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HomeMy WebLinkAboutMiscellaneous - 91 BOSTON STREET 4/30/2018 (2)i ti A • F i w 0 I -- a� � 0 a Y � = L O 3 b o � w o O = O a+ C x WrusLn d y N z z u U o � y O = = 0 N lu t a ti U OD a a T� o U U W � O = U -G1 L Or •� C N � 'U N U U d O N 00 N = pp 00 o0 00 r ;n y ca U 0 0 3 0 o I .o z N w = m o o I " z� I c� M W " O Z 0 N U O r'l � M _ eq O N � � O � O M a N = m a". h � I y x 42 UO Qn North Andover Board of Assessors Public Access Parcel ID: 210/107.11-0040-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO No Picture Available Location: 91 BOSTON STREET Owner Name: JOHNSTON, DONALD F NANCY JOHNSTON Owner Address: 114 BOSTON STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 5 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 1354 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 323,200 302,600 Building Value: 122,300 115,200 Land Value: 200,900 187,400 Market Land Value: 200,900 Chapter Land Value: LATESTSALE Sale Price: 78,442 Sale Date: 02/06/1985 Arms Length Sale Code: Y -YES -VALID Grantor: CLOUGH DONALD A Cert Doc: Book: 01926 Page: 0012 Page 1 of 1 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &Linkld=809535 3/7/2006 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/20/15 copy This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair of an On -Site Sewage Disposal System By: Bill Hall At: 91 Boston Street Map 107.B Lot 0040 North Andover, MA 01845 c�sfiall not be construed as a guarantee that the system will function satisfactorily. Issuance of this c�rtificat f� f Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby cer I that the Sewage Disposal System (t4onstructed; ( )repaired; By: ,G i t,� PC (Print Name) Located / r Located at: 00;:2yY►TY�f't'i� (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on �d/� /T. with a design flow of T7" gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 10. COIR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative (Signature) And — Print Name Final Construction Inspection Date: Engineer Representative (Signature) And — Print Name Installer: ` (Signature) - - Date: And — Print Name Enginer �`" (Signature) Date: And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web http://www.townofnorthandover.com <1 �!Ov 19 2014 PUBLIC HEALTH DEPARTMENT TOWN ut" N r,i lri Aw jfjv-:R Community Development Division HEA �- �", `t• TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby cer I that the Sewage Disposal System (t4onstructed; ( )repaired; By: ,G i t,� PC (Print Name) Located / r Located at: 00;:2yY►TY�f't'i� (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan, originally dated and last revised on �d/� /T. with a design flow of T7" gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 3 10. COIR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative (Signature) And — Print Name Final Construction Inspection Date: Engineer Representative (Signature) And — Print Name Installer: ` (Signature) - - Date: And — Print Name Enginer �`" (Signature) Date: And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web http://www.townofnorthandover.com <1 I OF NORTH qN �0 m 5 SSA C H us��� North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 91 Boston St. MAP: 107B LOT: 40 INSTALLER: Bill Hall DESIGNER: Christiansen & Sergi PLAN DATE: 9/10/14, Rev. 10/14/14 BOH APPROVAL DATE ON PLAN: 10/15/14 INSPECTIONS Jv�, TANK INSPECTION: 11/13/14 DATE OF BED BOTTOM INSPECTION: 11/14/14 DATE OF FINAL CONSTRUCTION INSPECTION: 11/19/14 DATE OF FINAL GRADE INSPECTION°oD,��� SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 1500 gallon tank has been installed H-10 loading ® Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ..a ® Outlet tee installed, centered under access port (gas baffle) ❑ inch cover to within 6" of finish grade installed over one access port ® Hydraulic cement around inlet & outlet (rubber boots) Comments: MRC - Inlet tee not under access port, requested to be adjusted, cover needed on one tank opening to within 6" of finished grade DISTRIBUTION -BOX ® Installed on stable stone base ® H-20 D -Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: MRC — Dbox needs cement around pipe penetrations. Need to perform water test to show even flow, no water was available at time of inspection SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan X Title 5 sand installed, if specified on plan (C30) ❑ 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder / concrete / timber/ block) ❑ Final cover as per plan Comments: w/overdig 42'Lx31'W, 30x20 system Comr DOCL As -Built Plan BM = 200.58 HR = 5.63 HI = 206.21 SYSTEM ELEVATIONS ROD AS -BLT INVERT ELEVATION ELEV DESIGN INVERT ELEV Benchmark 5.63 Building Sewer OUT 4.89 200.99 200.66 Septic Tank IN 5.24 200.64 200.44 Septic Tank OUT 5.54 200.34 200.19 Distribution Box IN 6.13 199.75 199.67 Distribution Box OUT 6.28 199.60 199.50 Lateral 1 Beg 6.38 199.50 199.40 Lateral 1 End 6.51 199.37 