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HomeMy WebLinkAboutMiscellaneous - 858 JOHNSON STREET 4/30/2018 (3)PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/19/2014 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On -Site Sewage Disposal System By: Bill Hall At: .858 Johnson Street Map 107A Lot 45 North Andover, MA -0.1845 Th s uanc of this c � 'fi to all not e construed as a guarantee that the system will function satisfactorily. ich a Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t!`4��ao en.•roU r°- P a 94 4R4t.0 •�,'�g . sSAcauS PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (`constructed; ( ) repaired; By: Ali L L.. �-I A L (Print Name) Located at:—b �� TO 91\k soAl ST • (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated 7 3 `� 't. and last revised on1b 6�,/,3 , with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative (Signature) And Print Name Final Construction Inspection Date: Engineer Representative (Signature) II And —Print Name Installer: (Signature) Date: S f F And — Print Name Enginer• ,7 -'' ignature) Date And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com North Andover Health Department Community Development.Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION \ ADDRESS:858 Johnson St. MAP: 107A LOT: 0045 INSTALLER: Bill Hall DESIGNER:Chir1"4'j"5 PLAN DATE: `&-T- ( o i3 BOH APPROVAL DA+E ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 10/11/13 DATE OF FINAL�CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: �� l SITE CONDITIONS Contractor reports any changes to design_glan Existing septic an -_ e ❑ Internal plumbing a o one ui ing sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK Building sewer in continuous grade, on ,_GU-Vf ©�C� `\I� compacted firm base Cleanouts per plan -= Bottom of tank hole has 6" stone base Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic tank construction Water tightness of tank has been achieved by ` visual testing ❑ Inlet tee installed, centered under access port t CONTROL PANEL ❑ Alarm ump are on separate circuits ❑ Alarm sou ds when float is tripped El Location of ntrol panel: basement El Alarm signal to ted inside: basement Comments: DISTRIBUTION -BOX - Installed on stable stone base H-20 D -Box 1?Net tee (if pumped or >0.087foot) [� Hydraulic cement around inlet & outlets Observed even distribution ❑ Speed levelers provided (not required) Comments: Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER - ❑ttom of tank hole has 6" stone base WWeephole lu ed plugged ❑ 15 gallon Pump Chamber installed ❑ H-10 oading ❑ Monoli is tank construction ❑ Inlet tee * stalled, centered under access port ❑ Pump(s) i stalled on stable base ❑ Alarm floatXorking ❑ Pump On/Offlfloats.working ❑ Separate on/o loats ❑ Drain hole in pre ure line ❑ cover at finarade installed over pump access port El Water tightness of tank , as been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm ump are on separate circuits ❑ Alarm sou ds when float is tripped El Location of ntrol panel: basement El Alarm signal to ted inside: basement Comments: DISTRIBUTION -BOX - Installed on stable stone base H-20 D -Box 1?Net tee (if pumped or >0.087foot) [� Hydraulic cement around inlet & outlets Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) Z Bottom of SAS excavated down to C soil layer, as provided on plan Size of SAS excavated as per plan W 5�n �. Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block°�� ❑ Final cover as per plan 'f Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: El Number of rows (trenches): Comments: Total Chambers Zti FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer i f / As -Built Plan M=_HRBM=- HR = HI = ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber , CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 Z Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Bank' 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 Z Drains (intercept g.w.) : 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells i 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Commonwealth of Massachusetts Map -Block -Lot 107.A0045 BOARD OF HEALTH --- ------------------- Permit No North Andover -09 BHP1317 -20 ----P-20-3-09 ------ FEE $250.