HomeMy WebLinkAboutMiscellaneous - 88 HAY MEADOW ROAD 4/30/2018TI1►,�F4r7
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NOTICE OFVARIANCE/DEED RESTRICTION
Pursuant to 310 CMR 15.000 Title 5, and as a condition of the North Andover Board of Health
Disposal Works, located in North Andover Massachusetts, that Construction Permit # 1184 was
granted on September 20, 2002, and notice is hereby given that real estate property located at
1
88 Hay Meadow Rd. North Andover, Massachusetts (aka approved Assessor's Map 1048
t Lot 104), as Described in deed from First Colonial Bank to Gabriel P.-& Janice I. Sciolla
June 27, 1991 and recorded in the Essex County Registry of Deeds in Book 3275 and page
# 184 and as Document #'11666, is the subject of a variance from the Town of North Andover for .
the Subsurface Disposal of Sanitary Sewage A 1.05 and C9.01(4) Said variance limits the
Maximum number of bedrooms at this dwelling to four bedrooms, and grants an allowable three
foot separation to ground water in accordance with 310 QWR 15.405, as accepted and approved c,
in engineering design pians_ (See Construction Note # 15 on approved plans), submitted to the
Town of North Andover's Board of Health Disposal Works by, JiVI Associates Civil Engineers, - ~;
cc
(Lic. # 312621, located at 324 Main Street North Reading, Massachusetts, Juiy 16, 2002. This
variance has been approved and is within the Jurisdiction of the North Andover Board of Health.
Signed and scaled this the 6th day of June 2003.
ESSEX NORTH REGISTRY OF DEEDS
LAWRENCE, BASS.
A TRUE COPY: ATTEST:
cm
CID
Property owner(s) i=
N
Essex, s.s. Date 2003
Then personally appeared the above named G'o -3i-i0� IC; and acknowledged the
foregoing instrument to be his/her/their free will and deed before me
I
Name Notary Pubic!
1 a, ti.M •Y , �/ ��V / / �/ �, M� Ji
F ' t
pV
Lot & Street Q �' Map/Parcel��� J�
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES NO Permit#
Plan Approval: Date:
Designer:
Conditions:
Water Supply: Town Well
Well Permit: Driller:
Well Tests: Chemical
Bacteria I
Bacteria II
Plumbing Sign -Off:
Comments:
Form °U" Approval
Date Issued
Conditions:
Final Approval:
Approved by:
Plan Date:
Date Approved
Date Approved
Date Approved
Wiring Sign -off:
Approval to Issue
By:_
YES NO
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other? YES NO
Any Variance Needed? YES NO LD
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
.s
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Begin Inspection:
Excavation Inspection:
Needed:
Passed: LD D By:
Construction Inspection:
Needed: 6V- k Di
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date: By:
Final Grading Approval: Date: By:
s
Final Construction Approval: Date: (0 01— By: 6
19
Certificate of Compliance: Approval: Date:
NO
Is the installer licensed?
G)
N
Type of Construction:
NEW
New Construction: Certified Plot Plan Review
YES
NO
Floor Plan Review
YES
NO
Conditions of Approval from Form U
YES
NO
Issuance of DWC permit:
YES
NO
DWC Permit Paid?
YES
NO
DWC Permit # Installer:
Begin Inspection:
Excavation Inspection:
Needed:
Passed: LD D By:
Construction Inspection:
Needed: 6V- k Di
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date: By:
Final Grading Approval: Date: By:
s
Final Construction Approval: Date: (0 01— By: 6
19
Certificate of Compliance: Approval: Date:
NO
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Commonwealth of Maasachdsetts`
Title.5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover
City/Town
MA 01845
State Zip Code
3/10/08
Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Benjamin C. Osgood, Jr
Name of Inspector
New England Engineering Services, Inc.
Company Name
1600 Osgood Street Suite 2-64
Company Address
No. Andover MA 01845
City/Town
978-686-1768
Telephone Number
B. Certification
State
License Number
Zip Code
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
asses ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
3- 1--n (�-- 0J -
-to-
Inspe is Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 15
♦-
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hav Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845 3/10/08
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If "not
determined," please explain.
❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or. breakout or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if (with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
A, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 88 Hay Meadow Road
Property Address
Wendy McKernon
Owner Owner's Name
information is
required for No. Andover MA 01845 3/10/08
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 15
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hav Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845 3/10/08
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**. .
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes
No
❑
E3,,
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑
pEr
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑
El-
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1h day flow
❑
Eg,,-
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑
[[�"
Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑
Er
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
TITLE 5 FORM 2007.DOC • 08/06
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 15
vE
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845
City/Town State Zip Code
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
3/10/08
Date of Inspection
❑ [� Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ [R Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ E2"- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ [9 The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ❑ - The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ISR� the system is within 400 feet of a surface drinking water supply
❑ [l"' the system is within 200 feet of a tributary to a surface drinking water supply
❑ LJ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area - IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 15
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
0�__ ❑ Existing information. For example, a plan at the Board of Health.
❑ ®,--- Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
TITLE 5 FORM 2007.DOC - 08/06 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner
Owner's Name
information is
required for
No. Andover
MA 01845 3/10/08
every page.
City/Town
State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes -No
❑
Pumping information was provided by the owner, occupant, or Board of Health
❑ [J"_
Were any of the system components pumped out in the previous two weeks?
hd' ❑
Has the system received normal flows in the previous two week period?
❑ DJ---
Have large volumes of water been introduced to the system recently or as part of
this inspection?
EV__ El
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑
Was the facility or dwelling inspected for signs of sewage back up?
[� ❑
Was the site inspected for signs of break out?
❑
Were all system components, excluding the SAS, located on site?
[�� ❑
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
�—
Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
0�__ ❑ Existing information. For example, a plan at the Board of Health.
❑ ®,--- Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
TITLE 5 FORM 2007.DOC - 08/06 Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 6 of 15
Commonwealth of Massachusetts
w Title 5 official Inspection Form
- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner Owner's Name
information is
required for No. Andover MA 01845 3/10/08
every page.
City/Town
State Zip Code Date of Inspection
D. System Information
❑
Residential Flow Conditions:
❑
Yes
❑
Number of bedrooms (design): Number of bedrooms (actual):
❑
Yes
Y��
DESIGN'flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms):
Number of current residents:
Does residence have a garbage grinder?