199.26 Lateral 2 Beg 6.38 199.50 199.40 Lateral 2 End 6.54 199.34 199.26 Lateral 3 Beg 6.33 199.55 199.40 Lateral 3 End 6.51 199.37 199.26 Lateral 4 Beg 6.39 199.49 199.40 Lateral 4 End 6.52 199.36 199.26 Lateral 5 Beg 6.39 199.49 199.40 Lateral 5 End 6.52 199.36 199.26 FINAL GRADE Loamed Seeded Cover per plan Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As -Built Plan BM = 200.58 HR = 5.63 HI = 206.21 SYSTEM ELEVATIONS ROD ELEVATION AS -BLT INVERT ELEV DESIGN INVERT ELEV Benchmark 5.63 Building Sewer OUT 4.89 200.99 200.66 Septic Tank IN 5.24 200.64 200.44 Septic Tank OUT 5.54 200.34 200.19 Distribution Box IN 6.13 199.75 199.67 Distribution Box OUT 6.28 199.60 199.50 Lateral 1 Beg 6.38 199.50 199.40 Lateral 1 End 6.51 199.37 199.26 Lateral 2 Beg 6.38 199.50 199.40 Lateral 2 End 6.54 199.34 199.26 Lateral 3 Beg 6.33 199.55 199.40 Lateral 3 End 6.51 199.37 199.26 Lateral 4 Beg 6.39 199.49 199.40 Lateral 4 End 6.52 199.36 199.26 Lateral 5 Beg 6.39 199.49 199.40 Lateral 5 End 6.52 199.36 199.26 _-w SKETCH PLAN CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other) Foundation 10 (5) 20 (10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Commonwealth of Massachusetts Map -Block -Lot 107.80040 BOARD OF HEALTH - ----- ---------- Permit NNo North Andover - BHP -2014-1287 ------------------ -- P.I. FEE F.I. $250.00 --------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Bill Hallnc. - I - - ------------------------------------------------------------------------------------------ to (Construct) an Individual Sewage Disposal System. at No 91 BOSTON STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2014-128 Dated November 12, 2014 ------------_ COR - ----------------- Issued On: Nov -12-2014 BOARD OF HEALT ---------------------------------------------------------------------------------- SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: � I (Address of septic system) Relative to the application of �i' (Installer's name) Dated _ /I—I`L—/q o ay s ate For plans by \ hr IA) n 't' t (Engineer) And dated 5E,4, /0 (Original ate With revisions dated © <-+ , 1 Z o (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the appr�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 requestinLy an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (VS 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(cr�,toNvnofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade — Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner. Lyeneral contractor. or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: by� � (Today's Date) << �« acne —Print)(Name — igne •FR I1 •. Application for Septic Disposal System Construction Permit -TOWN OF NORTH ANDOVER, MA 01845 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. r�5 Applicatio's hereby made fora permit to: A.Ponstruct 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 6aJ� Address or Lot # NO TODAY' DATE 4 Full Repair - Component City/Town 2.- *TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ❑ Gravity (choose one) ***If pump s stem, attach copy of electrical permit to application*** ➢ ejConventional 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. ➢ ❑ Does 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) [Bat is the Make? [khat is the Model. Name Address (if different from above) Cityrrown G State Zip Code 3. Installer Information 91")1 14.-,k k Name 1/r / r'U, r1 o,, S �-- Address +j Atx Cityrrown a. Designer Information r Name 16o S��Ir►er ��'. Address % `9 U." V CitylTdwn Telephone Number Name of Company State Zip Code Telephone Number (Cell Phone # if possible please) Name of Company MA o 5.30 State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 Y OF NORTH 4ti ° m 5� �9SSAC H USE�c Application for Septic Disposal System Construction Permit -TOWN OF NORTH ANDOVER, MA 01845 PAGE 2OF2 A. Facility Information continued.... 5. Type of BuildingXResidential Dwelling or ❑Commercial B. Agreement TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Board of Health, the installed system is not approved. Name Date Applicata Approve y: (Board of Health Representative) Na Date plication isapproved for the following reasons: For Office Use Only: L Fee Attached.? Yes No 2. Project Manager Obligation Form Attached.? YesV No 3. Pump System? If so, Attach coQ,v of Electrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? V4. Reviewed approval letter, all paperwork received.? Yes No S. Foundation As -Built? (new construction only): Yes No (Same scale as approved plan) 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 OF NORTy qti o �COPY �9SSACHUS�� North Andover Health Department Community Development Division October 15, 2014 Joseph Franciosa 9 Newell Farm Drive West Newbury, MA 01985 North Andover, MA 01845 Re: Subsurface Sewage Disposal System Plan for 91 Boston Street, Map 107B, Lot 40 Dear Mr. Franciosa: The proposed wastewater system design plan for the above site dated September 10, 2014 with a final revision date October 9, 2014 received on October 14, 2014 has been approved. The design has been approved for use in the construction of a replacement onsite septic system for a 4 -bedroom (max 9 -room) home. This plan is generally good for 3 -years from the date of approval however, as this is for a repair system, this is reduced to 2- years. The plan received the following local upgrade approval. 