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Bill -Hall -Inc. _--------_-_--_--_- ------------------------------------------------------------------------ - to (Construct) an Individual Sewage Disposal System. at No --858--JOHNSON----- STREET E17L,�_CQPY----------------------------- -- --------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2013-091 Dated October 02, 2013 Issued On: Oct -02-2013 --------------------------------- --------------------------------------------------------------- BOARD OF HEALTH FRECEIVED Application for Septic Disposal System apL T - 1 IJ Construction Permit — TOWN OF # T U �C; r l� gvFR ORTH ANDOVER MA 01845=,26fl,o®_� ,,� EUepair sSACNuse Important: Application is hereby made fora permit to: When filling out Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component — What? cursor - do not use the return key. A. Facility Information iSl Address or Lot # No , A idoyo `d City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install'this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information 'S+e R1 Qtl I-'-m_nCo'O.SO Name r rr tje.1z Address (if different from above) ANN City/Town State Zip Code -78 _3,(,(707'3 Telephone Number 3. Installer Information Ll I I Ne. -1t Name Name of Company Ll v v ,' Q n a Address AW vin Nle} 6 18 `f 4 City/Town State Zip Code 975 .3 0 _5_z8® Telephone Number (Cell Phone # if possible please) 4. Designer Information C.A r "'bt iy do so,-, Name Name of Company Address City/Town State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 oo Application for Septic Disposal System pConstruction Permit - TOWN OF ORTH ANDOVER. MA 01845 PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: gResidential Dwelling or ❑Commercial B. Agreement 1°—Z- / TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal. Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Application Approved and of Health Representative) 41 Date Application Disapproved for the following reasons: For Office Use Only: L Fee Attached. Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump Svstem? If so, Attach copy of Electrical Permit Yes_ No 4. Foundation As -Built? (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 1 P _ 0- SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: S8 an (Address of septic system) Relative to the application ofK% 1 1 6J sta` (Inller's name) Dated /d _2 �� I oo air's ate Fox plans by C_h� S x`0./1 SO ✓� —+- (Engineer) —(Engineer) And dated —1/_12 _5_— rigina ate With revisions dated 5- 3ti — / 3 (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans nor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (V5 inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept2townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the .excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer. I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: /O —2, -13 (Today's Date) (Name — not) (Name —Sime C AN 01 CHRISTIANSEN & SERGI, INC. S1 E PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 www.csi-enor.com fax 978-372-3960 MEMO To: /Susan Sawyer/ Jennifer Hughes From: Philip Christiansen CC: Data May 23, 2013 Re: 858 Johnson St I changed the plan slightly so that the work would be farther from the wetlands. I changed to the low profile chambers which are only 8 inches high. This change allowed installation of the chambers without having to change the surface topography for breakout and enables the chambers to be installed in the parent soil without excavation of the top and subsoil 5 feet around the system. Jennifer said that wetland flag 1 was missing so I had Leah Basbane go back out. She established a new flag 1 and also a flag 0. The plan shows those flags. Additionally Leah did two soil probes in the brush pile and found the soil to be upland soil RECEIVED MAY 2-3 2013 6F NOWH ANDOVER North Andover Health Department Community Development Division May 24, 2013 Phillip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Re: Subsurface Sewage Disposal System Plan for 858 Johnson Street (Map 107A, Lot45) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated April 25, 2013 and received on May 23, 2013 has been reviewed. Unfortunately, the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item. 1. Please reference the Lake Cochichewick watershed in the notes on sheet 1 (NA 3.2). 