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HomeMy WebLinkAboutMiscellaneous - 90 WINTERGREEN DRIVE 9/16/2015 e • • i I PUBLIC HEALTH DEPARTMENT "Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 9/21/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Bateson Enterprises At: 90 Wintemyreen Drive :Map 104.B Lot 196 North Andover, MA 01845 Tl uanc of this certifia sha `not be con trued as a guarantee that the system will function satisfactorily. l 'ichele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.coni I v�ryw UUlit;HEALTH DEPARTMENT (ornnrnnity ttevelopnwent Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed;( )repaired; By: � (Print Name) Located at: Flo (ej I�qr MLI t2v'-1 V (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated 14—15 and last revised on ,with a design flow of Pgallons per day. The materials used were in conformance with those specified on the j approved plan;the system was installed in accordance with the provisions of 310.CMR 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: �%" °i`� ✓ � �� � Engineer Representative(Signature) i, [2tA � And—Print Name Final Construction Inspection Date:--O- Engineer Representative(Signature) And—Print Name Inn staller:_ _(Signature) Date:— And—Print Name Engineer: 1 (Signature) Date: And—Print Name 1600 Osgood Stroet, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 a littp://ww w to no northandover.cocit Town of North Andover — Septic ic $ystem - AS-BUILT CHECKLIST J 1) All changes to the design plan have been reflected and noted on the as-built plan 2) As-built plan has a suitable scale; (I inch = 40 feet or fewer for plot plans) 3) Street Address,Assessor's Map and Lot Number 4) Lot Lines and Location of Dwellings served by the system 5) Locations,Elevations and Dimensions of As-built system components,including reserve (if applicable) 6) Ties to all tank openings,d-box,and leach area from dwelling or Permanent Structure Setback distances are shown on the as-built plan from system components to: Subsurface,interceptor&foundation drains Catch basins Property lines V Dwellings or other structures =Private water supply or irrigation wells Watercourses or wetlands 8) Locations of Wells,Drains,Wetland Resource Areas within 150 feet of system 9) Location of water,gas,electric lines,cable,control panel (if applicable) 10) Location of Structures within 6 Inches of Finished Grade 11) Original Stamp&Signature 12) Location and holder of any easements which could impact the system 13) Impervious Areas;Driveways,etc 14) "/"'North Arrow 15) Location &Elevation of Benchmark used 16) STATEMENT ON PLAN (NA 5.3) a. "I certify the locations, elevations, ties, cover material;exposed component covers etc., shown on this as-built substantially agree with the approved plan and have determined that the break out elevations,if applicable,ha vebeen met. Signature of Designer Date b. -'9f a,STUCTURAL WALL IS PRESENT(NA 4.9)a Letter or statement on the as-built indicating the wall- was or was not constructed in accordance with the intended design and any manufacturer's specifications. Signature of Designer Date Revised 3/17/15 North Andover Health Department Community and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 90 Wintergreen MAP: 104B LOT: 196 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering PLAN DATE: 5/14/15, revised 5/18/15 BOH APPROVAL DATE ON PLAN: 6/10/15 INSPECTIONS TANK INSPECTION: 8/4/15 DATE OF BED BOTTOM INSPECTION: 8/4/15 DATE OF FINAL CONSTRUCTION INSPECTION: 8/6/15 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS N/A Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered I Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ® Water tightness of tank has been achieved by visual testing ® Inlet tee installed, centered under access port i ® Outlet tee installed, centered under access pork (effluent filter) ® 24" inch cover to within 6" of finish grade installed over one access port X