1) A reduction to ground water from the bottom of the soil absorption system from 5 feet to 4.4 feet 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. Please keep the attached DEP Form 9b for your records (attached) 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 91 Boston Street October 15, 2014 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector 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. Public Health Director Encl. Form 9B Installers list cc: Philip Christiansen, PE File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 O N LOLO O r z z It O O 00 V)j 0 0 MM O N C) 00 m— 000 0000 O - - '��" 00 ,_, N 00 pmp C7 O m p O 0 0\ O \O oo 00 O 00 Q O7 00 O w �0 0 00 0000 0 00 O Oo O HHWW�W¢xa�Uzzg x�a��z x x�wa O> ��:) O� � >xx H �Zzaaw N O��� H Q O w U �zzHzO�OI�����z0 o 0 O 0 O H w w w w O H H 00 �z aaa¢�� Q¢¢�¢pz, QM ¢zzo I O M - - 00 to M to 00 N "O 01 kn 00 �.D kn M v1 l-- M O r - N r- I- — — O M -�,c O = O r- O 00 N M O �t �O O O O N M m d\ �,O a1 [� in a1 Do D1 M N M m �D M dV) O N a1 O 4 \O 01 o0 O \O Z w � � \O � l� M kn v'� O\ O �O r N l� � [� 00 v vi l O\ N M N tn I- v'i "0 l- 00 Do M "0 4 r v'� M O\ r- r V) A - 4 N 0000 I-- t --l-- 00 00 M 00 .--� 00 00 M 00 00 00 00 m 00 00 00 00 00 00 M M 00 00 00 00 m O1 a1 01 r- 0\ O �O r- a1 00 � t- al O kn O "0 l- O1 l- 0\ [- 01 l- al OS "0 V) l- a1 l- a\ l� 0\ l- O� (- O'\ O �,O O �c [- 01 [- O1 r- O1 [� O1 O � cn W J LUJ O ccn N ? N Z d c _ ~ N .3 m ti N by C3 � O _ O cd Z N N W 0cn U> U U `d .� ° '� �Q�x� t �� v, A� t„ 3 cu QH -1Q a) Cdo �,Cd a O Cd � W W W °�1pxai cd .� ' 0 0 0 0 0 CL cc ¢aaUQQQtiti °tititi wxxxxcnCZHH3 3 Commonwealth of Massachusetts City/Town of North Andover F o Local Upgrade Approval Form 913 �M DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. Zip Code 3. Type of Facility (check all that apply): x Residential ❑ Institutional 4 Desi n flow or 310 CMR 15 203w State Street Address State Telephone Number ❑ Commercial 440 ❑ School g p gpd 5. System Designer: Philip Christiansen Name 160 Summer Street Haverhill MA 01830 Address City/Town State, ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: 01845 Zip Code XPE [:IRS SAS size, sq. ft. % reduction 91 Boston Road Local Upgrade Approval* Page 1 of 2 A. Facility Information Important: When filling out forms 1. Facility Name and Address on the computer, use only the tab Joseph Franciosa key to move your Name cursor - do not 51 Hay Meadow Road use the return key. Street Address North Andover Q City/Town 2. Owner Name and Address (if different from above): Name City/Town Zip Code 3. Type of Facility (check all that apply): x Residential ❑ Institutional 4 Desi n flow or 310 CMR 15 203w State Street Address State Telephone Number ❑ Commercial 440 ❑ School g p gpd 5. System Designer: Philip Christiansen Name 160 Summer Street Haverhill MA 01830 Address City/Town State, ZIP B. Approval 1. Local Upgrade Approval is granted for: ❑ Reduction in setback(s) — specify: ❑ Reduction in SAS area of up to 25%: 01845 Zip Code XPE [:IRS SAS size, sq. ft. % reduction 91 Boston Road Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 913 41M Sye JV B. Approval (continued) ® Reduction in separation between the SAS and high groundwater: Separation reduction 6 feet Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): ft. 2 min/inch min./inch 4.4 feet ft. ❑ 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 List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Det Approving Authority Susan Sawyer October 15, 2014 Print or Type Name and Title nature Date 91 Boston Road Local Upgrade Approval, Page 2 of 2 Commonwealth of Massachusetts City/Town of Form 9A — Application for Local Upgrade Approval aY 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. 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 accordance with either the 1978 Code or 310 CMR 15.000. Important: When filling out compu er use A. Facility Information 1. Facility Name and Address: only the tab key Name move your c cursor- not use the return Street Address key. /i%/.E'%.l� AW -10 k45_& Citylrown State Zfp Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State 01_ e1eS` Zip Code Telephone Number 3. Type of Facility (check all that apply): RV Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) Conventional ❑ Other (describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): t5form9a.doc • rev. 7106 Application for Local Upgrade Approval* Page 1 of 4 Commonwealth of Massachusetts City/Town of 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 1. Proposed upgrade is (check one): I/yo gpd gpd ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: 2. Describe the proposed upgrade to the system: 54 -7%C /4-0Af 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%: date of inspection /goo 646, SAS size, sq. ft. % reduction a Reduction In separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ft. min.finch _ I/Lo ff. t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval- Page 2 of 4 Commonwealth of Massachusetts City/Town of - 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. 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 evaluator must be a member or. agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name (type or print) Signature Date of evaluation C. Explanation 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: S,4f-r- C-I'l�e lwb 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: t5form9a.doc • rev. 7106 Application for Local Upgrade Approval• Page 3 of 4 Commonwealth of Massachusetts City/Town of 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. C. Explanation (continued) 3. A shared system is not feasible: 4. Connection to a public sewer is not feasible: 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 pians 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 impriso ment for deliberate violations." ci ity Owner's Signal Date �j �y�NG:1 nS ►4' Print Name Name of Preparer Date Preparer's address City/Town hkt��l 1 a iota, 77 3.7 Via.__. State/ZIP Code Telephone t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4 J CHRISTIANSEN & SERGI, INC. ' PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 www.esi-engr.com fax 978-372-3960 91 Boston Street, Qctober 16, 2014 The bottom of stone elevation in the leach field in the originally approved septic system plan designed by Hayes Engineering dated March 2006 and approved by the Board of Health was 198.5. In the design prepared by Christiansen & Sergi Inc. (CSI) the bottom of stone elevation is 198.75 which is 0.25 feet higher than the approved design. The highest groundwater elevation recorded on the Hayes plan was 193.50, which showed the proposed system to be 5 feet above the water table. The highest groundwater elevation shown on the CST septic plan is 194.35 which means the bottom of the stone is 4.4 feet above the CSI groundwater. If the Hayes ground water elevation were used in the CSI design the proposed system would be 5.25 feet above the ground water. The discrepancy in the groundwater elevations is due to the elevation of the top of the test pits. The ground surface of the Hayes test pits was taken in 2003 and 2006. The CSI elevations were taken in 2014. The depth of the water table below the surface was taken from the Hayes soil logs. Thus if the surface elevations are different the ground water elevations will be different. Since our topography survey was completed 8 years after the last test pits were done we could only approximate the location of those tests when obtaining the surface elevation. This may well have led to the elevation differences. Below is a comparison of the soils data presented in the Hayes plan and that presented in the CSI plan. Test Pit Hayes CSI T -A top elev. 199.2 199.33 gw elev. 192.2 192.33 T -B top elev. 200.5 200.92 gw elev. 193.5 193.92 T1-06 top elev. 199.3 200.09 gw elev. 193.3 194.09 T2-02 top elev. 199.9 200.75 gw elev. 193.5 194.35 My professional opinion is that the Hayes elevations are more accurate since they were obtained at the time of the soil testing. However to ensure that the system was designed with the most conservative data we chose to use the higher ground water and request the Local Upgrade Approval to allow the 4.4 ft separation from ground water. North Andover Health Department Community Development Division October 8, 2014 Philip Christiansen, P.E. Christiansen and Sergi, Inc. 160 Summer Street Haverhill, MA 01830 i v/B�i�J �- Re: Subsurface Sewage Disposal System Plan for 91 Boston Street (Map 107B, Lot40) Dear Mr. Christiansen, The proposed wastewater system design plan for the above site dated September 10, 2014 and received on September 11, 2014 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, please indicate what portion of the proposed house will have a slab foundation and full foundation. 2. Please indicate the model number and brand of the proposed distribution box (NA 3.2). 3. On sheet 1 of 2, the soil evaluation results do not match the field book notes submitted with the application. Please revise the results accordingly to include, but not limited to, the 2006 soil testing date and all percolation test results. 4. On sheet 1 of 2, the soil evaluation results and the design parameters indicate the incorrect percolation test result. Based on the field book notes submitted with the application, both percolation tests resulted in a percolation rate of <2 minutes/inch. Therefore, a 5' separation distance is required between the bottom of the soil absorption system and the high groundwater elevation (3 10 CMR 15.212(1)). 