2. Please demonstrate that a conventional system in compliance with 310 CMR 15.000 can be built on the site in order to use the Infiltrator Chamber system according to Section I(3) of the DEP General Use approval letter. An outline and brief description of a conventional system on the site plan is sufficient. 3. The design plan references two different Infiltrator Chamber models (High Capacity and Standard Low Profile). It appears the design is based on the Standard Low Profile model. Please modify the design accordingly to correct the discrepancy. 4. Please indicate if the existing garage adjacent to the leaching facility has a slab foundation. If so, it must be 10 feet away from the proposed leaching facility. 5. It appears the existing dwelling is proposed to be removed and a new dwelling constructed. However, the design plan indicates the existing dwelling to be razed. Please clarify this note. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 0 f 6. The leaching detail on sheet 1, indicates a trench length of 44 but the design calculations indicate a trench length of 48'. The detail also indicates 1 I-rokebers per row but the design calculations indicate 12 chambers per row. 7. On the profile view on sheet 1, the pipe from the D -box should be connected to the inlet of the chamber. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director cc: Stephen Franciosa .File North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Page 2 of 2 Fax: 978.688.8476 Blackburn, Lisa From: Sawyer, Susan Sent: Tuesday, May 28, 2013 3:27 PM To: Lois Christiansen Cc: Blackburn, Lisa Subject: 848 Johnson Hi Lois, I would like to offer to not have another tree cut down, by asking if we can do two things via email Rather than printing out a new copy, could you put in writing answers to the following; Or request and give approval to change the plan I have. I will leave it to your discretion. Thank you Susan 1. Please reference the Lake Cochichewick watershed in the notes on sheet 1(NA 3.2). 2. Please demonstrate that a conventional system in compliance with 310 CMR 15.000 can be built on the site in order to use the Infiltrator Chamber system according to Section 1(3) of the DEP General Use approval letter. An outline and brief description of a conventional system on the site plan is sufficient. 3. The design plan references two different Infiltrator Chamber models (High Capacity and Standard Low Profile). It appears the design is based on the Standard Low Profile model. Please modify the design accordingly to correct the discrepancy. 4. Please indicate if the existing garage adjacent to the leaching facility has a slab foundation. If so, it must be 10 feet away from the proposed leaching facility. Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawverC@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htto://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. North Andover Health Department Community Development Division . May 30, 2013 Stephen Franciosa 8 Newell Farm Drive West Newbury, MA 01985 Subsurface Sewage Disposal System Plan for 858 Johnson Street, North Andover, Massachusetts Map 107A Lot 45. Dear Mr. Franciosa, The North Andover Board of Health has completed the review of the septic system design plans for the above referenced property, submitted on your behalf by Christiansen & Sergi, Inc. dated April 25, 2013, last revised on May 24, 2013 and received May 28, 2013. The design has been approved for use in the construction of a new onsite septic system for a 4 -bedroom (max 9 -room) home. This plan is good for 3 years from the date of approval. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. This approval is also subject to the following conditions: 1. Prior to the issuance of a Disposal Works Construction permit the following must be submitted. a. A Foundation plot plan in a 1" = 20' scale; the same as the approved plan ,A. Floor plans of the proposed home 2. 