❑ Yes `V No
Is laundry on a separate sewage system? [if yes separate inspection required]
Yes ❑ ' No
Laundry system inspected?
❑ Yes �l No
Seasonal use?
❑ YesNo
Water meter readings, if available (last 2 years usage (gpd)):
Za 6—PP.
Sump pump?]
Yes ❑ No
Last date of occupancy:
L"
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
Last date of occupancy/use:
Other (describe):
Gallons per day (gpd
Date
❑
Yes
❑
No
❑
Yes
❑
No
❑
Yes
❑
No
TITLE 5 FORM 2007.DOC • 08/06 - Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 15
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845 3/10/08
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
til' D j z oas;- -Fe P- caw t --It .
gallons
Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Yes � No
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
Other (describe):
�CL 4 P �-�✓p� T C -
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes � No
TITLE 5 FORM 2007.DOC - 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner Owner's Name
information is
required for No. Andover MA 01845 3/10/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer (locate on site plan): /
Depth below grade:
feet
Material of construction:
❑ cast iron 40 PVC ❑ other (explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: feet
Material of construction:
j cconcrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------------------------------------
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle 60
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? ptEllik a I C, Irp nr-
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner Owner's Name
information is
required for No. Andover MA 01845 3/10/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan)
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
�f Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
TITLE 5 FORM 2007.DOC - 08106 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 15
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845 3/10/08
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
*/ kTight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
* Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert `.�
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
OaK rti (ria 0 G0vtr>t 7z�►". iv &V i1>Cot cE o -So c tl> S
C A-lz!i y o.j Ric. D 2 L. F- A -"G -mac" (N d R O v7�)
Pump Chamber (locate on site plan):
Pumps in working order:
Alarms in working order:
E Q,' `Yes ❑ No
Yes ❑ No
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 88 Hay Meadow Road
Owner
information is
required for
every page.
Property Address
Wendy McKernon
Owner's Name
No. Andover
City/Town
D. System Information (cont.)
3/10/08
Date of Inspection
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
EL) M P C K r9 M 9,;F i2 c4 ^J A l ?7 o ,n
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑
leaching pits
❑
leaching chambers
❑
leaching galleries
❑
leaching trenches
leaching fields
❑
overflow cesspool
❑
innovative/alternative system
Type/name of technology:
number:
number:
number:
number, length:
number, dimensions:
number:
I F? Cc r>
X3,50 5-�
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
4lz6A yr- &4EAC f -C T=I Cd -D ova a nV,% iL EV , D te--
61 /N ct D AN4? S'J t� t _ 0 AJ J s y ,g c J E(r C-Ti4-17-4 At 5
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 15
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°w 88 Hay Meadow Road
M
Property Address
Wendy McKernon
Owner Owner's Name
information is
required for No. Andover MA 01845 3/10/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
/l/ I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
I Q- Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
TITLE 5 FORM 2007.DOC • 08/06 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 15
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner Ownet's'Name
information is
required for No. Andover MA 01845 3/10/08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
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0
PCM P
TA N K.
TITLE 5 FORM 2007.DOC • 08/06/ - Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 15
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Hay Meadow Road
Property Address
Wendy McKernon
Owner's Name
No. Andover MA 01845 3/10/08
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑
Check Slope
❑
Surface water
❑
Check cellar
❑
Shallow wells
Estimated depth to ground water: feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health - explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
fi9 ST a &N r7eiis .1dF,'> 6 _f4$ 3vC q MJ"g w
�c.AN> a Pt d �.�L
TITLE 5 FORM 2007.DOC - 08/06 - Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 15
'Mar 03 08 01:44p
Summary Record Card generated on 3/312008 10:32:35 AM by Lisa Evans
Town of North Andover
Tax Map # 210-104.B-0104-0000.0
88 HAY MEADOW ROAD
MCKERNON, WENDY NARDIN, FIL Since Jan 2006
88 HAYM EADOW ROAD
NORTH ANDOVER, MA
01845
Class
101 Single Family
Size Total
1 Acres
FY
2008
UB Mailing
Index
Name/Address
Type Loan Number
WENDY MCKERNON Owner
PHILIPO NARDIN
88 HAY MEADOW ROAD
NORTH ANDOVER, MA 01845
SCIOLLA, JANICE Previous Customer
88 HAY MEADOW ROAD
NO. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle
Bldg Id. 18128.0 - 88 HAY MEADOW ROAD
3180156 03 Cycle 03
UB Services Maint.
Property Type -- _._--
Active/Inact. From
Inactive 7/1/2005
Occupant Name Active/Inactive
Last Billing Date 1/15/2008
Active
Service Code
Multiplier/Users
Rate
MISCFEE ADMIN FEE
61.03
0.635/8
WTR WATER
Type
01 ALL METER SIZE
UB Meter Maintenance
Consumption
Posted Date
Serial No Status
1/2212008
Location
13242486 a Active
18
00
Date Reading
Code
12/17/2007
512
a Actual
9/14/2007
495
a Actual
6/21/2007
489
a Actual
3/16/2007
471
a Actual
12/13/2006
454
a Actual
9/19(2006
433
a Actual
6/20/2006
418
a Actual
3/2012006
399
a Actual
12/27/2005
384
a Actual
9/21/2005
359
a Actual
6/29/2005
280
f Final Bill
3/10/2005
245
a Actual
12/15/2004
223
a Actual
9/28/2004
199
a Actual
6/15/2004
77
a Actual
4/23/2004
38
a Actual
12/2912003
0
n New Meter
Charge
Multiplier/Users
7.82
11
61.03
11
Brand
Type
METE METE
w Water
Consumption
Posted Date
17
1/2212008
6
10/1212007
18
712012007
17
4/16/2007
21
1 /19!2007
15
10/20/2006
19
7/10/2006
15
4/17/2006
25
1/17/2006
79
10/14/2005
35
6/29/2005
22
4/5/2005
24
1/14/2005
122
10/8/2004
39
7/30/2004
38
5/17/2004
0
12/29/2003
Size
0.63 0.63
p.3
Page 1
1 Residential
Until
YTD Cons
0
Variance
156%
-62%
2%
-26%
50%
-20%
14%
-30%
-73%
198%
22%
-16%
-74%
58%
125%
0%
0%
Town of North Andover of No oTa qti
Office of the Health Department �_'`^� <
0
Community Development and Services Division
27 Charles Street
North -Andover, Massachusetts 01845 9SSgCHUSE%
Heidi Griffin
Acting Public Health Director
Telephone (978) 688-9540
Fax (978)688-9542
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
December 24, 2003
This is to certify that
the individual subsurface disposal system
constructed ( ) repaired (X)
by
Richard Aversa
at
88 Haymeadow Road
North Andover, MA 01845
as 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.