Neoprene boots around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box N/A 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: 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 — 30x40 w/overdig X Title 5 sand installed, if specified on plan N/A 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 N/A Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: 20x30 i FINAL GRADE Loamed Seeded E T Cover per plan J Comments: DOCUMENTS NEEDED Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan I I 1 1 BM = 134.50 HR = 3.44 HI = 137.94 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT 129.5 Septic Tank IN 8.49 129.10 129.20 Septic Tank OUT 8.83 128.76 128.95 Distribution Box IN 9.48 12ill 128.17 Distribution Box OUT 9.56 128 128.00 Lateral 1 TOP 9.63 / 9.80 Lateral 1 INVERT il27.96 7.79 127.95 / 127.80 Lateral 2 TOP 9.63 / 9.80 Lateral 2 INVERT 127.96 / 127.79 127.95 / 127.80 Lateral 3 TOP 9.63 / 9.80 Lateral 3 INVERT 127.96 / 127.79 -127.95 / 127.80 Lateral 4 TOP 9.63 / 9.80 Lateral 4 INVERT 127.96 / 127.79 127.95 / 127.80 Top of Chamber Bottom of Bed/Chamber 127.29 127.3 1 i I I CRITICAL SETBACK DISTANCES I Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer t ® Property line 10 10 -- M Cellar wall 10 20 -- ® Inground pool 10 20 M Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- M Waterline 10 10 10' M Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Bank 75 100 M Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 M Public well 400 400 M Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 M Drains (Other)Foundation 10(5) 20(10) M 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 rr N I f I �r// ��� �%//����+�j10111I�JIlj(r�7rl�{��II�uJ���� SIY�NPIt17iv161VNfdl�l�ll�%O�JI>4��i N r „r �r /i.,,.y/ ,<,,,..��%h,�,,/� ,,.:.��fe..,Y ���r!��1�/„/��� // ,/ f/ / /„,,.... ✓ r YIiO rr ,� ,,.. r - f.. t % % WWI Vk q n^n w �` IWr,'�nAr mw r Ar "✓�"� �i�" p V�rm !�,�� � k, a r ,�'�� M a � I mrvr taw ter ' �^ � Ar,, W k a JA 1 w w H'w A Ap9b n w wa a 7 r I Po A* 9 m kP "'u�,a aIw r,r bye ryµy yr� A" u a s�'� r A / ;vat! 1 Wf d l 1,ru a u➢ ' A � � Gl 1�9 I';f f � 9 Ada ur rg✓wt ,<w �I u r ,"g � a, r 'r ,�� r l/ / � �YY` �j dr " y v , r // a � O r f� v �f"r ////Ij, Jr DJ r1 % p�� A J Ag"""/i � y pia o, 77 / lit / /ji r h '� I �f /'��//' r/ � /, A r/ � rr'�/tl�✓ p�' li r e. v , 1 1, ti, • Commonwealth of Massachusetts M. lock-Lot • /l%/�%� BOARD OF HEALTH 1oa.golss North Andover Permit No j BHP-2015-0320 J ------------ FEE $250.00 DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson to(Upgrade)an Individual Sewage Disposal System. at No 90 WINTERGREEN DRIVE as shown on the application for Disposal Works Construction Permit No. BHP-2 - 32 _015____0_ __ Dated July 27,2015 ------- - - -- ---- - Application for Septic Disposal S ystem TODAY'S DATE Construction Permit - TOWN OF w� 250.00'—Full Repatr" NORTH ANDOVER, 01845 $72� Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use dKepair or replace an existing on-site sewage disposal system* only the tab key RECEIVED to move your F1 Repair or replace an existing system component—What? cursor-do not C° use the return A. Facility Information 7 f key. Ck Address or Lot# LiOaeC1°k( �'Ci �° Cityrrown ` 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ravity(choose one) * *lf pump system, attach copy of electrical permit to application'*` ➢ &COnventional 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. ➢ 51ftes;the system require an effluent filter? Yes 'lam'"' Na 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) What is the Make? WT/hatis the Mode€y 2. Owner Information _ Name / t W1,r/ati G Address(if different from above) City/Town State Zip Code 9,f 413 Telephone Number 3. Installer Information Name Name of Coin any (OVER L IE- 7V R'LL FfCJr�CJ Address , tVIA 01 1 U f �a City/Town State Zip Code Telephoned Number(Cell Phone#if possible please) 4. Designer Information S> , p td il° I� a. Name Name of Company Address 40 lam/ City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 G w®:7;1a Applicati-od..far Septic .is osai tof11 # 'Monstruction -Permit '— TODAY'S DATE IL a • R 1 ANDOVER, MA 01.845 $.250.00 T Full Repair ncuuS ` $125.00.