5. On sheet 1 of 2, the orientation of T2-06 is different from the field book notes submitted with the application and the Hayes Engineering design plan from 2006. In addition the percolation test that was conducted adjacent to T2-06 is missing from the design plan. 6. Please indicate the breakout elevation of the high and low ends of the leach field. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 7. On sheet 1 of 2, the breakout elevation on the high end (199.43) is not met based on the existing grades adjacent to the south western side of the leach field (3 10 CMR 15.255(2)). 8. On sheet 2 of 2, the profile view depicts less than 9" of cover material above the septic tank (3 10 CMR 15.228(1)). 9. On sheet 2 of 2, the distribution box detail depicts a 2" sump. A 6" sump is required (3 10 CMR 15.232(3)(e)). 10. A riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade (3 10 CMR 15.221(13) and 15.232(3)(f)). Please add a note to the design plan. On sheet 2 of 2, the profile view depicts the cover material at 9" to existing grade. However, the finish grade elevation may not be the existing grade elevation after construction. A note added to the design plan will ensure the installer is aware of the requirement. 11. On sheet 2 of 2, the profile view depicts the slope of the leaching laterals to be less than 0.005 feet per foot (3 10 CMR 15.251(9)). 12. The slope from the distribution box to the leach field inlet is approximately 0.5% for the longest run (10'). A 1.0% slope is preferred. 13. An inspection port is required in the proposed leach field (3 10 CMR 15.240(13)). 14. Please provide a note or graphic representation to indicate the soil layers being removed beneath the leach field. This will help to assist the installer during construction. Although not a reason for disapproval, you may wish to consider the following comment: The separation distance between the leach field laterals is proposed at 3.67'. You may wish to consider using 3.5' or 4.0' for an easier installation. 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. Sincere Susan Y. S e , HS/RS Public Health Director cc: Joseph Franciosa File Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 August 5, 2014 Mr. Joe Franciosa 8 Newell Farm Drive West Newbury, MA 01985 Subject: Wetland Delineation 91 Boston Street, North Andover, MA Dear Joe, I W,CC'WILLIAMS SPARAGES ENWERS a KANNERS I SURVEYORS T S As you know, we delineated the jurisdictional wetland resource areas at the rear of 91 Boston Street in North Andover, MA. The resource area delineated was a Bordering Vegetated Wetland and it follows the toe of slope at the rear of the lot There is also a Zone A, 100 Year FEMA flood plain in the rear of the lot that appears to be approximately 280 feet from the edge of pavement in the front of the lot. I have had a chance to review the plan that was prepared by Christiansen & Sergi, inc. and can confirm that the resource area flags depicted on the plan are the flags that I hung on August 8, 2014. Please note that any work within 100 feet of the delineated resource area will more than likely require permitting from the North Andover Conservation Commission and Massachusetts Department of Environmental Protection Agency. If you should have any questions regarding this information please do not hesitate to contact our office. Very truly yours, WILLIAMS & SPARAGES, LLC -"� )-141idt Greg J. Hochmuth, RS, PWS, CWS Project Manager 189 North Main Street, Suite 101 • Middleton, MA 01949 • Tel: (978) 539-8088 • www,wsengineers.com 75O�- �7� - X76- )tab d QA CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS CS01 160 SUMMER STREET, HAVERHILL, MA 01830 tel: 978-373-0310 www.csi-engr.com fax 978-372-3960 September 10, 2014 Ms. Susan Sawyer OCT -t 2U , LU ,-r Health Director TOWN OF NORTH ANDOVER 4;FAMI DEPARTMENT Town of North Andover Re: Subsurface Sewage Disposal System Plan Review for 91 Boston Street Dear Ms. Sawyer: We have revised the plan to address your 10/08/14 comments, as follows: 1. On sheet 1 of 2, please indicate what portiion of the proposed house will have a slab foundation and full foundation. Response: The site plan has been updated with a label and hatching to depict the slab foundation. 2. Please indicate the model number and brand of the proposed distribution box (NA 3.2). Response: The model number and brand has been added to the distribution box detail. 