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TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer, RENS, RS
Public Health Director
APPLICATION FOR SOIL TESTS
DATE: 0-4-14
LOCATION OF SOIL TESTS:
978.688.9540 - Phone
978.688.8476 -FAX
www.townofnorthandover
MAP & PARCEL:
°F NORTN Qy
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AUG 0 6 2014
OWNER: j2Q�W��L� Contact
APPLICANT: Contact #:
ADDRESS:
4URTH ANDOVER
DEPARTMENT
ENGINEER: Li k) rV (Aj ' -kI � ;� Contact #: (qW) e4 �--z c,- j /�-2�
CERTIFIED SOIL EVALUATOR: f j,Lt_ 502—
Intended Use of Land • Resid/ential Subdivisio Single Family Home Commercial NOW - 1C
Is This: Repair Testin • v eveloped Lot Testing:-Se"I"Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes
I
apml - lol 3A
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)
➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 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
Signature of Conservation
Date back to Health Department: (stamp in): �ro� '� t
1
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North Andover MIMAP
May 12, 2014
098.B-0079
Interstates
107.A-0067,_ 038.0-0060
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Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83,
#128 :. #815' #826
Meters Data Sources: The data for this map was produced by Merrimack
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THIS INFORMATION
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Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83,
Meters Data Sources: The data for this map was produced by Merrimack
Roads
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Valley Planning Commission (MVPC) using data provided by the Town of
North Andover.
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Additional data provided by the Executive Office of
Environmental Agairs/MassGIS. The information depicted
[ MVPC Boundary
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on this map is
for planning It be
0 Municipal Boundary
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purposes only. may not adequate for legal boundary
definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING
- Trails
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THE ACCURACY, COMPLETENESS, RELIABILITY,
❑ Parcels
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OR SUITABILITY
OF
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THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT
Hydrographic Features
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ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
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THIS INFORMATION
Streams
: Wetlands A
Exempt Lands 1 ^ = 233 ft "' V
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Town of North Andover
�`ti'•,'� HEALTH DEPARTMENT
�ss�cHus°�
CHECK #: 72-7V DATE:
LOCATION: G)_") 0 h h SO 1) hZ�p
H/O NAME: 4
CONTRACTOR NAME: 5 10 15
Type
of Permit or License: (Check box)
❑
Animal
$
❑
Body Art Establishment
$
❑
Body Art Practitioner
$
❑
Dumpster
$
❑
Food Service - Type:
$
❑
Funeral Directors
$
❑
Massage Establishment
$
❑
Massage Practice
$
❑
Offal (Septic) Hauler
$
❑
Recreational Camp
$
❑
Sun tanning
$
❑
Swimming Pool
$
❑
Tobacco
$
❑
TrashlSolid Waste Hauler
$
❑
Well Construction
$
SM7C Systems:
Septic - Soil Testing
$�00
❑
Septic - Design Approval
$
❑
Septic Disposal Works Construction (DWC)
$
❑
Septic Disposal Works Installers (DWI)
$
❑
Title 5 Inspector
$
❑
Title 5 Report
$
❑
Other. (Indicate)
$
La
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
„ORT” 6977
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Town of North Andover
HEALTH DEPARTMENT
,SSACHUg�t
CHECK #: 72-7V DATE:
LOCATION: 03, —j 0 h h SO L)
H/O NAME:
CONTRACTOR NAME:. IO 15
Type
of Permit or License: (Check box)
❑
Animal
$
❑
Body Art Establishment
$
❑
Body Art Practitioner
$
❑
Dumpster
$
❑
Food Service - Type:
$
❑
Funeral Directors
$
❑
Massage Establishment
$
❑
Massage Practice
$
❑
Offal (Septic) Hauler
$
❑
Recreational Camp
$
❑
Sun tanning
$
❑
Swimming Pool
$
❑
Tobacco
$
❑
Trash/Solid Waste Hauler
$
❑
Well Construction
$
SE C Systems:
Septic - Soil Testing
❑ Septic - Design Approval
❑ Septic Disposal Works Construction (DWC)
❑ Septic Disposal Works Installers (DWI)
❑ Title 5 Inspector
❑ Title 5 Report
❑ Other. (Indicate) $
LB
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
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North A� r 2 as.