-Component s PAGE 20F2 A. Facility.Information continued..,. 5. Type'of Buiidin-W ❑Residential Dwelling or®Commercial B. Agreement The undersigned agrees to ensure the constructlon and maintenance of the afore-described on-site sewage disposal system In accordance with the provislons of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulatlons for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been slue ..y this Board of Health. Date i�c Ion Apps ww, d : (Boa d of Health Representative) .. Name Date Application Disapproved for the following reasons: For office Use Onto: 1 Fee Attacbed?: Yes No 2,- ProjectAfjwaget Ohligatron Form Attached? :' Yes Nq_ 31; Pum,�S,�stem? Ifso,attach cony ofElect1rcal Pern�r"t'.•i Yes No 4. FoundatiarrAs Built.?(hew construction-ronly) Yes No (Same scale as approved plan) 4 — " 5. Floor Plans?(hew construction'only).. 1�1 "Yes No ApplCc�tlon'or-pisppsal ysterri: ®nstrUCElan Permn Page 2 Of 2 SEPT. ' . .. 'q -`03 GATIQM r As f$c.Nprtli er ' etl3ba ft fi]o tmcft f ih6aeptic system-for theptop s t: (Add ofs*dc sptem) (bitaces aura Aad dtt d (.Lacmrs u With revisions dated (L=t revised date) I understand the:fol!owIng b bbHgatiotw fat mo nagament of•#hits pra een i. Ae the iaatl I s sabl �nqabaltsptndBotofelth SIppmve4 PUMP921 to p� $any.svatic cin tt edte. Y maw*hs th ohm W,3��;� 2. As f6bo .I•#siii�IIIfor sad aS IElxom' aoatrac y . bQk,.ptojet:tm raga orany o0ttr panca not ttadochtted whh my 6ampaay klw. Wes•aa laaprec#m and the spated n is not ready,then h= aer"bi,�plkable. As thtst Ztntag> ecl to b9vey�vicer7c= ettd.pfldw the.appllgtbjejtcvdss bldkited b,0m•• �, t w: .•s t �t � �;( Jl �d7�t3�� #. $t�1GtC s�r 'w ++s Which al<btil bt�t3rin+:i Iit:" ;teat flit iliape st lout*(c dot have to bqns'etit:•. 6. ' . =ties,etc, �s • t Q �axb t,�Ifi`(ot trm�I ttx 'from the etfg'np&mast be titibi dItfed-to lhe.Bord-of l Ye"ask, Wes# for•lm ioayeci4a pane.'Ii Swllir in t he prcaaat f+a�r tl prnticitt, itl:st ckctrlc;>tr�vc?tk# at be;rratd otsti able to - " 't�aePt'�'•tci�orlc � :tao fad.• , • � •• . , ,. ',. .. .... to - e�t>illt cravat� ripe t tsesn vrbe i Sri!! din is catxtpltte: IasWci doei snot We to be±iiwette.• ' 4. !4 tbt:uastalter,'I named thsit s nag stnl ata wed' • tact aatoptete;t}ie�ieRt�.tlt[a rsf the tryttbra}iic��tt{ �#1i�ia }+etl.;a�rp ,dop�&tr 3tiet�atlon ' . `tt� ak7:�'AfaPtie ava�tcm�. ,NtI, �.t ;t err , 5., liit the.#nat ltts;=Y vt clt:rattaaii t I trntst< eY tx �thO par c e of t fQliMing Et on : .. • a +R: De*=z oadOd dWt!.dfiVpaperela A62 eafMC tarftMdaa hsa' bVM raachCA ' . � Inspe�d'oa o�`tfic eratrd d�,q�a x�aide recd • .. 'Pl�aararpcati'orrbplfaauo?'ai!'`STaiftb�e 'vtcoauhtt d .Ta druat5tc oft lr,D-. #aegp ri Ftorte, pentipump rs, r twit llaad otiar . ad that 1, Uudd Segtic Ift >m pow lyst�c ,..,. I 6 f North Andover Health Department (ommunity and Economi(Development Division 4 June 10, 2015 i Joanne Shaughnessy 90 Wintergreen Drive North Andover,MA 01845 Re: Subsurface Sewage Disposal System Plan for 90 Wintergreen Drive (Map 104B,Lot 196) Dear Ms. Shaughnessy: The proposed wastewater system design plan for the above site dated May 14, 2015 and received on May 18, 2015 has been approved. The design plan has been approved for use in the construction of a new on-site septic system for a 4-bedroom (max 9-room) home. This design plan approval is valid until June 10,2017. 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 of 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. i This approval is also subject to the following conditions: I. 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 90 Wijitergreeii Drive 3 UtW 10, 2015 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, 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. 