3. On sheet 1 of 2, the soil evaluation results do not match the field book notes submitted with the application. Please revise the results accordingly to include, but not limited to, the 2006 soil testing date and all percolation test results. Response: The 2006 soil testing date and percolation test results have been added to the soil evaluation results on sheet 1 of 2. The B horizon for T1-06 has been updated to match the field book notes. This was originally copied off the plan submitted by Hayes which had an error depicting the color of the soil. 4. On sheet 1 of 2, the soil evaluation results and the design parameters indicate the incorrect percolation test result. Based on the field book notes submitted with the application, both percolation tests resulted in a percolation rate of <2 minuteslinch. Therefore, a 5' separation distance is required between the bottom of the soil absorption system and the high groundwater elevation (310 CMR 15.212(1)). Response: The soil evaluation results have been updated. An LUA has d June 6, 2013 been requested under the Variance note on sheet 1. 5. On sheet 1 of 2, the orientation of T2-06 is different from the field book notes submitted with the application and the Hayes Engineering design plan from 2006. In addition the percolation test that was conducted adjacent to T2-06 is missing from the design plan. Response: The orientation of T2-06 has been adjusted to match the field notes and plan. The additional percolation test has also been added to the plan. 6. Please indicate the breakout elevation of the high and low ends of the leach field. Response: A breakout elevation has been added to the plan. 7. On sheet 1 of 2, the breakout elevation on the high end (199.43) is not met based on the existing grades adjacent to the south westem side of the leach field (310 CMR 15.255(2)). Response: Proposed grades have been added to the site plan to meet the breakout elevation. 8. On sheet 2 of 2, the profile view depicts less than 9" of cover material above the septic tank (310 CMR 15.228(1)). Response: The profile has been adjusted to show 9" of cover over the septic tank. 9. On sheet 2 of 2, the distribution box detail depicts a 2" sump. A 6" sump is required (310 CMR 15.232(3)(e)). Response: A new distribution box has been added to sheet 2. 10. A riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches below grade (310 CMR 15.221(13) and 15.232(3)(0). Please add a note to the design plan. On sheet 2 of 2, the profile view depicts the cover material at 9" to existing grade. However, the finish grade elevation may not be the existing grade elevation after construction. A note added to the design plan will ensure the installer is aware of the requirement. Response: A note has been added to sheet 1. 11. On sheet 2 of 2, the profile view depicts the slope of the leaching laterals to be less than 0.005 feet per foot (3 10 CMR 15.251(9)). Response: The top of stone at the low end is at 199.75 and the top of stone at the high end is at 199.90. The length of the field is 30 feet which is 0.005 feet per foot. 0 Page 2 June 6, 2013 12. The slope from the distribution box to the leach field inlet is approximately 0.5% for the longest run (10). A 1.0% slope is preferred. Response: The system has been updated to allow for a I% slope on the longest run. 13. An inspection port is required in the proposed leach field (310 CMR 15.240(13)). Response: An inspection port has been added to the leach field. The detail has been added to sheet 2. 14. Please provide a note or graphic representation to indicate the soil layers being removed beneath the leach field. This will help to assist the installer during construction. Response: A note and graphic representation has been added to the profile view to help indicate the soil layers that must be removed beneath the leach field. trust that this response and the revisions made to the plan fully address all of your comments. Please contact me if you have any questions. Best regards, Christiansen & Sergi, Inc. Philip Christiansen 0 Page 3 TOWN OF NORTH ANDOVER OE NORTq Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'SS�cMuset Susan Y. Sawyer, REHS/RS Public Health Director April 4, 2006 Gordon Rogerson, Project Engineer Hayes Engineering, Inc. 603 Salem Street Wakefield, MA 01880 978.688.9540 — Phone 978.688.9542 — FAX healthdept@townofnorthandover.com www.townofnorthandover.com Phone: 781.246.2800 Fax: 781.246.7596 Re: 91 Boston Street, North Andover, MA 01845 — Deep Hole Observation Dear Mr. Rogerson, This letter is to inform you that your request to "extend the length of time for the deep observation holes beyond the two (2) year expiration deadline" has been approved. The request was heard at a regularly scheduled Board of Health meeting held on March 23, 2006 and the vote was unanimous to grant a variance to section 7.05 of the North Andover Subsurface Disposal Regulations. The approval extension is for one (1) year. Thank ofi, r rr XS an Sawyer, REHS/RS Public Health Director Cc: owner, 91 Boston Street , Grant, Michele From: Merrill, Pamela Sent: Friday, March 17, 2006 10:44 AM To: Leathe, Brian; Brown, Gerald Cc: McKay, Alison; Grant, Michele Subject: 91 Boston Street Good morning! The Conservation Dept. received a complaint yesterday from a neighbor on Boston Street regarding some work being done potentially near a wetland. The property in question is 91 Boston Street. In speaking with Michele