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Home My WebLink AboutSeptic Plan Submittal Form - Receipt - 106 ROCKY BROOK ROAD 7/6/2020 TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.688.9542—FAX E-MAIL:healthdept@northandoverma.gov WEBSITE:hqp://www.northandoverma.gov SEPTIC PLAN SUBMITTAL FORM Date of Submission:August 27, 2019 of N QEQP� Site Location:106 Rocky Brook Road Engineer:John M. Morin,The Morin-Cameron Group, Inc. New Plans? Yes X $275/Plan Check#2562 (includes I"submission and one re- review only) Revised Plans?Yes $125/Plan Check# Site Evaluation Forms Included? Yes X No Local Upgrade Form Included? Yes X No Telephone#:978-777-8586 Fax#:978-774-3488 E-mail:John@morincameron.com Homeowner Name:Aleksandr Shneyderman OFFICE USE ONLY When the s fission is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Foiwvard to Consultant ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of North Andover IR Form 9A — Application for Local Upgrade Approval a wM 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 exist�iDQ approved capacity of an on-site system constructed in accordance with either the 1978 Code or 40 15.000. A. Facility Information Impo rtant:When filling out forms 1. Facility Name and Address: �o1Q��Q�GQpE� on the computer, 1r� use only the tab Aleksandr Shneyderman key to move your Name cursor-do not 106 Rocky Brook Road use the return Street Address key. North Andover MA 01845 011� Cityrrown State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State 978-235-1852 Zip Code Telephone Number 3. Type of Facility (check all that apply): ® 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): Existing - leach trenches Proposed - Leach Field _ Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval, Page 1 of 4 Commonwealth of Massachusetts 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. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ❑ Voluntary ❑ Required by order, letter, etc. (attach copy) ® Required following inspection pursuant to 310 CMR 15.301: 5-16-19 date of inspection 2. Describe the proposed upgrade to the system: Installation of a pump chamber, distribution box and leach field 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 25 min./inch Depth to groundwater 3 ft. Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of North Andover W 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 evaluatormust be a member or agent of the local approving authority. High groundwater evaluation determined by: Erin Kirchner 7/12/19 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: Cost and limited space 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: Alternative system will add cost and we will still need reduction in depth to ESHWT even with alternative technology Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval, Page 3 of 4 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 M 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 otherstems in area are failed _ 4. Connection to a public sewer is not feasible: no sewer in this area 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 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 deliberate violations." �. a t.r.n� a S ✓t r:2 tX Fa y Owner's Signature Date Aleksandr Shneyderman Print Name John M. Morin, The Morin-Cameron Group Inc. Name of Preparer Date 66 Elm Street Danvers Preparer's address City/Town MA, 01923 978-777-8586 State/ZIP Code Telephone Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval, Page 4 of 4 Authorization Form Re: 106 Rocky Brook Road, North Andover I, Aleksandr Shneyderman, authorize The Morin-Cameron Group, Inc. to sign any and all applications to the Town of North Andover on my behalf regarding the above- referenced property. Aleksandr Shneyderman Date Dber"o PUMPsV o Pump Specifications ' FL30-Series 1 /3 • : Submersible Effluent Pump LITERS PER MINUTE 0 50 100 150 200 25 7 20 6 PERFORMANCE 5 CURVE 15 w w w w 11 w z Z 4 0 o w = 2 J J F 0 0 10 3 2 5 1 0 0 0 10 20 30 40 50 60 GALLONS PER MINUTE FL30 Pt R1/12/2018 ®Copyright 2018 Liberty Pumps Inc. All rights reserved. Specifications subject to change without notice. IMP a � 1 � p t_, ' s r 4 t ..j :..