3. The typographical error indicating the leach field width of 25' on page one of the design plan shall be corrected by either submission of a corrected design plan or the engineer Vladimir Nemchenok may come to the office and amend and initial the change on the plans on file at our office. A, 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, Michele Grant Health Inspector Encl. Installers list cc: Vladimir Nemchenok, 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 Gra%z, Kchele From: wrdufresne@comcast.net Sent: Thursday,June 11, 2015 2:07 PM To: Grant, Michele Subject: Re: 90 Wintergreen street Attachments: Shaughnessy.pdf Michelle My apologies, here is what we have here, somewhere along the line it was corrected but you got the incorrect plan. I Will deliver 3 sets of the correct plans tomorrow. My apologies for the confusion. Bill ........... ....................... .......... ........-............... From: "Michele Grant" <MGran ld)townofnorthandover.com> To: "wrdufresne comcast.net" <wrd ufres n eCa),com cast.net> j2- Sent: Thursday, June 11, 2015 12:45:45 PM Subject: RE: 90 Wintergreen street Bill, Please see the attached. This is the plan we have. Sincerely Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email rTigrant(@townofnorthandover.com Web www.TownofNorthAndover.com From: wrdufresne@comcast.net [maiIto:wrdufresne@comcast.net] Sent: Thursday, June 11, 2015 1:31 PM To: Grant, Michele Cc: Blackburn, Lisa Subject: Re: 90 Wintergreen street Michelle | @nO X}Dt's8dbv your e-mail 3S the plans VV8 have OD record here iO the office for 9O Wintergreen Drive dOnot indicate G leach field width of 25 f8G¢ but in fact 20 feet. The dinlHO8ioD ShOVVD in p|8D view is 20 feet, the text in p|8D view calls out 8 20' x 30' leach field and the Design C@|C'8 indicate 82U' X3O' |88chfie|d. 8Dl | misunderstanding you? P|88S8 clarify. Thank you Bill From: "Michele Grant" To: "Bill Dufresne" Cc: "Lisa 8|aCkbVOl" Sent: Thursday, June 11, 2O1511:34:28AK8 Subject: 90 Wintergreen street Dear Mr. Dufresne, The typographical error indicating the leach field width of 25'on page one of the design plan shall be corrected by either submission of a corrected design plan or the engineer Vladimir Nernchenok may come to the office and amend and initial the change on the plans on file at our office. Please indicate how you would like to precede. Regards, Michele E. Grant Public Health Agent Town nf North Andover � z6OO Osgood St | Suite ZO55 North Andover,xxA 01845 Phone 978.688.9540 Fax 97&688.8476 Email Web All eOla'| messages and attached content sent from and tO this eDMa'| @CC0UDt are DUb|'c [eCD[JS unless OU8|'f^eH as an exeUlDt'DD under the Massachusetts pUb|^c Records Law. Visit us online a[ www,townofnorthandover.com Blackburn, Lisa From: Dan Ottenheimer <dano @millriverconsulting.com> Sent: Wednesday,June 10, 2015 5:32 PM To: Grant, Michele; Blackburn, Lisa Cc: 'Isaac Rowe'; Pam Lally Subject: Plan review, 90 Wintergreen Drive Attachments: 90 Wintergreen Drive Approval letter June 10 2015.docx Michele, Lisa- Attached please find our plan review letter for the onsite wastewater system design at 90 Wintergreen Drive. We are recommending approval of this design with a condition that a typographical error be amended to prevent any confusion occurring during the construction. Please feel free to contact me should you have any questions. i Best, i Dan Mi I I Rih i consulting Daniel Ottenheimer, President Mill River Consulting, Inc. 6 Sargent Street Gloucester, MA 01930-2719 978-282-0014 x 802 www.millriverconsulting.com dano @millriverconsulting.coiri Member: Massachusetts Association of Onsite Wastewater Professionals, Massachusetts Environmental Health Association, Cape Ann Chamber of Commerce, Gloucester Rotary Club, New England Water Environment Association Grant, Michele To: Bill Dufresne Cc: Blackburn, Lisa Subject: 90 Wintergreen street Dear Mr. Dufresne, The typographical error indicating the