP9( qP, , p A' Facility inforri��►.lon .__ 5 LQuUon: /9 TolOprtOno ------- um pin Rekord ��',:�:.y•LI��`i;i:..fNrnn,.J'i./RQ'+n� ,. �., l%�j[ IJ ' Dale Of Gh0' G� 2 ^.ar:'�� C 3. TYPe PI eyalem; : Cos9pool(y) �SBpLC Tangy ;, ' i;`' • �', '1;�,:i•�' � I,n^l Tens Al Mom T :CD %Ocher, (des ri 00 ca('Pr03vnr? Yv9 n'o ' is• ;!,,1.'r�, j;�,:i ...int•,. Ftl 1 r- I! y8s. n89 I( c!aanao% ' l�,!'.,<.'r' Yes .. , •: , ,;�,�,,•�.;�'•6'I�'�Coridl�lori'p(;9yf,�m", Pvmpod 8y: `w�1, 'rlI !�1 f ' 1' (� ! %1VehlcJe UWH NJT.ier ., .gin•,(, ��,4`, ., /,��n'i,�►A �t'�t•!ttiiiM��r,l' 11 ���'�fR1/I(�,,�1�� loci on. where r !;•,'�,• :,... co(1lenls',were dl�poseo: • ,, .'. ;:,�'; '1' :IIS;,. • �' :.�;i;':,;;;..�,,,;,.rJ.'"r,S�nerluiolh'eVre{; ,• �.,,•. ,,, � % �p�. :!w,�V,mBSS, OV/ • .i/.,ll :%' •' �el� OO . _ � 9,.•deawelar/epprovaJs/Ib/orm9,r:�nnl�9�eCl Q0 p9l CItv/iown `ter p „ •System Owner,•�� `!'' . •� r;�L, �1��`, None ,�•;�'I••.•r.11 '.�,_' •� '•';;',:;;,, ,.; ::.• 'a'•.':,;'; . � � ._ - J�=Ste',.: .�.:�;� dVretenl ItQ n "UOn) TolOprtOno ------- um pin Rekord ��',:�:.y•LI��`i;i:..fNrnn,.J'i./RQ'+n� ,. �., l%�j[ IJ ' Dale Of Gh0' G� 2 ^.ar:'�� C 3. TYPe PI eyalem; : Cos9pool(y) �SBpLC Tangy ;, ' i;`' • �', '1;�,:i•�' � I,n^l Tens Al Mom T :CD %Ocher, (des ri 00 ca('Pr03vnr? Yv9 n'o ' is• ;!,,1.'r�, j;�,:i ...int•,. Ftl 1 r- I! y8s. n89 I( c!aanao% ' l�,!'.,<.'r' Yes .. , •: , ,;�,�,,•�.;�'•6'I�'�Coridl�lori'p(;9yf,�m", Pvmpod 8y: `w�1, 'rlI !�1 f ' 1' (� ! %1VehlcJe UWH NJT.ier ., .gin•,(, ��,4`, ., /,��n'i,�►A �t'�t•!ttiiiM��r,l' 11 ���'�fR1/I(�,,�1�� loci on. where r !;•,'�,• :,... co(1lenls',were dl�poseo: • ,, .'. ;:,�'; '1' :IIS;,. • �' :.�;i;':,;;;..�,,,;,.rJ.'"r,S�nerluiolh'eVre{; ,• �.,,•. ,,, � % �p�. :!w,�V,mBSS, OV/ • .i/.,ll :%' •' �el� OO . _ � 9,.•deawelar/epprovaJs/Ib/orm9,r:�nnl�9�eCl ���-�-.� v�•��✓off r7 AS -BUILT CHECKLIST ✓� LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER �A LOT LINES & LOCATION OF DWELLINGS LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE _ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION v' LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM / LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX i ` STAMP & SIGNATURE IMPERVIOUS AREAS -"DRIVEWAYS, ETC. ✓ NORTH ARROW TIN'Al CONTOURS f LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN