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HomeMy WebLinkAboutMiscellaneous - 9 TURTLE LANE 4/30/2018I S� Commonwealth of Massachusetts Map -Block -Lot 106.B0104 BOARD OF HEALTH ----------------------- Permit No North Andover - BHP -2017-11 - 08 - - --------------- ---- FEE $350.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James Kellett ---------------------------------------------------------------------------------------------------------------- to (Construct) an Individual Sewage Disposal System. at No 9 TURTLE LANE ---------------------------------------------------------------------------------------------------------- ---------------- ------ ----- as shown on the application for Disposal Works Construction Permit No. BHP -2017- d Pdov 2017 Issued On: Nov -28-2017 -------------------- ------------------------------------------- BOARD OF HEALTH �1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILS ,eaan Application for Septic Disposal System Construction Permit —TOWN OF NORTH ANDOVER, MA 01845 Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? _ A. Facility Information 9 '�urL�� (ANe. Address or Lot # o2.-tf ky d a o e.2-. City/Town NOV, ?il 2-0I`7 TODAY'S DATE $350.00 - Full Repair $175.00 - Component 2.- *TYPE OF SEPTIC SYSTEM*: ➢ Pump ❑ Gravity (choose one) ***If pum s stem, attach copy of electrical permit to application*** ➢ 2Conventional 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) -->-- Pressure- Dosed,_(D-Box-Present)-S-.A:S-.S.----_—_-- ➢ IL the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) Wlb2t is the Make? What is the Model. 2. Owner Information Name 01 Tu y L A 6- U41t-L- Address (if different from above) M, A&dave,n- "A Ul�yS City/Town State Zip Code 97&'- 5 -02 - Email address Telephone Number 3. Installer Information Name Name of Company 400 SA" sq Address City own State Zip Code Telephone Number (Cell Phone # ifpossible please) 4. Designer Information r C/C C� Aaot —B", C. Name Name of Company 15-7 i34,v >= J=- 5-77 Address JAS N11 03 0 7 City/Town State Zip Code 77k- 1135-- 1.32 `-/ Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Application for Septic Disposal System %flay - 2_1 I Z;&)71 Construction Permit — TOWN OF TODAY'S DATE NORTH ANDOVER MA 01845 $ -Full Repair , $1775.5.00 00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type ofBuilding: esidential Dwelling or ❑Commercial B. Agreement 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, 11 a e Local Subsurface Disposal Regula ions for the Town of orth Andover. 1 underst t until a final Certificate of Complia a has been issued by t "s Board of Healt/r', the stalle tem is not approved. V Date �A o By: (,Ward of Health Representative) Date n Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes/ No 2. Project Manager Obligation Form Attached. Yes v No 3. Pump System? Ifso, Attach copy ofElectrical Permit Yes No AppAcant-received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approvalletter, all paperwork received. Yes v No missing,— 5. Foundation As -Built? (new construction only): Yes No (Same scale as approved plan) G. Floot Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 81 4 Town of North Andover %;'• �' HEALTH DEPARTMENT ,SSACNU`+tt CHECK #:3,2,o(. DATE: LOCATION: _ 9 /uri �e zzn r -- H/O NAME: L�Ji���/� "l'y`�.2, CONTRACTOR NAME:Oa-me,,-7 AelleH 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 $ SEPTIC Sustems: ❑ Septic - Soil Testing $ �❑j Septic - Design Approval $ L� Septic Disposal Works Construction (DWC) 0 ` ,❑` Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ HMft&Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER `� �• Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street RECEIVED NORTH ANDOVER, MASSACHUSETTS 01845 AUG 16 2017978.688.9540 — Phone i< 978.688.9542 — FAX TOWN OF NORTH ANDD healthdept@northandoverma.gov HEALTH DEPARTMENT www.northandovenna.gov APPLICATION FOR SOIL TESTS DATE: 8-14-17 MAP & PARCEL: Map 106B -104 LOCATION OF SOIL TESTS: 9 Turtle Lane OWNER: William Durfee Contact #: 978-502-4920 APPLICANT: same Contact #: ADDRESS: 9 Turtle Lane, North Andover, MA 01845 ENGINEER: Ben Osgood, Jr. Contact #: 978-435-1324 CERTIFIED SOIL EVALUATOR: Ben Osgood, Jr. Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Yes Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No X ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x.11"Plot plan & Location of Testiue (please hidicate test nit sites on the plait) ➢ Fee of $585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of4$ 40.00 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: 1h 4 / Z b f 4 Signature of Conservation Date back to Health Department!(statnp in): ✓`o�osu..( will r'e�'uist`C Co�s�,�va`F-tr1-�1-�Q`�.e�t�-�ek� ��tl��. Z 1 x� T....... ..i AI.. ..A.L. A—.1—.- SAA 1 WVVII VI IVVi ILII P'U I%AVv�.I. 1-1l1 9 Turtle Lane, North Andover d f .8-0080) Property Information Property 106.6-01040000.0 ID Location 9 TURTLE LANE Owner DURFEE, WILLIAM M V\ 106.13-0057 C TCs 106.8-0104 106.8-0058 / 106. A� MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied, concerning the validity or accuracy of the GIS data presented on this map. I 1106.B-0103 n MUYUJL 1'+, LVl/ 106.8-0102 0 1"=87ft I N. 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U>, >N W o Mn c O L g m O o d w 3 m a) Eco N C W N O Z = N 0 _ L �m 0 c a> 0 LM a U Q E 0 w ODS N z Z$ 00 O r - N m m a m N O CL N 6 to 3 m as O L O f+ E CD N � a N > Q O ♦, Z 36 r o C E O E E ';s— o o� O U U LL co 0 co a) rn m a 0 Q 0 O Z ai c m J (D 7 F- 0) 0 LL Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 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 William Durfee key to move your Owner Name cursor - do not 9 Turtle Lane key. Street Address or Lot # North Andover Ma 01845 City/Town State Zip Code Contact Person (if different from Owner) Telephone Number B. Test Results ^ / ^ A- ^. All Board of Health Witness Comments: t5form12.doc• 08/15 Perc Test • Page 1 of 1 Date Time Date Time Observation Hole # TP 1 Depth of Perc 24"/20" Start Pre -Soak 9.49 End Pre -Soak 10:05 Time at 12" 10:05 Time at 9" 10:14 Time at 6" 10:26 Time (9"-6") 12min Rate (Min./Inch) 4 mpi Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benjamin C. Osgood, Jr. Test Performed By: Isaac Rowe, North Andover Board of Health representative Board of Health Witness Comments: t5form12.doc• 08/15 Perc Test • Page 1 of 1 6n soleO dwnd 6u!soa L60Z/66/06 gjdad wjely. 00'06 05"06 gjdad dwns ' '.40 dwnd ♦ 05'06 Z6"06 60' 66 ®`up dwnd ♦ `up 00'66 wieib 4lp!M Od ap!sul 75 05" 66 u;6ua-1 Od ap!sul 0076 ui Panul dwnd 00176 0576 00'£6 05"£6 00" 6 `ul IPanul ♦ 001,6 OS"76 SU0148AD13 awnlon 868Jo}S A3u86J9w3 ZZL gjdaa 96eJOIS Aoua6J9w3 g£ oBejo4s A3ua6jaw3 ABG gad sasoa 7'7 azls asod plaid 00 6 Mold AI1ed 077 lea gad sasoa azls asod plaid 006 awnlon � oee u!ejd 7 azls asod le;ol 706 g gjda(] 6u!lejadp dwnd g suol;elnolea 6ulsoa awnlon � oea ulejd 7 ownloq )loee uleia gjdad wjely. Z yt6ua-j ulevy aojod OZ gjdad dwns ' 6 -el(] uleW aoiod Z joo13 dwnd 01 uI }Panul 6q Aea gad s9SOG 7 4lp!M Od ap!sul 75 (4dJ) Mold AI1eQ 077 u;6ua-1 Od ap!sul gg ui Panul dwnd 00176 :Aq p.Ngo 008 :Aq ppleO VW `Janopud yluou `eue-i a1:pn16 :sa3oN Od 10/19/2017 Pump to D -Box Pump Calcs v1 9 Turtle Lane, north Andover, MA Calc'd by: BCO Chk'd by: Total Dynamic Head = Static Head + Friction Head Static Head: (D -Box Inlet) - (Pump Off Elev.) = 97.25 - 90.50 = 6.75 Friction Head = (Total Equivalent Pipe Length) PC Notes: x (Friction Head/100' of pipe) (131.1) 1 90* Elbows each @ 5.2 = 5.2 Pump Off Elev. 90.50 0 45o Elbows each @ 2.8 = 0 n D -Box Inlet Elev. 97.25 1 Check Valve each @ 17.2 = 17.2 s Force Main Length 20, 1 Gate Valve each @ 1.4 = 1.4 i Equivalent Pipe Length = 23.8 d Select Pipe Diameter 12 `! +Actual Pipe Length = 6 e Equivalent Pipe Length Inside Pump = 29.8 Select Pipe Material Plastic W 1 90° Elbows each @ 5.2 = 5.2 O 2 450 Elbows each @ 2.8 = 5.6 u 0 Check Valve each @ 17.2 = 0 t 0 Gate Valve each @ 1.4 = 0 s Equivalent Pipe Length = 10.8 i + Actual Pipe Length = 20.0 d Equivalent Pipe Length Outside Pump = 30.8 e Total Equivalent Pipe Length = 60.6 Total Equivalent Pipe Length 60.6 Friction Head 0.5333 x Friction Head per 100' of Pipe 0.88 Static Head 6.75 Total Dynamic Head 7.28 @. 20 .GPM Total Equivalent Pipe Length 60.6 Friction Head 1.8907 x Friction Head per 100' of Pipe 3.12 Static Head 6.75 Total Dynamic Head 8.64 @. 40 . GPM Total Equivalent Pipe Length 60.6 Friction Head 3.939 x Friction Head per 100' of Pipe 6.5 Static Head 6.75 Total Dynamic Head 10.69 @ 60 , GPM Total Equivalent Pipe Length 60.6 Friction Head 6.7266 x Friction Head per 100' of Pipe 11.1 Static Head 6.75 Total Dynamic Head 13.48 @ 80 , GPM Total Equivalent Pipe Length 60.6 Friction Head 10.181 x Friction Head per 100' of Pipe 16.8 Static Head 6.75 Total Dynamic Head 16.93 @ 100 GPM 10/19/2017 Pump to D -Box Pump Calcs v1 9 Turtle Lane, north Andover, MA Calc'd by: BCO Chk'd by: Septic Tank: M 1500 Cover over tank (ft.). 0.8'. Ground water Elev. 92.62 Tank Inlet Elev. 94.30 Weight of Tank and Soil 11035 5417 16452 Weight of Water 11140 Buoyancy OK Pump Chamber: 1000 H Cover over tank (ft.), -0.8 Ground water Elev. 92.62 Pump Inlet Elev. 94.00 Weight of Tank 11035 Length Width Cover 10.8 5.7 0_8 Weight of Soil 5417 Groundwater Elev. 92.62 Bottom of Tank Elev. 89.72 Length Width Water 10.8 5.7 2.9 Weight of Water 11140 Weight of Tank and Soil 11035 5417 16452 Weight of Water 11140 Buoyancy OK Pump Chamber: 1000 H Cover over tank (ft.), -0.8 Ground water Elev. 92.62 Pump Inlet Elev. 94.00 Weight of Tank and Soil 9785 3661 13446 Weight of Water 8307 Buoyancy OK 10/19/2017 Buoyancy Pump Calcs v1 Weight of Tank 9785 Length Width Cover 8.0 5.2 0_8 Weight of Soil 3661 Groundwater Elev. 92.62 Bottom of Tank Elev. 89.42 Length Width Water 8.0 5.2 3.2 Weight of Water 8307 Weight of Tank and Soil 9785 3661 13446 Weight of Water 8307 Buoyancy OK 10/19/2017 Buoyancy Pump Calcs v1 Job Address ,9 Turtle Lane, north Andover, MA Calc'd by: BCO ESHGW @ tank 92.62 ESHGW @ pump 92.62 Se_ lect Tank Tank Inlet 94.30 ___ M jsoo Tank Outlet 94.05 - - 3 inch walls; (132.3) Select Pump Chamber Pump Inlet 94.00 1000 H Pump Outlet 93.75 D Box Inlet 97.25' ESHGW @ tank 92.62 ESHGW @ pump 92.62 Gf NORT `,� 79b5 0 s R r Town of North Andover ,S ::,' HEALTH DEPARTMENT SACHUSE CHECK #: 785 DATE: LOCATION: Tv/' 114P_ H/O NAME: CONTRACTOR NAME: 05 oocC 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 $ SESystemsSeptic xx - Soil Testing $ yyd❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Hea `gent Initials White - Applicant Yellow - Health Pink - Treasurer November 22, 2017 William Durfree 9 Turtle Lane North Andover, MA 01845 North Andover Health Department (ommunity and Economic Development Division Re: Subsurface Sewage Disposal System Plan for 9 Turtle Lane (Map 1068, Lot 104) Dear Mr. Durfree: The proposed wastewater system design plan for the above site dated October 16, 2017 with a final revision date of November 6, 2017 and received on November 6, 2017 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a Four (4) bedroom home with a maximum of Nine (9) total rooms utilizing a pump chamber and leaching field system. This design plan approval is valid until November 22, 2020. 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. In the event an imminent health problem, such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. 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)) 2. 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, Page 1 of 2 North Andover Health Department 120 Main Street North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 9 Turtle Lane November 22, 2017 Zoning Board, Planning Board, Building Inspector, Plumbing Inspector 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. 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, rian. LaGrasse, CEHT Director of Public Health Encl. Installers list cc: Benjamin C. Osgood, Jr., PE, 157 Bluff Street, Salem, NH 03079 Page 2 of 2 North Andover Health Department 120 Main Street North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.9542 C�Qar\n Commonwealth of Massachusetts D City/Town of North Andover Form 9A - Application for Local Upgrade Approval ;M 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 your local Board of Health to determine the form they use. Form 9A 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 15.404(1), is not feasible. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab 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 15.415. 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 capacity of an on-site system constructed in accordaniebe 1978 Code or 310 CMR 15.000. RECEIVED A. Facility Information NOV 0 6 2017 1. Facility Name and Address Name 9 Turtle Lane Street Address North Andover City/Town TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 2. Owner Name and Address (if different from above): William Durfee Name North Andover City/Town 01845 Zip Code 3. Type of Facility (check all that apply): ® Residential ❑ Institutional 4. Describe Facility: 4 bedroom home 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) NOV lF 2017 TOWN NEAOLTH DEPARTMENT ANDOVERF NORTH MA 01845 State Zip Code 9 Turtle Lane Street Address MA State Telephone Number ❑ Commercial ❑ School ® Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): leach field t5forrn9a • rev. 7/06 Application for Local Upgrade Approval* Page 1 of 4 5 ' Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 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 your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Design flow of proposed upgraded system Design flow of facility: B. Proposed Upgrade of System 440 gpd 440 gpd 440 gpd 1. Proposed upgrade is (check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Install new 1500 gallon tank, 1000 gallon pump chamber and pipe in stone leach system 3. Local Upgrade Approval is requested for (check all that apply): ❑ Reduction in setback(s) — describe reductions: ❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 1 ft. Percolation rate 4 MPI min./inch Depth to groundwater 3 ft. t5form9a • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A - Application for Local Upgrade Approval ;M 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 your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12 -inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met— describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluatormust be a member or agent of the local approving authority. High groundwater evaluation determined by: Isaac Rowe Evaluator's Name (type or print) C. Explanation Signature 9/22/17 Date of evaluation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: no area on the lot available 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: cost is prohibitive t5form9a • rev. 7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts City/Town of North Andover a Form 9A — Application for Local Upgrade Approval uM 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 your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: no adjacent property available for a shared system 4. Connection to a public sewer is not feasible: sewer is too far 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site 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). ❑ Other (List): D. Certification "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 imprisonment for deliberate violations." acility wner's Signature Benjamin C Osgood, Jr., Agent for owner Print Name Benjamin c. Osgood, Jr Name of Preparer 157 Bluff Street Preparer's address NH 03079 State/ZIP Code iIRAI VA Date 11/6/17 Date Salem City/ Town 978-435-1324 Telephone t5form9a • rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4 Benjamin c. Osgood, Jr. P E. 157 Bluff Street Salem, NH 03079 Tel: 978-435-1324 November 6, 2017 Brian LaGrasse, Health Director North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: 9 Turtle Lane, North Andover Dear Brian: Enclosed are three sets of revised septic system design plans for the above referenced property These plans incorporate the items required to address the previously submitted plans and they include a pipe in stone leach field versus the previously designed infiltrator system. These plans also require that a Local Upgrade Approval for the reduction in offset to the water table from 4' to 3'. A Form 9A Local Upgrade Approval Request form is attached. With this letter we request that the Health Department approve the local upgrade approval and the proposed plans. If you have any questions please do not hesitate to contact this engineer. Sincerely, Benjamin C. Osgood, Jr., PE RECEIVED NOV 0 6 2017 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RECEIVED NOV ' 2017 wo TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 4L FCLE C�?d North Andover Health Department Community and Economic Development Division November 2, 2017 Benjamin Osgood, Jr., P.E. 157 Bluff Street Salem, NH 03079 Re: 9 Turtle Lane (Map 106B, Lot 104) Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated October 16, 2017 and received on October 19, 2017 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. On sheet 1 of 2, a north arrow was missing from the site plan (3 10 CMR 15.220(4)(g)). 2. An effluent filter is required prior to or within the pump chamber (3 10 CMR 15.23 1 (10)). 3. On sheet 2 of 2, the pump chamber detail and model numbers need to indicate a monolithic the tank. The pump notes indicate a monolithic tank but the model number indicates a 2 -piece tank. 4. Since the Infiltrator Chamber system is proposed as an alternative soil absorption system the "Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use" will apply. Please provide the following as required by the approval conditions Section II(7): e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection; North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Page 1 of 2 Fax: 978.688. 9542 Section II(18): c) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: 1. has been provided a copy of the Title 5 IIA technology Approval, the Owner's Manual, and the Operation and Maintenance Manual, and the Owner ajzrees to comply with all terms and conditions; iii if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and iv whether or not covered by a warranty, the System Owner understands the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303. Please feel free to contact the office or Mill River Consulting at 978-282-0014 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. FX ely, J. aGrasse, CEHT Director of Public Health cc: William Durfee File Page 2 of 2 North Andover Health Department, Town Hall, 120 Main Street, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542 nECEIVED SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS NOV 2 8 2017 As the North Andover licensed installer for the construction for the septic system for the prop Tot OF NORTH ANDOVER rU Ic— L AN HLTH DEPARTMENT (Address of septic system) For plans by J� L/ /� (Engineer) Relative to the application of V A mea (Installer's name) And datedIc'�', !6 ! ZV -7 nglna ate Dated ND u 2-1, 2-DI1 ( o ay s date With revisions dated Y o U , & t Zo (Last revised date Lfi I understand the following obligations for management of this project: fi�Q l Gfj GC>/'% 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans riot 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 beim levied against me and/or my company a. Bottom of Bed — Generally, this is the first (1'� 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: healthdept@northandoverma.gov) 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_bp 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 ofHealth 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 anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: A1 e e (Name — Print) Hou , L-7, 2,0-7 (Today's Date) 11 `l //7 �7—Signed) It TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER, MASSACHUSETTS 01845 SEPTIC PLAN SUBMITTAL FORM Date of Submission: 10-20-17 Site Location: 9 Turtle Lane Engineer: Benjamin C. Osgood, Jr. 978.688.9540 - Phone 978.688.9542- FAX E-MAIL: healthdept@northandoverma.gov WEBSITE: hn://www.nortliandoverma.,izov RECEIVED OCT 10 2017 TOiOF NORTH ER DEPARTMENT HEA New Plans? Yes X $275/Plan Check # 795 (includes 1St submission and one re- review only) Revised Plans?Yes $125/Plan Check # Site Evaluation Forms Included? Yes X Local Upgrade Form Included? Yes. Telephone #: 978-435-1324 E-mail:-Bosgoodpe@gmaii.com Homeowner Name: Bill Durfee OFFICE USE ONLY No No N/A Fax #: N/A 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 TOWN OF NOR TH ANDOVER RFPORT OF PERC TEST ADERESS OF SYSTEM �Llr �� G DATE /0 Z 7 C NAME OF PROFESSIONAL ENGINEER CR SANITARIAN CONDUCTING TESTS 4:;�,,,r ��() NAME OF LOTOWNER i'j ADL&�ESS j�J�?lrs SHOW APPROXI1,1ATE LOCATION OF PITS ON SKETCH ON REAR OF THIS SHEET Total Soil Log: To sp oil Subsoil `T Depths & Tis Water Level Pit Depth NORTH ANDOVER BOARD OF HEALTH /7 G Time to Time to Pe T sts Depth Saturation Time Drop 1211 - 911 DroD 9" - 61, Other Considerations: j Recommendations: 4 Signature Jao..Ice 3: 3 7 4 113 IL TO: NORTH ANDOVER, MASS a /7 19 7.7 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at LL 1r 7` 1-t iC rLZ--- Z4 /VE North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated ��WWo� eif eg. S/hitari C� \�� �� ,I� � Q �r�� ANDOVER rH ANDOVER HOUSEHOLD HAZARDOUS HASTE PAINT r.nT,r.p.rTmnt Free Estimates r 41 WEST FOREST STREET "Ac&"4� Sc.m seozo&e OWNED AND OPERATED BY THE KING FAMILY Serving Homes — Factories — Restaurants — Institutions 'SEPTIC CERTIFICATION Tel. 452-7750 LOWELL, MASS. 01851 DATE: _-7IiNb� /O PROPERTY ADDRESS: On the above date, I inspected the -septic system.at the.above referenced property. Based on my inspection, I certify that the,system, at this time: is in proper working order. is NOT in proper working order. VA�TC;X RUR/N';&�C )91fe-K FpoJ**'�' i SIGNATURL: / Francis,R. King Jr. ACTION -KIND ENTERPRISES, INC. d/b/a ACTION -KING SEWER CO. 14 Livingston Street Y� Lowell, Ma. 01852 (Cy USS Vacc', -rS��t',dS 5 tkl�� Gt ✓fit `r Y v ✓ rte �/: 10 61er_ Sewers — Drains Opened Serving Homes — factories — Restaurant — Institutions