HomeMy WebLinkAboutPlans - 29 GRANVILLE LANE 7/10/2015 TON11"N OF -NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARY.NIENIT
St7
1600 OSGOOD STREET; BITILDING 20-, JTE 2-36
NORTH ANDOVER. MAS SACHT-7,SETTS 01845 A
97C.688,9540-Plime
Siisi
5 iiY. Siii-Ner,REHS/RS 978.658.8476-FAX
Public Health Director E-NLUL
"�VEBSITE:
RECEIVED
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: July 10, 2015
TOWN OF�,,�ORI B MIDOVER
H LA.`PAR fMEN1
Site Location: 29 Granville Lane
Engineer: Scott P. Cameron, PE - The Morin-Cameron Group, Inc.
New Plans? Yes Z$225/Plan Check#60306 (includes 1St submission and one re-review
only)
Revised Plans? Yes ❑$75/Plan Check#
Site Evaluation Forms Included? Yes Z No F-1
Local Upgrade Form Included? Yes Z No F-1
Telephone 4:978-887-8586 Fax#:978-887-3480
E-mail:scott(?
,morincameron.com
Homeowner Name: Robert Lanigan
OFFICE USE ONLY
When the submi sion is complete (including check):
➢ V Date stamp plans and letter
➢ L/ Complete and attach Receipt
➢ Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
The Morin-Cameron Group, Inc. Bank W v ,
447 Boston Street;Suite 12 America's Most Convenient Bank®
Topsfield,MA 01983 53-7054 2113
978-887-8586
CHECK DATE y
7/9/15
m
PAY Two hundred twenty-five & ---------------------------------------------00/100 dollars
ro
AMOUNT
TO Town of North Andover $225.00
c
8
LAN3 3 70
AUTHORIZED SIGNATURE
The Morin-Cameron Group, Inc. 60306
Lanigan 3370 — Septic app. fee $225.00
60306
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Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:when
filling out forms A. Site Information
on the computer,
use only the tab Robert J. and Maureen M. Lanigan
key to move your Owner Name
cursor-do not 29 Granville Lane
use the return
key. Street Address or Lot#
North Andover MA 01845
--- ----- ----- ------- ---------- --
rQ City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
06/18/15 09:53
Date Time Date Time
Observation Hole# TP15-1
Depth of Perc
53"
Start Pre-Soak 09:53
End Pre-Soak 10:08
Time at 12" 10:08 _
Time at 9" 10:12
Time at 6" 10:16
Time (9"-6") 4 minutes
Rate (Min./Inch) 1.33 mpi
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Alexander F. Parker
Test Performed By:
Mr. Isaac Rowe _
Witnessed By:
Comments:
t5form12.doc•06/03 Pere Test•Page 1 of 1
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.
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 CM 15.000.
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address:
on the computer,
use only the tab Robert Lanigan
key to move your Name
cursor-do not 29 Granville Lane
use the return Street Address
key.
North Andover MA 01845
r� City/Town State Zip Code
2. Owner Name and Address (if different from above):
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Single family dwelling
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
Septic tank, pump chamber and leach field
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach Field
Local Upgrade Approval.doc•rev.7/06 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: 440
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: 444
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: September 23, 2014 date of inspection
2. Describe the proposed upgrade to the system:
Install new two compartment septic tank, 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 less than 2
min./inch
Depth to groundwater 4' proposed
ft.
Local Upgrade Approval.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
°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.
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:
Isaac Rowe June 18, 2015
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:
Topography, wetlands and existing dwelling location limit available area for SAS.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
cost
Local Upgrade Approval.doc•rev.7/06 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;
Abutting septic not failed.
4. Connection to a public sewer is not feasible:
Not 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
Z 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 elib to violations."
-7°7 Facility Ow w er s Signature Dale
Vt,6 evr 4J , Inwf6-A
Print Name
The Morin-Cameron Group, Inc.
Name of Preparer Date
447 Boston Street Topsfield
Preparer's address City/Town
MA 01983 978-887-8586
State/ZIP Code Telephone
Local Upgrade Approval.doc•rev.7/06 Application for Local Upgrade Approval-Page 4 of 4