Jonathan arkey
North Andover Board of Health
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
TOWN OF NORTH AN'DOV'ER SEWAGE DISPOSAL SYSTEAj
INSTALLATION CERTIFICATION
0
'I1,e undersigned hereby certify
( )repaired; I
deal the Sewage Dispos.11 SystP-w X'hl' eonsttucted;
by
located at— 88 -"la neadow Road
was installed ib coafor mance with the North Andover Beard Of Health approved plan,*
Systern Design Permit. #�K3-?plan dated 6 -16 - 0
of 440 aEIons j- 0 2 --- -- with a design flow
g per day. tle materrals used were in conformance '% ith those specified
on the approved plan; the system Was intellect in accordance with the provision, of 310
C?MZ 15.000. Title 5 and local regulations, and the final
the grading agrees substantially with
approved plan. All work is accurately represented on tete As -built whicb has been
submitted to the Board of Health,
'Please nate C.'ilan
o� a, �ep*�iG tank and pura chamber.- location as
Bscd�zas' ciox�aie:r1I(3- 1�n of 1�� mr 31..02;
--„_. ?ohn kin
Engmeeir Representative
Sinai inspection date: 10 �_?-02 John McQui:kin
Bngi nee, Representative
TnsK�ller= ``"r --
fir. x�eex 0000l w
Date:
4
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes
A. Bottom of Bed /
1. Excavation to proper depth bJ
2. With trenches, sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation, etc.
Comments:
B. Retaining Wali
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 90° 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. Inlgt 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 %" crushed stone under tank
14. Tank is watertight
Comments:
NO
E. Pump Chamber
1. If separate from tank, compact base with 6" of 3/<" 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:
Yes
V
V
_ z
F. Distribution Box
1.
D -box level
VL
2.
Minimum 0.1 T' (2") drop from inlet to outlet
3.
Minimum 6" sump
;/
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
S. Schedule 40 pipe
Comments:
G. Soil Absorption system
1. All stone double -washed -3/4" - 1 '/2" ✓
- pea stone
Bucket test done?
2. Minimum 2" of pea stone above distribution lines
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 <50 feet or specified
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6" per 100'
8. Depth of trenches below outlet invert minimum of 6".
lace
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
Yes NO
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: Grp CURRENT INSTALLER'S LICENSE# /53
LOCATION:
LICENSED INSTALLER
SIGNATURE: TELEPHONE# �j'�—J/�
'C
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
160.00 Fee Attached?
Project Manager Ob.
Foundation As -Built?
Floor Plans?
Administrative Use Only
Yes No
Yes f No
Yes No
Yes No
Approval Date:
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JM Associates
Civil Engineering Consultants T•.': - -,
324 Main St.
North Reading, MA 01864
oil
Tel: (978) 664-6668
r Ili• • � �
LETTER OF TRANSMITTAL.
RE: 88
A P MG14-&VV Rt�
WE ARE SENDING YOUAttached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ,^ ❑ Specifications
❑ Copy of letter El Change order I�-ppe- Test' am Sol, GVQl , TOrm�j
COPIES
DATE
NO.
DESCRIPTION
- ♦/.�1
®worm
_
"
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
W/For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
S I G N E D:?4CA 1j(_L4L�hAA;ili.
If enclosures are not as noted, kindly notify us at once.
FORM 11 - SOIL EVALUATOR lr O1t4l
Page 2 of 3
i
Location Address or, Lot No. @U ISA`( MEA06v\/
Oji -site Review
Deep Hole Number
Date:.. '8' �� Time:., /D DZ) A4
Location (identify on site plan)`F:....� Ni
Land Use... c51.DC_TIAL Slope f%) Surface Stones ..,
Vegetation ,.....L-.............
Landform SU)5Q1y►Slpr.1
Position on landscape (sketch on the back) ....... ....
Distances from:
Open Water Body . �0�!+ feet . Drainage way ../`�' feet
i Possible Wet Area J.QG,.—.,� feet Property Line 3�`} feet
Drinking.Water Well feet Other :.................... .............
DEEP OBSERVATION MOLE LOG*
Weather CLouDY eo
Depth from
Surface finches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
lMunselll
Soil
Mottling
Other
(Structure,•Stones, Boulders, Consistency, 96 '
Gravel)
5andy
)oYK 313 '
�Wti Ph �Q�+ru U�-a✓2
Loarn
- 3a
��
sandy
10Y9 51�
Loarn
t 0c) -r -C (a 4.1
Sawnd
n
Cgawelly
51
; I6` k 518
b8
C
�;►-)e
5Y 513'.
Loam
MINIMUMIGF-YRDI
ES"f�EaarAF6
A1"EVE'FiYPaa�;�f5
[5t8 L�Ca
qq
EA
Parent Material (geologic) �Gf-Gl al TI I` DepthtoBedrock: N/ti
N. 9 4
Depth to Groundwater. Standing Water In the Hole: Q ( > Weeping from Pit Face;
Estimated .Seasonal High Ground Water: 51 tr
i
DFiP APPROVED FORM - 12/07195
i
I ,
i
i
I ,
FORM 11 - SOIL EVALUATOR IrOlthl
i .. Page 2 of 3
Localion /Address or Lot No. 88 4Aqr�EAW\jv
Pit -site Review
Dee Hole NumberTP80 0
Deep --�—�—�� Date:.. S Time;.:i (�•4b: A" Weather CLCu'pY 80Q
Location (identify on site plant
Land Use ..YcS1QENt L- Slope (%) a Surface Stones .., NO
i Vegetation L A\Nt\j
Landform ..............