Grant (Health Inspector), she was out with Don Johnston, homeowner / contractor that morning performing soil test pits for a septic system. After reviewing the building file, it appears a demo permit was issued on Feb 21, 2006 with no sign off from either Health or Conservation. Just as a reminder for all future demo application, all applicable boards should sign off on a 'form u' application to demo. This is so the applicant & / or homeowner can expect what other permits they will need to obtain should they want to rebuild, and so that Conservation can inspect the site to see if erosion controls are necessary. It is my understanding in speaking with Michele that Don Johnston was claiming he was 'remodeling' his house to skirt around doing 2 extra test pits required for new construction. Michele & Susan somehow figured out that he is actually demo-ing the house to build a larger home. I have a call into Don requesting a site inspection to see if erosion controls are necessary. They'll have to file another 'form u' application for the construction of the house, but if he knows there are wetlands within 100' of his project, he can work on obtaining the necessary approvals from the Conservation Commission. Thanks! Pam Pamela Merrill Conservation Associate North Andover Conservation Department Office: 978.688.9530 Fax: 978.688.9542 Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPRO p � - Commonwealth of Massachusetts FEB 2 1 2006 North Andover, Massachusetts TOWN OF v4oRTH ANDOVER HEALTH DEPARTMENT Application for Local Upgrade Approval Title 5,310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) To be submitted to Local Approving AuthorilyMoard of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310- CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state of federal facility, where full compliance, as defined in 310 CMF 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15/000. 1) Facility/System Owner: Name: '(0o,v Jclh n S-10 U Address: 114 %3o S1�oN Sf Phone #: (017-9��-�JpOS Address of facility: q/ go,v 5-1 2) Applicant (if different from above) Name: Pow Address: Phone #: 3) Type of Facility: _Residential Commercial School Institutional (Specify) 4) Type of Existing System: _privy cesspools) other(describe) Page 2 of 5 Y- conventional system Type of soil absorption system (trenches, chambers, pits, etc.p 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system ,(/,vK,v Wq gpd Approved: _yes Approval date: no Why: b) Design flow of proposed upgraded system Why _ ¢�� c) Design flow of facility Vd 6) Proposed upgrade of existing system is: a) _� Voluntary required by order, letter, etc. (attach copy) Required following inspection required by 31 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: c) Which of the following are applicable to the proposed upgrade? Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) Percolation rate of 30-60 minutes per inch (state actual perc rate) Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) Reduction of required separation between bottom of SAS & high groundwater (specify proposed reduction & perc rate) M Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code) System upgrades that cannot be performed in accordance with 31 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410-15.417. 7) 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 ground water elevation pursuant to 310 CMR 15.405(1)(1)(1). The evaluator must be a member or agent of the local approving authority: Distance from soil absorption system to high groundwater 4¢ feet As determined by: //�� Evaluator's name: /' U/ ze-Be4-Aic, Evaluator's Signature: Date of evaluation: S,�m y, 003 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property 9or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15,405, Page 4 of 5 List of affected abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Date notified Address 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) An upgraded system in full compliance with 310 CMR 15.000 is not feasible: b) An alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible. No7 Newer c) A shared system is not feasible. "r NLO"p d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? _�_ yes no Page 5 of 5 11) Certification 1, 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 knowing violations." Owner's Signature Print Name Date .vii yEs ��y6.,t/ ic/6 & c. (�� r ar ;00-3 Name of Preparer Date 603 S.969-� Sf 114 Telephone No. & Address of Preparer 79-/- ;2qG-2ODv NOTE: Title 5,310 CMR 15.403(4) requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. I O W a� z E c� C. Lo d cm 0 a 0 N d --- - - -40: �,j *+ vx ci E 'a a Lm— N L = cm0 O d. 