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)). 3. 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 North Andover Health Department, 1600 Osgood Street. Building 20, Suite 2035. Page 1 of 2 North Andover, MA 01845 Phone: 978.6889540 Fax: 978.688.8476 858 Johnson Street May 30, 2013 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. Sincer , Susan Y awy HS/RS Public Healt irector cc: Christiansen & Sergi, Inc. file Encl. copy of the approved Installers List for N.A. North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2035, Page 2 of 2 North Andover; MA 01845 Phone: 978.688.9.540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER. Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER; MASSACHUSETTS 01845 978.688.9540 = Phone Susan Y Sawyer, REHS/RS 978.688.8476— FAX Public Health Director E-MAIL: healthdept@townofnorthandover.com WEBSITE: httii://www.townofnorthandovei.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: �5/Z1 1, Site Location: 858 Johnson Street Engineer: Christiansen & Sergi, Inc, Philip Christiansen [RECEIVE® hIAT L 2013 TOWN OF NORTH ANDOVER New Plans? Yes XX $225/Plan Check # 3 1lD� (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check # Site Evaluation Forms Included? Yes XX No Local Upgrade Form Included? Yes No Telephone #: 978-373-0310 Fax #: 978-372-3960 E-mail: Phil@csi.-engr.com Homeowner Name: Alice Holt �PliC.Rlytt• 5kph F-ra e—tosa,r �t`� - 36 / — 7079 OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts -- } ---- - C ity/Town of . . (; Percolation Test rRECE1V_E_,Y_ �J Form 12 TOWN OF NORTH ANDOVR HEALTH DEPARTMENT Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: When filling out forms A. Site Information on the computer, use only the tab Key to move your Uwner Name cursor - do not 858 Johnson Street ilea tha roti irn key. Street Address or Lot # No. Andover Ma. 01845 City/Town State Zip Code Phil Christiansen 978-373-0310 Contact Person (if different from Owner) Telephone Number B. Test Results 4-17-113 Date Time 3 48" 10:35 10:50 10;50 11:05 11:26 21 minutes 7 min/inch Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ F.Paul Cardone/Septic Compliance,lnc Test Performed By: Mill River Engineering Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 4-17-13 9:55 Date Time Observation Hole # 1 Depth of Perc 56" Start Pre=Soak 9:55 End Pre -Soak 10:10 Time at 12" 101,10 Time at 9" 10:25 Time at 6" 10:42 Time (9"-6") 17 MINU_' ES Rate (Min./Inch) 6 MIN/INCH 4-17-113 Date Time 3 48" 10:35 10:50 10;50 11:05 11:26 21 minutes 7 min/inch Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: ❑ F.Paul Cardone/Septic Compliance,lnc Test Performed By: Mill River Engineering Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 2 J LO a 00 O co 2 WIVA 0 O U a N fn Cl.El N m M M Q 0 CL Q' f0 U O O O C7 (d cu .0 U L N c C� M O E O z O N m ❑ N U) cu E m Z Z O z O Z a) O Q ❑ O O cm C CL a v7 O z IZ as E C: } O 0 Q U O O O Z z O U � N z > 0 ❑ CL O El ElUs � cn O � E L'O 0 = U) w U) U U N d UU U N v) to r_ 0 (n (� a) a) O c U) m O O 0 CL cc U C cu O LL C C� O c O L O w O W) a) C (0 C 0 ca Z a) QLcu "' NC f° a) O s o U N a) L Q) 00 > (n a) O L L a) L O O O 4 O to (O I� C) O l9 ® ❑ U U N a d O ami O �. vm ` Q Z d d N 0 N a) T pp O, «_ O O ❑ O > 72 E 0) fn W N O C C O "= z (on fn Cl.El N m M M Q 0 CL Q' f0 U O O O C7 (d cu .0 U L N c C� M O E O z O N m ❑ N U) cu E m Z Z O z O Z a) O Q ❑ O O cm C CL a v7 O z IZ as E C: } 0 Q U O O U � N z > 0 ❑ 2, O � O d E L'O 0 = o w U U N d m U N fn Cl.El N m M M Q 0 CL Q' f0 U O O O C7 (d cu .0 U L N c C� M O E O z O N m ❑ N U) cu E m Z Z O z O Z a) O Q ❑ O O cm C CL a co 0 a� rn ns d m N 0 CL N N N .O. 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Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y: Sawyer, REHS, RS Public Health Director APPLICATION FOR SOIL TESTS DATE: 3/18/2013 978.688.9540 - Phone 978.688.8476 - FAX www.townofnorthandover MAP & PARCEL: 107A/ 45 LOCATION OF SOIL TESTS: 858 JOHNSON ST owlvER ALICE HOLT. APPLICANT: S—FRANCIOSA Contact #: Contact #: 978-361-7078 ADDREs. 