IPPOEM DATE
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SSMC SISTEK
INSTALLATION CHECK LIST • LOT #
N' trSkP XCAV TICK
�asc=�S
PAIL
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1.
Distance Tos�,
a. Wetlands
b. Drains
V
c. Well
2.
,Tater Line Location
3.
No PPC Pipe
-_..
Septic Tank= -4-
-
--
- a. --Tees -_Length & To Clean Out Co®`ers. _
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b. Cement Pipe to Tank - On Both Sides of Tank --
5.
Distribution Box
44
a. Covers & Box - No Cracks
,r
b. All Lines Flowing Equal Amounts
C. No Back Flow
_
6.-
Leach Field or Trench
a. Dimensions
Stone Depth
c. Capped Ends
d. Clean Double Washed Stone.
?Leach
Pits
a. sions ;
b. S Depth -
C. Spla
d. Tees
e. C�nent Pipe to t - Both Sides
f. Clean Double Washed Stone
'
8.
No Garbage Disposal
k
9•
Final Grading Inspection
®f
10.
Barricading Covered System
3.1.
As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Aegard_to Pere Test
d. Elevations
e. Water Table
•
BoardNggl.th
+
North Aa_arilaz s.
SSG' SITFK
IN91 AMATIQN C hi LI ST LOT
P� C1PL� DATE
DISkPt tt(�'�i � I'�—
XCAVATICK ON L .�
eaqqnst
Y FAn
OK
.1.
Distance To:'
a. Wetlands
b. Brains
c. Well
..0001
2.
Water Line Location
Olel
3•
No PVC Pipe k
,.
40
Septic Tank
a. Tees -_Length & To Clean Out Goers.
b. Cement Pipe to Tank = An Both Sides of Tank -_
r
5.
Distribution Box
a. Covers & Box - No Cracks
mow_
b. All Lines Flowing Equal Amounts
c. No Back Flow
6.
Leach Field or Trench
.f
a. Dimensions
Stone Depth
c. Capped 'Ends
=
d. Clean Double Washed Stone
70
Leach Pits s,s
a. Dimensions
b. StoneDepih
c. Spsh Pads
do Tees
e Cement Pipe to Pit - Both Sides
. Clean Double Washed Stone
40,
8.
No Garbage Disposal
9•
Final Grading Inspection
10.
-Covered
Barricading System
.�'
11.
As Built Submitted
w
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
`�
e: Water Table -
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Blackburn, Lisa
From: Isaac Rowe <irowe@millriverconsulting.com>
Sent: Friday, September 19, 2014 8:03 AM
To: Blackburn, Lisa; Sawyer, Susan
Cc: 'Pam Lally'; 'Isaac Rowe'
Subject: RE: 865 Johnson St.
Attachments: 865 Johnson Street - Soil testing results 9-18-14.PDF
Susan,
Attached are the soil testing results for the above referenced property. We did a total of (5) lots. Generally good soil
except some pockets of excessive rock. There is relatively a high groundwater table throughout the site so all systems
will be raised above grade.
I allowed (2) deep holes and (2) perc tests per system area because they were across the proposed system location.
Trenches will be proposed. If leach beds are proposed instead thenve should probably require additional test pits
before or during construction. The soil was consistent and I am not worried about lack of soil depth in the areas we
tested.
Please let me know if you have any questions.
Thanks,
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930-2719
Phone: 978-282-0014 ext.804
Fax: 978-282-1318
irowe(cD.millriverconsulting.com
www.miliriverconsultin-g.com
From: Blackburn, Lisa[ma iIto: LBlackburnC&townofnorthandover.com]
Sent: Wednesday, August 27, 2014 3:26 PM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Cc: Sawyer, Susan
Subject: 865 Johnson St.
Good Afternoon,
Please contact Bill Dufresne to set up soil testing for 865 Johnson St. Thank you.
Lisa Blackburn
Health Department
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
Phone 978-688-9540
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