I Position on landscape (sketch on the back) f= t=`- 51.Z T C 1-1 '
Distances from:
Open Water Body,.I00� feet . Drainage ways+ feet
Possible Wet Area
i t
Imo--+, teat Property Lined ± feet
Drinking.Va/.ater Well feet Other :..........
DEEP OBSERVATION HO -LE LOGS
Depth from Soil Horizon Soil Texture Soil Col
Sur face (Inches( IUSOAt (Munsell)or Soil
Mottling (Structure, -Stones,
Consistency,
! Q_ y ^ F 1 r1G I OY R al l'
1
ne !M41
S
A� �NICavL.o✓t Gs 'T let, Ff
i LUQ VY1
i
L�u+ya.s� �Cb
� lea ve l��• '
iJ Sa ncl � � •
0 40
I0 x 518�
!
i
. i faIRIFAU vf�3F3�RaCE�iE�D-1rR^E/6/�C'f �EVI:RY�Fia1�8E15-[Tf�i�1(I.�CREA.
Parent Material (geologic)
—Oep th t
DepthloBedrock: A14
oGroundwaterann Water
In the Hole:
NON l' Weeping from Pit Face: (pp
Estimated -Seasonal High Ground Water:_ y0U
i
1 1
1 s
1)El' APPROVED FORM - 12/07/95
I
i
Ys'
�a yc�y MEA`bow T�oAO
Percolation Test
Date:�.y.-.....
Time: .......... g..`..... M
Observation Hole #
-a
Depth of Perc
'f
1`�
Start Pre-soak
End Pre-soak
S � 33
Time at 1 Z"
Time at 9"
q �3�
Time at 61'
X0:57
Time (9"-61
4a
QO min.
Rate Min./Inch
7
Site Suitability Assessment: Site Passed zslte Failed ❑
Additional Testing Needed:
Performed By: Sohn t�lCQu t�Ln
Witnessed By.:..... R add Am11 o
Comments: :50CkV e(A Dll - q - -CO
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Loc All 710:N: ' l
SOH \/vi N 4C -/C
-OL^ i ION
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TIMLEAT E"
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JM Associates
Civil Engineering Consultants
324 Main St.
North Reading, MA 01864
(978) 664-6668 Fax (978) 664-8155
SKETCH OF TEST PTT
LOCATION AT #88 HAYMEADOW ROAD
NORTH ANDOVER, MA.
MAY 8, 2000 AND SEPTEMBER 14, 2000
TP -Q TP
°P,
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APPKo x.
Don► t=ti^t_ t NC-�
-----------
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TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
27 CHARLES STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Sandra Starr
Public Health Director
January 28, 2002
Gabriel Sciolla
88 Haymeadow Road
North Andover, MA 01845
RE: 88 Haymeadow Road — letter of noncompliance
Dear Mr. Sciolla:
Telephone (978) 688-9540
FAX (978) 688-9542
It has come to my attention that the septic system at 88 Haymeadow Road in North
Andover has been failing to protect public health and the environment as defined in 310 CMR
15.303(a)(7) for close on to two years. Although soil tests and a site evaluation were carried out
by JM Associates in the year 2000, to date no plans have been submitted to the Board of Health
for review.
This LETTER OF NONCOMPLIANCE comes to inform you that your septic system is in
noncompliance with 310 CMR 15.000 and that you also are in violation of 310 CMR 15.000
under 15.024(5), and 15.022, and may soon be in violation of 15.305(1) if the system is not
repaired this spring. Please also be aware that you are in violation of 105 CMR 410.300 and
410.750(F) of the State Sanitary Code, Minimum Standards of Fitness for Human Habitation,
Chapter II, that the Board of Health may subsequently make a finding that your dwelling is unfit
for human habitation, and may condemn it and order you to vacate.
Please immediately contact your chosen engineering firm and request that they design a
Title 5 compliant septic system repair to submit to the Board of Health for approval so that you
can take appropriate action.
In addition to possible legal action, you are also subject to fines of not more than $500 per
day as long as the noncompliance continues. If you have any questions, please call the Health
office at 978-688-9540.
Sincerely,
Sandra Starr, R.S., C.H.O.
Public Health Director
Cc: JM Associates
H. Griffin
BOH
File
JM Associates r
Civil Engineering Consultants
324 Main Street
North Reading, MA 01864
Tel: (978) 664-6668
MELETTER OF TRANSMITTAL
TO Go. bre e
DATE O1 ^ / /O JOB NO.
ATTENTION
RE:
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
YAs requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED: n�j�z"5�
If enclosures are not as noted, kindly notify us at once.
SEPTIC PLAN SUBMITTAL FORM
LOCATION: 1` OE�o�19
-2�
NEW PLANS: YES $16 tan
REVISED PLANS: YES
SITE EVALUATION FORMS INCLUDED:
l
DATE: Z= t 2q' 71-
DESIGN ENGINEER:
$ 60.00/Plan
MIA
DATE TO CONSULTANT:
When the submission is all in place, route to the Health Secretary.
Project Request Record
Town of North Andover
Date:
Client Id: ToNA Card Id: ToNA Client/Company Name: Board of Health
Card; Type -Client.
Contact Name: Ms..Sandra,Starr
Phone:
978-688-9540
Title: Director
Fax:
978-688-9542-
I Address: 2T Charles Street
Email: sstarr@townofnorthandover.com,
Notes:
Town: North, Andover
State: MA Zip Code:. 01845
7.
1
Other contacts; if: applicable.; W -Eu ataller
c� 7 �—
r
Name:. ✓ .%/ /� S ���r�
Phone:
/
Title:Fax:
Address:
Email:
Notes:
Town:
State: Zip Code
Project:
Project Id: 1770 Project Title: Town of North Andover, Board of Health
(JOB NO) (PROJECT NAME & STREET ADDRESS)
Manager: NOW Billing Group: / Billing Cod : Fixed Fee,
Contract Info: Project Description for each.billing group
BG/ Applicant s3 "z�;-/ ✓/� C�-y'-pt-L,4
Assessors Man Lot Street1 Y6�� ✓ �- ���
Type, of service S
4
Officedorms/jbrqutona
NOONAN & Mc DOWELL, INC.
25 Bridge Street, Suite 6, Billerica, MA 01821-1023
Voice (978) 667-9736 Fax (978) 671-9565
Email: nmgnetway com
Date: March 1, 2002
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System
Plan Review, 1770/067
88 Haymeadow Road
Assessors Map _, Lot
Dear Members of the Board,
Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated November 14, 2000, by
JM Associates. It is our opinion that the proposed design will meet the requirements of Title 5 and the
North Andover Board of Health `By -Laws" if the following is addressed:
Add Abutters names. NA 8.02I
1,,-2) Identify limits of overdig on plan view. NA 8.02z
Z -,--I) Provide a locus plan. 220(4)t
4 Provide location of test pit 1.
r/5) Design perc rate is from perc 2 not 1. Please revise label.
Deep holes were witnessed by Ms. Starr, perc by Rotollo. Please revise.
Identify water line as either pressure or suction. 220(4)(m)
8) Provide length of pipes, size and slopes in profile 220(4)(o), NA 8.02c - S C!4 /e
4,_�9) Identify were on sill benchmark is located. 220(4)(q)
Identify the presence or not of the location of surface water supplies within 400 ft., public wells
within 250 ft. and private wells within 150 ft. 220(4)
o£ -I p 7
11) Identify wetlands within 150 ft. NA 8.02r =
c_12) Provide a note to ensure proper compaction for proposed septic tank in area of old system.
L,, --'f3) Provide a note stating all connections are to have water tight joints.
Land Surveyors Civil Engineers Environmental Planners
---1-4) Detail on plan for septic tank does not comply with Title V Requirements. Revise accordingly.
�5) Provide buoyancy calcs for septic tank. 221(8)
X16) Specify compact soil and 6 in. of 3/4 "stone under septic tank".
L,--17) Specify compact soil and 6 in. of % "stone under D -Box".
,l 8) Specify compact soil and 6 in. of % "stone under pump chamber.
t --N) Provide buoyancy calc's for pump chamber.
✓l0) Top of septic tank and pump chamber shall be at or less than 36" below grade.
21) Provide system head and pump head curves.
Please note that alarm is to be on a separate circuit from pump. 231(9)
V23) Please note that a manual operating switch shall be installed. NA 12.01
,__-24) Lowest bottom of bed elevation is based on highest ground elevation. This results in a 156.67
ground water level.
25) Check breakout grade 15 ft. around leaching system. 255(2)
26) Extend leaching pipes to end of crushed stone.
27) 10 ft. minimum separation between adjacent leach fields. 252(2)0
0 --
---Revise vent detail to show an elbow up at end of lines to prevent back flow.
L---29) Provide one vent per leaching field.
c-30) Provide assessors map and lot number.
Respectfully,
John L. Noonan, P.L.S.-P.E.
G:offce/boh/1770067
Land Surveyors Civil Engineers Environmental Planners
2
14) Detail on plan for septic tank does not comply with Title V Requirements. Revise accordingly.
15) Provide buoyancy calcs for septic tank. 221(8)
16) Specify compact soil and 6 in. of 3/0 "stone under septic tank".
17) Specify compact soil and 6 in. of 1/4 "stone under D -Box".
18) Specify compact soil and 6 in. of % "stone under pump chamber.
19) Provide buoyancy calc's for pump chamber.
20) Top of septic tank and pump chamber shall be at or less than 36" below grade.
21) Provide system head and pump head curves.
22) Please note that alarm is to be on a separate circuit from pump. 231(9)
23) Please note that a manual operating switch shall be installed. NA 12.01
24) Lowest bottom of bed elevation is based on highest ground elevation. This results in a 156.67
ground water level.
25) Check breakout grade 15 ft. around leaching system. 255(2)
26) Extend leaching pipes to end of crushed stone.
27) 10 ft. minimum separation between adjacent leach fields. 252(2)(f)
28) Revise vent detail to show an elbow up at end of lines to prevent back now.
29) Provide one vent per leaching field.
30) Provide assessors map and lot number.
Respectfully,
John L. Noonan, P.L.S.-P.E.
G: office/boh/ 1770067
Land Surveyors Civil Engineers Environmental Planners
2
1-21-1996 3.22PM FROM
JM Associates
Civil Engineering Consultants
324 Main $t.
North Reading, MA 01864
(978) 664-6668 fax (978) 664-8155
March 27, 2002
Town. of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Ma. 01845
Attn: Sandy Starr
Re: 88 Hayrneadow Road
Dear Sandy:
In reference to your fax of March 12, 2002 regarding the comments of the
reviewing engineer, we would like clarification of the following,
Comment #5" Clarification Needed
"Design perc rate is from Perc 2 Only one percolation test was t4en. It was
not 1. Please. revise label." labeled Perc #1 in our log. I am unclear why it
should be changed to Perc #2.
Comment #24
"Lowest bottom of bed elevation
is based on highest ground
elevation. This results in a
156..67 ground water level-"
Comment #27
"1 Oft. minimum separation
between adjacent leach fields.
252(2)(f)"
The highest recorded water table is elevation
155.67: It is our intent to ruinirnlize the impact
the raised system will have on the use of the
homeowners yard. Are you requiring the system
to be raised one foot?
I designed the field as one L-shaped field
distributing from one distribution box. Separating
the field into three separate beds will further
disrupt the homeowners yard closer to the house
and the wooded area of the Iot. Are you requiring
the field to be designed as separate fields?
P. 2
1-21-1996 3.22PM FROM P.3
We would appreciate your clarification as soon as possible.
Thank you for your attention.
Very truly yours,
JM: ASSOCIATES
r 44., X --k
V
John F. McQuilkin P.E.
cc: Gabriel Sciolla
1-21-1996 3.21PM FROM P.1
JM Associates
Civil Engineering Consultants
324 Main St.
North Reading, MA 01864
(978) 664.6668 Fax (978) 664.8155
Date: --?. -i_-) . o i
TO: 5��.�y s�AQ9
Fax No: 97 er - C "fj� 9s vz
Time: A.M. 0 Y.M. Q
From:
Fax No:
Telephone No. ( ) Telephone No. ( )
Number of Pages
Including Cover Sheet- Yes 0 No E
IZeroiark.s:
JM Associates - - -
Civil Engineering Consultants Li!'RD OF
324 Main St.
North Reading, MA 01864 r�
(978) 664-6668 Fax (978) 664-8155 JUL 17 2002
July 12, 2002
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Ma. 01845
Attn: Sandy Starr
Re: 88 Haymeadow Road
Dear Sandy:
On May 2, 2002 we transmitted to your office revised plans (dated April 4, 2002)
for the septic system repair for the dwelling at 988 Haymeadow Road. These plans
incorporated the comments of Noonan and McDowell dated May 1, 2002.
According to that Noonan and McDowell comment letter "the proposed design will
meet the requirements of Title 5 and the North Andover Board of Health by-laws if the
following is addressed. "The letter goes on to list seven (7) comments. Thus it was my
understanding that the design had been approved. However, per our phone conversation
today, you have further comments regarding this design.
I would appreciate your sending us you're comments in writing as soon as possible
so we may address them and proceed to construction.
Very truly yours,
JM ASSOCIATES
/fu�
John F. McQuilkin, P.E.
cc: Gabriel Sciolla
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
27 CHARLES STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Sandra Starr
Public Health Director
July 15, 2002
Jack McQuilkin
JM Associates
324 Main Street
North Reading, MA 01864
Re: 88 Haymeadow Road
Dear Mr. McQuilkin:
pORTN
OF w•�•e � '�h
f . A
� °wwno �•• 4h
1SSACMU`��t
Telephone (978) 688-9540
FAX (978) 688-9542
This letter comes pursuant to our recent telephone discussion concerning the proposed
plans for the repair of the septic system at 88 Haymeadow Road in North Andover. As we
discussed, the following items must be addressed before the plans may be approved:
1. The fee of $ 60.00 for the second review has not yet been received.
2. The profile is not to scale as required by 310 CMR 15.220(4)(o) and NA 8.02c.
3. After discussion with DEP, the leach areas may be considered as one leach field.
4. The LUA form has not been submitted.
5. Please add to the plan a note stating that a variance was granted to 310 CMR
15.405 allowing a three- foot separation to groundwater. (This will be verified
once the LUA form has been reviewed by the Health Department.)
For future reference, please be aware that the company that provides technical review for
plans and other Title 5 services does not have the authority to approve or reject any proposed
septic plan. Only the Board of Health and/or the Health Department have that authority. Also, all
plan re -submittals have an attendant fee attached to them. Generally if there is no payment
included with the re -submitted plans, it is considered an incomplete submittal and receives no
attention until complete.
Please call me at 978-688-9540 if you have any questions.
Sincerely,
Sandra Starr, R.S., C.H.O.
Health Director
Cc: Homeowner
File
Town of North Andover, Massachusetts Form No. s
o� N°RTh, BOARD OF HEALTH
F w
. F
DESIGN APPROVAL FOR
C"V� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant_ /�.L—f�,L�d CC_� Test No.
Site Location d 0
Reference Plans and Specs.
GI DESIGN DATE
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
Site System Permit No. %
Massaphusetts Department of Environmental Protection
Bureau of Resource Protection - Wastewater Management Program
Form 9A - Application for Local Upgrade Approval
IL Required by 310 CMR 15.403(1)
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
� I
Form 9Ai is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1); is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacityof a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information F _ ,
1. Facility Name an ss �'7
Gabriel Scioll fi
88 Ha meado
Street Address
North Andover
City
Ma 01845
--- -State --------------- Zip Code -
2. Owner Name and Address:
same as above
Nam* Street Address
City..----- ---------------- State ---._._—.
978-687-_2649_
Zip-+---------- --------------- Telephone Number
3. Type of Facility (check all that apply):
❑ Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Existinq4 bedroom dwelling— -----------._ --
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) Z Conventional ❑ Other (describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
leachfield
Sciollaga.doc • rev. 5102 Application for Local Upgrade Approval, Page t of 4
Mas*44husetts Department of Environmental Praftetion
®urea of Resoume Protection - Wastewater Management Program
ForM 9A - Application for Local Upgrade Approval
RequW by 310 CMIR 15.401(1)
A. lithInformation(continued)
'r, Design Flow per 310 CMR 15,203:
Design flow of existing syslatn:
DoOtSm flow of proposed upgraded system
-flow of facility
Upgrade of System
"0
gpd
440
90
440
upgrade is (check. one):
1 oluntsry Q Required by order, letter, etc. (attach copy)
R*uired following inspection pursuant to 310 CMR 15-301:
-
date Of inspeclion
2. Desqribe the proposed upgrade to" system
Rebate system to -rear rLard_ Provide 1350 VA leaching area.
I L"N Upgrade Approval is requested for:
0 Oteduction in setback(s) - describe reductions.
0 Percolation rate for 30 to W min.linch.-
C1 OteductIon in SAS or" of up to 2596:
0 itteduction in separation between the SAS and high groundwater:
$eparation reduction
Percolation rate
26.7
loopth to groundwater
3.34
0 Otelocation of water supply well (explain):
ScioNaGe doe - rev. UO2 APPICation for LW -49 Upgrade Apwovaje Page 2 of 4
—' Massachusetts Department of Environmental Protection
j Bureaui of Resource Protection — Wastewater Management Program
I
Form 9A - Application for Local Upgrade Approval
- _
Requitied by 310 CMR 15.403(1)
❑ other requirements of 310 CMR 15.000 that cannot be met — describe and specify sections of the
Pode:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorptipn system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groOndwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member
or aged of the local approving/ authority.
Hig4 groundwater evaluation determined by:
Sanidy Starr 5/8/2000
Eval4ator's Name (type or print) Signature Date of evaluation
C. Eiplanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
con1pleted)
1. An 4P9raded system in full compliance with 310 CMR 15.000 is not feasible:
Addling an additional foot of sand would add to the cost of a system which is already very expensive
and would also create grading problems along the boundary lines.
2. An i0iternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
An Iternatives ststem would still require a waiver to ground water and create2rading problems.
3. A Oared system is not feasible:
Nohare�Lstemavail_able -- -- --------------- -------- --- ---
4. CoMnection to a public sewer is not feasible:
No sewer available.