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W O No. THE COMMONWEALTH OF MASSACHUSETTS FEE JBOARDj(OF H /EALTH 0 (_L J 0 F /OZ /1 c oy e�j APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair A ) Upgrade ( ) Abandon ( ) - ❑ Complete System ❑ Individual Components 'f l56-S7bd d T_ Location Map/Parcel # Lot # Installer's Name Address Telephone # Type of Building: -a'n` Dwelling — No. of Bedrd"( Other — Type of Building Other fixtures Address �g _?TCI '— v fess o. of persons ^Telephone # Lot Size J � Qc Garbage Grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required)/gpd Calculated design flow gpd Design flow provided Plan: DaM_, 2-7% 706.Number of sheets ZI /J Rev'' * Date Title /GoG"� zr� 4/7 �-s� //%4.�!!�� � rt'm !�`4� Description of Soil(s) -ece 4-&-t­r '« Soil Evaluator Form No. %/ Name of Voil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS to of E gpd The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed _ Inspections Date FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Date FORM 2 - DSCP FORM 1255 (REV 5/96) Board of Health DEP APPROVED FORM 5/96 H&W HOBBSB WARREN TM PUBLISHERS - BOSTON 3 E Z O J a fV 0 � N Q w Q co CL _N I� 3 A U) �o0 O 4) C a` € 4) R E d a� U) C 3: U) o +? 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W 0 HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD MA01880 -- — )248.2800 FAX (781) 246-7596 FORM 12 - PERCOLATION TEST Location Address or Lot No. �OSitJ , JOS FILE COMMONWEALTH OF MASSACHUSETTS n/o� -oar �t/,Quv�o ✓�2 M assachusetts , Percolation Test' Date: —U 3 �...... ..._. Time :.........:...�.....�..,.�.,, . Observation Hole- # Depth of Perc Start Presoak n �f �.T End Pre-soakT Time at 12" Time at 9,- "Time Timeat 6-- "Time Time(9"•6") 3 Rate Min./Inch * Minimum of 1 percolation test must be performed reserve area, in both the prima ^/ ry area •ANU Site Passed Ll" ' Site Failed ❑ Abandoned Performed By: v /�: ................. ... ............. .w��.���..._.-..._..........�..��._.....�._............ .... ............ -._ .� _....._ Witnessed By; C`on` ments:...,............ 7 DFP "PROVO FORM • U/n/95 , A a� w a E 7 z J IL ro 2 `o N a N dQ In Q, .y d V/ G C;)p O a L d C � ID E R �a N 0 a? N C 3 N Lo N .� cc Q O0.0 O E5 E .2 � 0 n. Cl) Q � U ou) V40- ECo E N L 2 m LL 0 a� O Q 0 Q co co a� � U L c_ L O o= :3 L ,Op Z o O J O co co a) co (o C a) io H •L � co - = a o O O Q CD Q o. = o :D U Z O Cl. w � N c } o O C'• co � m 3 w = M Q 0 4) c D O cu cn oQ L O_ 0 fo � C O d U !A- m a� w cuP-� -C c - yo C � N o2 oV a) O J O`-' (h CL N d aci � C U o � L (D W o C C N W E� m v (o � W 1 � 0 C xm O N 0 >0) L n� m co C � C c Q Q Q Q N O 3 .w > t —c N U - O C m m °) _O 0 t v U) Qi O m N E :� =O LU vOi m p 0 L O d N U) N i+ O U D 'o y ca z 3 L C C co E to N O o 0 m LO ami c O s 0 3 co ° L t L c a a a O c O ❑ ❑ O O � E 5 C = `o LL z E N N E d v co d y = C Q � N 0 a� O Q 0 Q co co a� � U L c_ L O o= :3 L ,Op Z o O J O co co a) co (o C a) io H •L � co - = a o O O Q CD Q o. = o :D U Z O Cl. w � N c } o O C'• co � m 3 w = M Q 0 4) c D O cu cn oQ L O_ 0 fo � C O d U !A- m a� w cuP-� -C c - yo C � N o2 oV a) O O`-' (h CL aci � C U o � W o C N W E� m v (o � W 1 � 0 xm O N 0 >0) o n� co 0� C x O 3 .w —c N U - O m 2 H m 3 N_ LL N C _O fo U CD a r `o _ fo 0) C 0 Q Q N a� L_ O v _ N .Q to _ E E N H O z ti O co CD cv 0 0 am rn m9 co ra+ C O E coy Q :o 0 r U. a W e v m 0 cn 0 cn a y N N a O 0 CO i CDq y yO N co CD v 0 v /J o2 /c✓ �Jt M CD N - E O N M j 0 =1 C CL ' CD cD to g m p -, o d _ CD V! —v d 0M Al (D M CD CD m (D 3 = aa n ` ota /1 3 �iL, to f /, P/f(D ' tD CD v N� O N a �a m y 0 0 d a 0 z a` ` r- 3 3 v 1 � TOWN OF NORTH ANDOVER °E NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET * " NORTH ANDOVER, MASSACHUSETTS 01845 as CHU Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX healthdept@townofnorthandover.com www.townofnorthandover.com tr`VJ APPLICATION FOR SOIL TESTS .41`.. Z"o Cc. DATE: 312h 4 MAP & PARCEL: LOCATION OF SOIL TESTS: �� /15 �,,, [ 1 ; 11VZ OWNER: � r , 2/h Contact #: 5F7�F A� APPLICANT: ponoell'I T; Ah S Contact #: y %�—� �2_ /� �� ADDRESS: ENGINEER: Contact #: %LF/-- c2 -T1 — —'2 c?a o CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision !mingle Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11 "Plot plan & Location of Testing (please indicate test pit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent. Date back to Health Department: (stamp in): J fN 1-% --x I I I Ql q N Its ay - ;i Its 4. BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS, .` 2. k G NAME �� a•, .-�GQ c ��. I. .. .DATE ./ . . 2. ADDRESS �.� :: �. .: �. :'. LOT NO, TEL. . . . . . . . . . 3. NO. OF BEDROOMS . . . DEN YES . . . ". NO. .X. . 4. GARBAGE GRINDER YES . . . . . NO. 5. SHOW DIDENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DI%,,ZNSIONS OF LOT 8, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9, NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM! 10. SHOW LOCATION OF BROOKSS STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE . NOTE : LOCAL REGULATIONS SHOULD BE READ CAREFULLY. v F -.- C6 M Ln 300.0' 28.0' (n 0 U) W 24.0' N 00 M � m z z CO r o ri 2.0' 0 45.3' M r 4.0' 0 CV N LO T- A -, - z z O O? 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