__....,. :.__._.._.. s, .-.,....fir. .. .. .-r.. .. __.._.......... l t f � Alt f - '5ki,,.. P F i i u SOIL SUITABILITY ASSESSMENT REPORT COMMONWEALTH OF MAS SACHUSETTS NORTH ANDOVER, MASSACHUSETTS SOIL EVALUATION FOR REPAIR OF ON-SITE SUBSURFACE SEWAGE DISPOSAL SYSTEM SITE INFORMATION Street Address: 106 Rocky Brook Road Town: North Andover State: Massachusetts Zip Code: 01845 County: Essex Land Use: Single-family dwelling Latitude: —42040' 27.5"N Longitude: —71002'42.9"W Elevation: — 134-136' PUBLISHED SOIL DATA AND MAP UNIT DESCRIPTION Physiographic Division:Appalachian Highlands Physio.Province:New England Physio. Section: Seaboard lowland section Soil survey area: Essex County Massachusetts,Northern Part Series name: 711C—Charlton-Hollis rock outcrop complex Order: Inceptisol Suborder:Ochrepts Family:Coarse-loamy, mixed mesic Typic Dystrochrepts Soil moisture regime: Udic Soil temperature regime:Mesic Depth to restrictive feature:Variable to densic material Soil hydric or upland: Upland Average depth to water table: 50" Runoff class:Negligible Frequency of flooding:None Frequency of ponding:None Available water capacity:Moderate(-7.5") Drainage Class: Well drained Hydrologic Soil Group:A Ksat:Moderately low to mod.high(0.06—0.20 in/hr) WETLAND AREA tic USGS WELL MEASUREMENTS National Wetland Inventory Map:NA Wetlands Conservancy Program:NA Bordering vegetative wetland:NA Current Water Resource Condition(USGS): Well Site#4234010711093801 MA-XMW 78 Wilmington,MA Well completed in Sand and gravel aquifers and ice-contact deposits including kames and eskers. Well depth: 12.00 feet Borehole depth: 12.00 feet Land surface altitude: 95.00 feet above NGVD29 Most recent data value: 7.43'on 07/12/19(depth below land surface) Range:Normal SURFICIAL GEOLOGY: Surficial geology map: Ogm;Ground moraine Geologic parent material: Coarse-loamy lodgment till Geomorphic component: Rolling ground moraine Slope aspect: Easterly Landform position(2D): Summit, backslope Landform position(3D): Side slope, crest Slope gradient: —00-03% Down slope shape: linear Across slope shape: Concave Slope complexity: Simple Bedrock outcropping in vicinity:None observed Glacial erratics in vicinity:None observed Bedrock Type: Andover Granite: Light-to medium-gray foliated,medium-to-coarse-grained muscovite-biotite granite. Pegmatic masses common Includes Acton Granite. Late Ordovician to early Silurian in age. 1 MCG Project#3884 TP 19- 1 DEEP OB S ERVATION HOLE 106 Rockv Brook Road, North Andover, Massachusetts Date:July 12,2019 Time:09:15 Weather: Overcast,rain, —75-80°F,NE breeze,humid Landscape: Upland Landform: Rolling ground moraine Position on landscape: Back slope/side slope Slope aspect: Easterly Slope(%): 00-03% Slope complexity: Simple Land Cover: Grass lawn Property line: 10'feet Drainage way: 50'feet Drinking water well: 100�feetfeet Abutting septic system: 50' feet Wetlands: 100'feet Public water supply reservoir: 400'feet Tributary to reservoir: 200'feet SOIL PROFILE ► TP 19-1 Depth below Soil Soil Texture Soil Color Redoxomorphic Consistence,grade,size,structure,grain size,soil moisture state, land surface Horizon/ (USDA/MRCS) (Munsell) Features/ roots,horizon boundary,clasts,stratification,artifacts,restrictive (inches) Layer ESHGWT features,etc. Very friable;moderate-grade fine-to-medium sub-angular granular 00" 06" Sand Loam 10YR 3/2 structure;somewhat cohesive;fine grained mineral content;dry Ap y none observed matrix;non-sticky;non-plastic;many fine grass roots,free of very dark grayish brown clasts;clear wavy