Scioila9a.doc • rev. W2 Application for Local Upgrade Approvai• Page 3 of 4
Massa#huaetta Department of Environmental Protection
Bureau! of Resource Protection — Wastewater Management Program
Forn) SA o Application for Local Upgrade Approval
- Requirod by 310 CARR 15.403(1)
The;4priate
pplication for Local Upgrade Approval must be accompanied by all of the following (check the
app boxes):
❑ A.pplication for Disposal System Construction Permit
® �omplete plans and specifications
❑ �ite evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR -15.405(2).
[] Qther (List):
Da Ceftification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imorisocd nent4er-de4bamlle violations."
Owner's Signature
,I Sciolla
Print
JM 4kssociates
NamO of Preparer
324I.Main _Street
Prerer's address ---------------------------._ --
Ma.;01_864
Stat�fZlP ---- -------------------
7/15/02
Date
7/15/02
[late
North Readip_q --
City/Town
978-664-6668
Telephone
NOTE: 310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade
approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of
Resourde Protection, Division of Watershed Management, upon issuance by the local approving
authorio and before commencement of construction.
Sciollaga.doc • rev. 5102 Application for Local Upgrade Approval* Page 4 of 4
!' JM Associates
Civil Engineering Consultants
324 Main St.
North Reading, MA 01864
(978) 664-6668 Fax (978) 664-8155
Buoyancy Calculation for 1500 gal Septic tank
Buoyant Force
length
10.5 X
SG=62.4 Ibm/c.f.
width height volume
5.67 X 5.67 = 337.56
Buoyant Force
62.4 X 337.56 = 21063.96 Ib
(SG x volume = force upward)
Restraining Force
Weight of Unit
E.F. Shea
Weight of soil above
length width
10.5 A 5.67
Summary
SG=110 Ibm/c.f.
Restraining Force
13,135 Ib
height volume
X 3 178.61
Restraining Force
110 K 178.61 = 19646.55 Ib
(SG x volume = force downward)
Bouyant force 21,063.96
Restraining Force (13,135.00)
Restraining Force (19.646.55)
(11,717.59) therefore NOT BUOYANT
s:\ mIformulas\buoyancycalc-1500
JM Associates
Civil Engineering Consultants
324 Main St.
North Reading, MA 01864
(978) 664-6668 Fax (978) 664-8155
Buoyancy Calculation for 1000 gal Pump Chamber
Buoyant Force
length width height volume
9.67 X 5 X 5.83 = 281.88
SG=62.4 Ibm/c.f.
Buoyant Force
62.4 A 281.88 s 17589.34 Ib
(SG x volume = force upward)
Restraining Force
Weight of Unit
E.F. Shea 6" top
Weight of soil above
length width
9.67 x 5
Summary
SG=110 Ibm/c.f.
Restraining Force
14,825 Ib
height volume
K 3 145.05
Restraining Force
110 R 145.05 = 15955.5 Ib
(SG x volume = force downward)
Bouyant force 17,589.34
Restraining Force (14,825.00)
Restraining Force (15.955.50)
(13,191.16) therefore NOT BUOYANT
s:\jm\formulas\buoyancycalc-1000
BARNES 3SE.
SUBMERSIBLE NON -CLOG PUMPS
2" Spherical Solids Handling
Series: 3SE 0.5, 0.75 & 1.0HP
1750 RPM
(CSA Standard on 1 Ph, OPTIONAL on 3Ph)
CH 1k) Canadian Standards Association
File No. LR16567
UL Underwriters Laboratories Inc.
File No. E142177
Description:
SUBMERSIBLE NON -CLOG SEWAGE
PUMP DESIGNED FOR TYPICAL RAW
SEWAGE APPLICATIONS.
Sample Specifications: Section 1 Page 5.
CRANE®
PUMPS $SYSTEMS
A Crane Co. Company
Y
Bames Pumps, Inc
Distributor Sales & Service Dept.
DATE
420 Third Street/P.O. Box 603
REPLACES
Piqua, Ohio 45356-0603
SEAL PLATE:
Ph: (937) 615-3595
IMPELLER: Design:
Fax: (937) 773-7157
Specifications:
SECTION
1B
PAGE
28
DATE
2/97
REPLACES
6/96
DISCHARGE:
3 " (76mm) NPT, Vertical.
LIQUID TEMPERATURE:
104°F (40°C) Continuous.
VOLUTE:
Cast Iron, ASTM A-48 Class 30.
MOTOR HOUSING:
Cast Iron ASTM A-48, Class 30.
SEAL PLATE:
Cast Iron ASTM A-48 Class 30.
IMPELLER: Design:
2 Vane, Open, With Pump Out
Vanes On Back Side. Dynamically
Balanced. ISO G6.3.
Material:
Cast Iron ASTM A-48 Class 30.
SHAFT:
416 Stainless Steel
SQUARE RINGS:
Buna-N
HARDWARE:
300 Series Stainless Steel
PAINT:
Air Dry Enamel.
SEAL: Design:
Single Mechanical, Oil Filled Reservoir.
Material:
Rotating Face - Carbon
Stationary Face - Ceramic
Elastomer - Buna-N
Hardware - 300 Series Stainless
CABLE ENTRY:
15 ft. (4.6M) Cord (Plug On 115 Volt),
Pressure Grommet For Sealing And
Strain Relief.
SPEED:
1750 RPM (Nominal).
UPPER BEARING:
Design:
Sleeve
Lubrication:
Oil
Load:
Radial
LOWER BEARING:
Design:
Single Row, Ball
Lubrication:
Oil
Load:
Radial & Thrust
MOTOR: Design:
NEMA L -Single Phase, NEMA B -Three
Phase Torque Curve. Completely
Oil -Filled, Squirrel Cage Induction.
Insulation:
Class A.
SINGLE PHASE:
Permanent Split Capacitor (PSC).
Includes Overload Protection In
Motor.
THREE PHASE:
Tri Voltage 200-230/460;
Requires Overload Protection to be
Included In Control Panel.
OPTIONAL EQUIPMENT:
Seal Material, Impeller Trims, N/C
Temperature Sensor with cable for
3 phase pumps, Additional Cable,
CSA Listed on 3 phase pumps.