leach field width of 25' on page one of the design plan shall be corrected by either submission of a corrected design plan or the engineer Vladimir Nemchenok may come to the office and amend and initial the change on the plans on file at our office. Please indicate how you would like to precede. Regards, Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant@townofnorthandover.com Web www.TownofNorthAndover.com i i 1 Blackburn, Lisa l From: Blackburn, Lisa Sent: Monday, May 18, 201S 1:11 PM To: Dan Ottenheimer;Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 90 Wintergreen Dr. Good Afternoon il will be mailing out septic plans for 90 Wintergreen Dr. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iaackburn@townofnorthandover.com Web www.TownofNorthAndover.com 1 TOWN OF NORT11 ANDOVER 11.1ice of "O11JN11' ' 1E ELt I'tl'VI:ENT AND SERVICES HEALTH DEPARTMEN17 1.600 OSCt" OD S'I'R EFT; SIJI'M 2035 NORI'lt ANDOVER, MASSAC,t.:CUS "f'S 01 8-45 9'78.6M9540 - Phone Susan V. Sawyer,REHS/ S 978A8.84'76 F""rl: Public Health Director 17,-M/4 @° 1¢ ° x ....n...g$.u.rrt6nanc._c7_ve..::.c,cm W1 i'q_6.6 _ ,rjtj�//w%vww,,;gawvrri�t ic rtlt rr7alovcr.c_orri SEPTIC PLAN SUBMITTAL FORM Date of Submission: r Site Location: olo `mil-I et ed a Ll Engineer: L(ZA V eW1 % New Plans? Yes V/$225/Plan Check# (includes ls' submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes—Z No Local Upgrade Form Included? 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OEP has provided this form for use by local Boards of Health. Other forms may be uaed, but the information must bo substantially the same aa that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. ��~�N� KN��^�������~��0� ��en0|ingout ""~ ~°~~ Information °" forms onthe computer, use Joanne Shaughnessy only the tab key Owner Name � to move your 90 Wintergreen Drive � oumo/-donc$ Street Address or Lot # use the return key. North Andover &4A 01810 Qtyrrown State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 5-30-15 12 pm Date Time Date Time Observation Hole# P-1 | Depth ufPere 8411 ( / Start 12'2O Pra'@ooh � End Pre-Soak � ' Time at 12'' 24 Gal's used � Time at8^ Time at 6" Time (9"-6") Rate (K8in.8noh) <2 Test Passed: Test Passed: Test Failed: E] Test Failed: �] William Dufresne Test Performed By: | Isaac Rowe � Witnessed By: Comments: � t5fonn12.don 06/03 PemTeo ^Page 1of1 � ,' :�•� rte; , _ � � i � i _._ � 1 � � ' I i , i a i I i i Blackburn, Lisa From: Blackburn, Lisa Sent: Thursday, April 16, 2015 1:43 PM To: Dan Ottenheimer;Isaac Rowe; Pam Lally Cc: Grant, Michele Subject: 526 Winter St. Attachments: 201504161356.pdf Good Afternoon, Attached is an application for soil testing at 526 Winter St. -----Original Message----- From: noreply tonofnorthandover.com [mailto:noreplytownofnorthandover.com] Sent: Thursday,April 16, 2015 1:56 PM To: Blackburn, Lisa Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 04.16.2015 13:55:59 (-0400) Queries to: noreollv@townofnorthandover.com 1 i I a• TOWN OF N Dwm ANDOVER Office of COMMUNITY DE Na;LOPMENT AND RVICE 1600 OSG'00 D 511 1 1"; SUITE 2035 MSG 11-1 .ANDOVER, C ASSA 'L.f[1S F.i,S 01 845 J I Susan V.Sawyer,111FIIS, RS 97Ya.688 9540 Phone Public Health Director 9'78,688,8 476 ....FAX heafthd,aga!@;1u r;_c4tigg thane.it yer.cw n, www,towaiol'iiorthandovca°.aeon APPLICATION FOR SOIL TESTS DATE: "°` 1 MAP&PARCEL: 1 �✓ ' 1 4 LOCATION OF SOIL TESTS: ° OWNER: W -jV+Au fl ct#: APPLICANT: Contact#: ADDRESS: ENGINEER: Contact#:��' 47°--:" - 7 5;`�; y1 CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision mgle Family Home Commercial l 2015 Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition: t`O 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 Il"Plot plan do Location of Testing(please indicate test pit sides on the plan) Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of 3$ 60.00 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): � I L 0-1 V-7 ,y j : k 1 I u. lit6'• ... � � I 1 VAN I � �