boundary. Human transported material;mechanically mixed layer;firm; 06" 46" Sand Loam 1 OYR 5/3 brittle;massive angular blocky structure;tight cohesive matrix; C y none observed mixed medium to fine-grained mineral content;dry matrix;non- fill mixture brown o sticky;non-plastic;approximately 15/o sub-angular to sub- rounded gravel,20%sub-angular to sub-rounded cobble and 15-20%angular to sub-rounded boulder content of mixed lithology;diffuse smooth boundary. Firm;brittle;strong-grade,medium-to-coarse subangular blocky 46" 96" 2C Sandy Loam 1 OYR 5/6 55" structure,compact matrix;mixed fine to medium grained mineral d stonyyellowish (m,3,d) content;crudely stratified;somewhat silty;dry matrix;non-sticky; brown 5YR5/8 non-plastic;poorly sorted;approximately 15%sub-rounded to 10Y7/1 angular gravel,20%sub-rounded to sub-angular cobble and 15-20% sub-rounded boulder content of mixed lithology;lithic bedrock contact at bottom of the test hole. 96" R Undulating,cohesive lithic bedrock contact Depth to bedrock: 96" Seasonal High Groundwater Table: 55" Apparent water:_ L_ 2 MCG Project#3884 TP19-1 DEEP OBSERVATION HOLE 106 Rocky Brook Road North Andover Massachusetts DEPTH TO PHREATIC GROUNDWATER TABLE: Apparent water seeping from pit face:_(below land surface) Depth to stabilized apparent water:_(below land surface) Soil moisture state: Der ESTIMATED SEASONAL HIGH GROUNDWATER TABLE: Depth of Estimated Seasonal High Groundwater Table: 55" (below land surface) Kind: Iron concentrations;noncemented iron masses and reduction spots—iron coatings on sand grains Location: In 2Cd matrix surrounding redox depletions Shape: Irregular/laminar Hardness: Soft Boundary:Clear Abundance: Common Size:Fine and medium Contrast: Distinct Concentration color: 7.5YR 5/8 red Reduction color: 1 OY 7/1 light gray Moisture state:Pa DETERMINATION OF HIGH GROUNDWATER ELEVATION Observed depth to redoximorphic features: 55" inches below grade Observed depth to stabilized phreatic water: _ Inches below grade Observed water weeping from side of deep hole: inches below grade DEPTH OF NATURALLY OCCURRING PERVIOUS MATERIAL: ► 4,16 feet Depth of naturally occurring pervious material in TP19-1 Upper boundary: 46" Lower boundary: 96" Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct evaluations and that the above analysis has been performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017, I further certify that the results of my soil evaluation,as indicated in the attached Soil Evaluation Form,are accurate and in accordance with 310 CMR 15.017. Alexander F. Parker 91848 June 1998 Massachusetts Evaluator&Certification number Date of Soil Evaluator Certification Ms.Erin Kirchner,C.H.O. 07/12/19 Town of North Andover witness Date of soil testing 3 MCG Project 43884 TP19-2 DEEP OBSERVATION HOLE 106 Rocky Brook Road, North Andover, Massachusetts Date:July 12, 2019 Time: 10:02 Weather: Overcast,rain, —75-80°F,NE breeze,humid Landscape: Upland Landform:Rolling ground moraine Position on landscape: Back slope/side slope Slope aspect: Easterly Slope(%): 00-03% Slope complexity: Simple Land Cover: Grass lawn Property line: 10`feet Drainage way: 50'feet Drinking water well: 100+feet Abutting septic system: 50'feet Wetlands: 100'feet Public water supply reservoir: 400'feet Tributary to reservoir: 200`feet SOIL PROFILE ► TP19-2 Depth below Soil Soil Texture Soil Color Redoxomorphic Consistence,grade,size,structure,grain size,soil moisture state, land surface Horizon/ (USDA/MRCS) (Munsell) Features/ roots,horizon boundary,clasts,stratification,artifacts,restrictive (inches) Layer ESHGWT features,etc. Very friable;moderate-grade fine-to-medium sub-angular granular 1 OYR 3/2 structure;somewhat cohesive;fine grained mineral content;dry 00" 06" Ap Sandy Loam none observed matrix;non-sticky non-plastic;many fine grass roots,free of very dark grayish brown clasts;clear wavy boundary. Human transported material;mechanically mixed layer;firm; 06" 33" C� Sandy Loam 1 OYR 5/3 brittle;massive angular blocky structure;tight cohesive matrix; one observed mixed medium to fine-grained mineral content;dry matrix;non- fill mixture brown sticky;non-plastic;approximately 15%sub-angular to sub- rounded gravel,20%sub-angular to sub-rounded cobble and 15-20%angular to sub-rounded boulder content of mixed lithology;diffuse smooth boundary. Firm;brittle;strong-grade,medium-to-coarse subangular blocky 33" — 91" 2C Sandy Loam 1 OYR 5/6 55" structure,compact matrix;mixed fine to medium grained mineral d stop yellowish (m 3 d) content;crudely stratified;somewhat silty;dry matrix;non-sticky; y brown non-plastic;poorly sorted;approximately 15%sub-rounded to 7.SYR5/8 angular gravel,20%sub-rounded to sub-angular cobble and 10Y7/1 15-20% sub-rounded boulder content of mixed lithology;lithic bedrock contact at bottom of the test hole. 911, R Undulating,cohesive lithic bedrock contact Depth to bedrock: 91" Seasonal High Groundwater Table: 55" Apparent water:_ 4 MCG Project 43884 TP 19-2 DEEP OB SERVATION HOLE 106 Rocky Brook Road. North Andover, Massachusetts DEPTH TO PHREATIC GROUNDWATER TABLE: Apparent water seeping from pit face:_(below land surface) Depth to stabilized apparent water:—(below land surface) Soil moisture state:D_yr ESTIMATED SEASONAL HIGH GROUNDWATER TABLE: Depth of Estimated Seasonal High Groundwater Table: 55"(below land surface) Kind:Iron concentrations,•noncemented iron masses and reduction spots—iron coatings on sand grains Location: In 2Cd matrix surrounding redox depletions Shape:Irregular/laminar Hardness: Soft Boundary:Clear Abundance:Common Size:Fine and medium Contrast:Distinct Concentration color:7.5YR 5/8 red Reduction color: IOY 7/1 light gray Moisture state:Der DETERMINATION OF HIGH GROUNDWATER ELEVATION Observed depth to redoximorphic features: 55" inches below grade Observed depth to stabilized phreatic water: _ inches below grade Observed water weeping from side of deep hole: inches below grade DEPTH OF NATURALLY OCCURRING PERVIOUS MATERIAL: ► 4.83 feet Depth of naturally occurring pervious material in TP19-2 Upper boundary: 33" Lower boundary: 91" Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct evaluations and that the above analysis has been performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017, I further certify that the results of my soil evaluation,as indicated in the attached Soil Evaluation Form,are accurate and in accordance with 310 CMR 15.017. Alexander F.Parker #1848 June 1998 Massachusetts Evaluator&Certification number Date of Soil Evaluator Certification Ms.Erin Kirchner,C.H.O. 07/12/19 Town of North Andover witness Date of soil testing 5 MCG Project#3884 SOIL SUITABILITY PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS NORTH ANDOVER, MASSACHUSETTS 106 Rocky Brook Road North Andover, Massachusetts Percolation Test Percolation Test-1 TP 19-2 Depth to shelf: 36" Depth of test: 54" Depth of hole: 18" Start presoak: 11:50 End presoak: 12:05 Time at 12"--> 12:05 Time at 9"—> 13:06 Time at 6"— 14:21 Total time 9" to 6"-> 75 minutes Rate 25 MPI (minutes per inch) CLASS II SOIL LTAR 0.40 Alexander F.Parker #1848 Massachusetts Evaluator&Certification number Ms.Erin Kirchner,C.H.O. 07/12/19 Town of North Andover witness Date of percolation testing 6 MCG Project#3884 r• O,'NO pTti�y I LZ 3?• COL �1d F S j « . � Town of North Andover HEALTH DEPARTMENT S^CHUSf CHECK#: r�! — DATE: LOCATION: /06 A0r--,t A,-oot H/O NAME: Q. ��- I CONTRACTOR NAME: 4kla Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ I ❑ 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 Systems: ❑ Septic-Soil Testing $ L Septic-Design Approval $X)Jc Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ H Ith Agent Initials White-Applicant Yellow-Health Pink-Treasurer