Barnes Pumps, Inc.
Bid -To -Spec & Project Sales
1485 Lexington Ave.
Mansfield, Ohio 44907-2674
Ph: (419) 774-1511
Fax: (419) 774-1530
Barnes Pumps Canada, Inc.
83 West Drive
Bramalea, Ontario
Canada L6T 2.16
Ph: (905) 457-6223
Fax: (905) 457-2650
MEMBER
SECTION
16
PAGE
29
DATE
2/97
REPLACES
6/96
13.25 Inches
(337) (mm)
6.25 2.06
(159) (52)
BAIL Pt s, NYC. 4.88
1 (124)
3"(76) I 1
NPT DISCH. - - 9.75
19.00 (248)
(483)
i
9.00
(229)
MODEL PART HP VOLT PH RPM NEMA FULL LOCKED CORD CORD CORD
NO. NO. (NOM) START LOAD ROTOR SIZE TYPE O.D.
CODE AMPS AMPS
3SE514L 086051 0.50 115 1 1750 A 11.6 18.4 14/3 SJTOW-A 0.390
3SE524L 086052 0.50 230 1 1750 A 5.8 10.5 14/3 SJTOW-A 0.390
3SE594L 086053 0.50 200-230 3 1750 AB 3.9/3.4 6.8/7.8 14/4 SO 0.600
3SE544L 086054 0.50 460 3 1750 8 1.7 3.9 14/4 SO 0.600
3SE554L 089286 0.50 575 3 1750 B 1.3 3.1 14/4 SO 0.600
3SE724L 085519 0.75 230 1 1750 A 8.9 17.5 14/3 SJTOW-A 0.390
3SE794L 085521 0.75 200-230 3 1750 B/E 5.1/4.4 13.9/16 14/4 SO 0.600
3SE744L 085522 0.75 460 3 1750 E 2.2 8.0 14/4 SO 0.600
3SE754L 089287 0.75 575 3 1750 E 1.7 6.4 14/4 SO 0.600
3SE1024L 085523 1.0 230 1 1750 A 10.9 17.5 14/3 SJTOW-A 0.390
3SE1094L 085525 1.0 200-230 3 1750 AB 6.8/6.0 13.9/16 14/4 SO 0.600
3SE1044L 085526 1.0 460 3 1750 B 3.0 8.0 14/4 SO 0.600
3SE1054L 089288 1.0 575 3 1750 B 2.4 6.4 14/4 SO 0.600
Standard Units:
(Optional Temperature sensor cable for 3 phase models is 14/2 SO, 0.530 OD.)
CSA Listed Units:
(Optional - CSA Listed Power Cable for 3 Phase Models is 14/4 SOW, 0.600 O.D.)
(Optional - CSA Listed Temperature sensor cable for 3 phase models is 14/2 SOW, 0.530 OD.)
IMPORTANT I
1.) PUMP MAY BE OPERATED "DRY" FOR EXTENDED PERIODS WITHOUT DAMAGE TO MOTOR AND/OR SEALS.
2.) THIS PUMP IS APPROPRIATE FOR THOSE APPLICATIONS SPECIFIED AS CLASS I DIVISION II HAZARDOUS LOCATIONS.
3.) THIS PUMP IS NOT APPROPRIATE FOR THOSE APPLICATIONS SPECIFIED AS CLASS I DIVISION I HAZARDOUS LOCATIONS.
4.) INSTALLATIONS SUCH AS DECORATIVE FOUNTAINS OR WATER FEATURES PROVIDED FOR VISUAL ENJOYMENT MUST BE INSTALLED IN
ACCORDANCE WITH THE NATIONAL ELECTRIC CODE ANSI/NFPA 70 AND/OR THE AUTHORITY HAVING JURISDICTION. THIS PUMP IS NOT
INTENDED FOR USE IN SWIMMING POOLS, RECREATIONAL WATER PARKS, OR INSTALLATIONS IN WHICH HUMAN CONTACT WITH PUMPED
MEDIA IS A COMMON OCCURRENCE.
CRANE®
A Crane Co. Company
PUMPS & SYSTEMS
Bames Pumps, Inc
Distributor Sales & Service Dept.
420 Third Street/P.O. Box 603
Piqua, Ohio 45356-0603
Ph: (937) 615-3595
Fax: (937) 773-7157
Bames Pumps, Inc.
Bid -To -Spec & Project Sales
1485 Lexington Ave.
Mansfield, Ohio 44907-2674
Ph: (419) 774-1511
Fax: (419) 774-1530
Bames Pumps Canada, Inc.
83 West Drive
Bramalea, Ontario
Canada L6T 2.16
Ph: (905) 457-6223
Fax: (905) 457-2650
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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH /1'�i// /1
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APPLICATION FOR SITE TESTING/ INSPECTION
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Applicant
Site Locat
Engineer
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Test/I nspection Date and Time
CHAIRMAN, BOARD OF HEALTH
Fee" Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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DATE: `'d - '-A- G
t-KUrd H;UGtF' I t/-UVUtIKSUIV I SJu u L 0011 I t5
BOARD OF HEALTH
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NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
MAP & PARCEL: -�' 8 e 1-4 y w- — () a w Q '3'
LOCATION OF SOIL TESTS: j.7 ✓� , T c rJ .f C k
OWNER: G A -3 e . L SC , o C. (- a TEL. NO.: (. 8 "1 - Z r- 't °I
ADDRESS: Pr 8 e 1`1 y-- �3° `"r a 0
ENGINEER: J t"x A r s a c„ T 'r TEL. NO.: S- 6 r- 4- r- 6 C 8
CERTIFIED SOIL EVALUATOR: ..i o i./ VV ` Cv ' 4- Az -
Intended
Intended Use of Land: Residential Subdivision in le Family Home Commercial
Is This:
Repair Testing: t/ Undeveloped lot testing:
In Lake Cochichewick Watershed? Yes - No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. Fee of $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 upgrade.
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 fortes shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval: ( 5
Date Received:
Check Amount:
Check Date:
Id -13-200 9:27AM FROM ROBERT E ANDERSON 1508 GSA 8155 P.3
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