8 NEWELL FARH DR, W NEWBURY, MA 01985 ENGINEER: P CHRISTIANSEN Contact #: 978-373-0310 CERTIFIED SOIL EVALUATOR:. PAUL C'ARDON E 1,• Intended Use of Land: ;.. Residential Subdivision. Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: XX Upgrade for Addition: X In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED,WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11 "Plot Plan & Location of Testing (Please indicate test nit sites on the Plan MAR Z.11 2013. 4OF NORTH ANDOVER ➢ Fee of $425.00 per:lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of3$ 60.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only. Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ , Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH. representative. ➢ Full payment will be required for .all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled'plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢!, Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: J'S ` 1 e Signature of Conservation Agent. 4-' p� �-� i(J�V.�T 5 Tc� W�i�l� . J� C0 t.A- 04 - Date back to Health Department: (stamp in): (V�•r71�.C- C_�dp49� � '�-�.. uJ�\0.v� I �� CvfF r( -f�a It .01:; 60-0: \ — -- — \o \ \ p�nmw \ OB 1 ? w M I �- \ I I o W.QQ� W Z Q \ w N \ �\ cc3 uj C I "W m0WQ C,N23: s3w 1 II I 1 \ \ \ nacow I \ II � V I 1 0 �ooZ LL. $� �u:Ww a � dHW 0 N O, 00 00 OO+ N C4, •• N to N to LO (0 N. U S!6' U N N " .O O f{{I c C d 0 1,0 .6 0 (o N ..N. m d N i0'LO O N Y Y + � rl C14 (0 00 al cc: a0) C 0 y� c O_ �'��' 0— 0M 'fturl O ;Z' Q'� o N .I Z N N10 N 00: O ON�2N LL O'mom H 9 ' ... to J J Z d.0 0 O O W �_� O. O �y a� O a�� o O �NvEQo..�U'�tL� O LL Zoo 0.0 ''1 v,~ LL Zp t9 x s �U� LLS Q sQ Q Q. {1 � )�nZ WI IS,) U Q W M �,aomao a)rn s JQ�vo J O'0) W � 00 O0 00 0)0) J � o Uo V W.� r - mm K O O} m7 W Z 1 Cl0 mom! M M _ § FO �rco ;mea U U G)o�11110 0 O CL p~~ O oo = �cninU �a O BIZ in °U U CL r Z i 1 O Olio T,cO { o" nc r .: m �N uM " (y U) m 'm (D N o� tm. tt J N A) 03 ` i ,r 0)Q�O 03 003 O� •'� ��-SID Q . Mme: J CQ U),�+ ILL CTE, �,Z • Q O•y�(n (n 'p ' rF-rr cll y'e IY O O N U �O CO LL of U) C) _ co �O oo \ �r 1.110) Cc�o I'clIm Q "O O co Oa; V.'O co'N rrLL LL Q 0)�x'..p 0) f0 d:LLI cu Co OQy w iaa 0' Q7s; xLn . LL W ii, a".vlc`o af0i°�fo i3C9 M C 00 U :D.H �ujI>— 900-o 0 Z Q to N r !OH'�H- M - H- } col- N y LL co `' L,LLo CD a -w � M. r m� ;�Oi� cLiNi.(o(n o 7 �4 �p��m M O LL W Q a m�m:m�a �+'Yt �9jE W Z W2 tea, o m m.xas:waita. cn cn.. HCayLL'+S,WmYW". MmQ �. '20O'Z U Z O U'No< U Q U (1)Z� d Q S a x of �o a�:oU _ Q _ c m.c2a L J v) -'o O a H F o ���i c f a`.. v, e f= W 3 vco . �� P p. Q cn;(n;� w LL r,LL LL;U a w U) O (o CL RECEIVE® APR "i 7 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT liih la . a���llll 11 11 � it - w 11 1 111 1 •a � 11 111 1 111!!.■'! I r •► 11. ! i 1 111 11 p !� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date TYPE OF IMPROVEMENT PROPOSED USE i� CONTRATt®RFNa w ' �. ,ks RPh ,. Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family . No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: F®fSepticWell '' F 11 iFloodplain ®1Netla f ds t aWater.,sh70 Dis rs c : - OWNER: Name: ArlrlrP.-,- DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) Phone: 4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $.12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ? - ir SignatureSignature Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans i� CONTRATt®RFNa w ' �. ,ks RPh ,. i ,Address ^ Supe�rviso 140—�onstruct_ion Lficens4e: 4 Ex a§te e .:Home IlmprvementLicense'_�Ezp®ate_ - – ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $.12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ? - ir SignatureSignature Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ ' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENTEl COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on /24.1, Signature COMMENTS 3 D 3 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT _ Temp Dumpster on site yes no, Located at'124.Main'Street Fire ®epaierifi signature/date F n I