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HomeMy WebLinkAboutSoil Testing Results - 394 BOSTON STREET 12/28/2007 TOWN OF NORTH ANDOVER Office of COMMUNITY Y DEVELOP MIN"T AND SERVICE"s HEALTH DEPARTMENT 1600 OSGOOD STREET;IWII DING 20;SMITE 2-36 NORTH ANDOVER,MASSACIIUSETTS 01845 978.688.9540—Phone Susan V.Sawyer,REHSIRS 978.688.8476-FAX Pnblic WOM Di—to, E-MAIL hp,althde t<tq f Ihgndov wEHSITE:i ://www.lownofnorthandover.cq SEPTIC PLAN SUBMITTAL FORM Date of Submission:__L?-Z-7Ai Site Location: �7°l nO�oP� Ca'I K-ECG"{' Engineer: M k.rV_-- EAOE �2,Ph New Plans? es - Check#_�j(�2i'l (includes I't submission and one re- review only) Revised Plans?Yes $75/Plan Check# �� Site Evaluation Forms Included? Yes✓ No JAN 1)MUS if1 rllt f71 fAIVl7f}�^l:l�f Local Upgrade Form Included? PA--Yes No is o PAR 1iM 1v Telephone#: (`17J��1�i'7�/r7 t'i VZ©Fa.#: 174,) `�r-�''�`'���✓ E-mail:--*Jr, Li F12Eaj Homeowner Name: .1OYGE OFFICE USE ONLY When the submission is complete(including check): ➢ Date stamp plans and letter ➢ ' ,_Complete and attach Receipt ➢ ___Copy File;Forward to Consultant ➢ _ 2.-/ Enter on Log Sheet and Database Location:" .Oe�F'>. :TT" Onver's Nome 14�'1�fl,-,0<e cUnpfparcel: !0•.� b Addmss: !j V'/u'�` tJfh..� C7' Instdlec Tel V. (4015- ?e� .Nee Bnot-__Repsir - Date: J2•y't7"� Wepnnds Ltco7naeII=S.RSnobol _SoIl Nhme �tar�°�°;:.rt SaR Qtn Deep Observation Hole Logs El.%don Depth S0111161zon Soil Texture SnR Color- Sollhtottline. %Gravel,Stang,etc: 1" �h 95. Pvm{niNerid. 'f-1 Li.. IkpWp&dn�_b'W4gWx¢WMcHde` WespinermmF��f.1Y ',. IZF ��•c.. Zs s�� l�e� LS3 P{ Vv ""i" P�emlALletW .��.1. lkptpM Bdr.e�&�.V.t Wna4asHda_Waeplo=fnnraF��_EffiCW��F` • Date � -5-. 7 Percolation Tests c Observation Hole& - DepthofPcv '3 90-M tJ, Startpre-task o:e Time at ux Time at 9" Time at6" Time(9"-6")_� 'L Rate MioRarb . Performed By;_ �r.1. ()I`% ., Vrit- ed Ry- Commonwealth of Massachusetts '..... IFFCityfTown 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. 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. A.Facility Information Important: when fining out 1. Facility Name and Address: rums on the computer,use Joyce Perocchi Residence only the tab key Name to move your 394 Boston Street eureor do not se so-eetnadreee u the return key. North Andover Me 01845 Citylrown Slate - Zip Cotle 2. Owner Name and Address(If different from above): Joyce Perocchi 394 Boston Street imm Name _. _. _.. Street Atltlress North Andover Me City/Town _... state 01845 _ _. _.. 1978)663-8784 Zip Code - Telephone Number -- 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bdrm,House 5. Type of Existing System: ❑ Privy ❑ Cesspool($) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system(trenches,chambers,leach field,pits,etc): Seepage Pits t5foim9a.doc•rev.7106 Application for Local Upgrade Approval-Page t of 4 Commonwealth of Massachusetts WVCityfFown 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. C.Explanation(continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None Available 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." J /i 12-26-07 jn y owner•"signature Date Joe Perocchi Print Name BIII Dufresne/Merrimack Engineering Services 12-26-07 Name of Prepm r Date 66 Park Street Andover Preparer's address City/town 01810 (978)475-3555 State/21P Code Telephone t5f—ga.doc•rev.7/06 Application for Local Upgrade Approval-Page 4 of 4 `h J \� r •�"��1iV t I s� G O�, CN 01 ,?s � a s �o i r i m r,l,. flI A I, �