Loading...
HomeMy WebLinkAboutMiscellaneous - 440 BOSTON STREET 11/24/2015 (3) 0 ro 0 0 M 0 0 0 3 (A m cn o o 3 3 0 a) = * 0 CL 0 C 0 0 Cl) (D CL cn 0 m o M (D =3 U) cn z (D -0 El 0 =r cr 0 0 =3 0 0 0 U) <LO (D 0 m m Al C- (D (Ey r 0 o (D CL L 0 0 0 to CL C =r o (a :3 0 U G) (D 0 0 c CD (D A) 0 (D CL P' (1) --1 0 C El CD 0 CL -< 6 5 T 0 (D (D 1 CD — U) m 0 Et (D CD 71 CL —41 (D =3 rlj P� 0 00 9 < :3 0 CD 00 (D (D 0 0) OD M. :3 :3 M Z RL (D 0 El > C) c 0 0 —h (D cn 2 0 0 C) -1 c -n co R (D Q0 r- C: (D 0 3 (D 0) < 61 (D (D (D 2. (D m = 0 U) :3 c) C: 0 9 (D 0 0 CD cn 9 (D W :3 CL iD' ❑ p =%CD CD=3 0 C: (D . > ::E (D m (D CD 0 cn 3 0 m 0 0 rt :3 =$ 3 CD cr CL 0 2: EP =3 m -n 0 @ cn (D 0— (D at =CL c a) (1) =$ (D (D 0 =3 0 m U) U) El (1) CD cr in 0 0 -< C C:(D 0 0. co ran(D (D (D 9 cn ro V) cu CO) 0 ElU) -n 03 g m CD m CL m N) 0 z (D 0 0 0 N 0 00 m a D n 0 Q tD s fD RO 000 O Cll o v O cn 6 Z r2. m m I ® (7 Q7 Y K o rt o m �- 2. =3 C =r 2 CD� A Eo o Es vi, C)O C O rr d Z N -� -G c O C CD Ua M 3 n W ® (® =3 cr C .-o ®. (p Q v U N ro 00 ' A a � :(7 O Ol o 00 n m c o ID rt TI -n V1 (n CO) CL CL I lv p 0 D a a 3 3 ..m ch °' a c0i v am YI tpn goo (0)O W M O N N _cl o (n o U) CD in c c o N e� o U) o 0 m CY cD -o (D o s w m o � 00 y O w N 1 no 0 0 M G) -o ® G) o ® -e 3 CD in 3 ( Q C V I m vii (D M 0 X p -a p ❑ (v' 3 -i d p :T cr ® s < _ �_ _ a O C N (O/) to C m' -h (L7 (D ro =" ® o C ® p _ _ CL 2) d = O s=u O 0 z 0 < f11 0 = (D ct (D 'W N C) C K Q pf O r9 =3 El Sy �° -, a = r ®. � (D (D W c N (D rF (D CD (p 0 c CD ❑ O. T� m ro p N n (�.) _—a � o e '"� s s = Z < N m + = n El ro m 01 m O = .« 0 (' Gn ❑ tD r 0 > a C _ m (D N 0 n C) -n Cl' (o r N o m (0 ::z r C o m (D m CL I 0 N C'ti ( (D (DD K (n :3 (D (D 0� -1 y (g c 0 n (D m C) m m C o TL (D ? 6 U) C ��- ❑ M. m j tD« = Er D m m(n (A (D (D '* (D (D n rt 3 @ B -n Q' O T ®_ } ~ rG O TI m ° m C �• 7 O O E S = > ° p m 0 @ CL ° Vmi U) Q U) c° ' a U) m w CD =r w Q (D m U) m 0 CL ❑ c w � c cD ® m m _ p m Q .. N f0 N O z U) W CD 7 O n a o 4' m o ° o a i i o 3 J> 0 (� ,� Cn O 1 _' Ll o _ m O 0 0 p fly : CO) N O in O ca Z 0_ ;2 :D 1 o n W D mo r' 0 0 0 � s a :3 =r 0 CO) 2 (De E o. 0 � O fA 0) W7 �x 4) W CD cr A O O '! ®. O a _— y 7 (D f O O ,r✓ W a k N �! 3 to O O 2:® o c� c CTI n N o 0 flI iU 0 3 CL K �G C -i 1 O i U) a o 2. CL 3 v G) o <o n, tD v m u »v e O 3 M U) N � e®e O n> v su of in c c n U) CD v v m m n `D ° v DO o ®�'_ N' a C7 0 cD fD !D w m O rn ? to O 0 9 OD i CL o o n v CD ❑ ® ❑ ❑ � rt m ® OO � C ® ® ® o (D o N O O j O o a Q 1 41 cf) a �° �A — .ja Cn mC a, O -0 (D V/ a ❑ cn OL N a ° I I ° X '3 � z a a a =3 ® CD OJ o 0 � ro to cr(D ~o 0) ' C c m r m U) ? (D �' c O c m cr In tti a N cR @ 2 o O cn m a �° I c N w _ N 0 ro N rn `� o 2 CL V� cn cn a o � ® I 3 ac I I ° (D P17 El cD a, m m r« O su' COCOS ® a (D G ro m cn > > N > > O 3 rt 3 3 :7 3 N Cl) o N N C/) `� `� � cn cr 3 N = = 2 X X N N N Q I `ief N -r 3 ro a rt c o r ° o o c :E o 000 o aar C CD o a c c oroi o rn a Q ® v N' O N v o I7 = 0 a °) s s am N C(DD OD O l; � I 1 z 0 a D o o < ' m m ® E- V o a ® ® 0 o o r" ° O `C O a q can a�i u �� 'OD �_ -0 ffi N N (D -0 0) z V = � rr '�' O @ ® M "a E] 3 � 0 ®• I I z a ( X a `� (�A O O = N Q m a CL =3 t�°h CD ,=p; O T N n O (D O a M. o/? 0 O cr o' cD c ® C (D Yom/ N a O O ( S p OM C pl J C (DD O 3 � m (DD M °' :E O ::r :2 Q (!1 (D T1 lu °r O O a (`�i (D cr ro y a a 9 C I v N m (D (A m CL 3 CD N c c (D ::E O -Z ° ro rt n 0 00 o a 07 3 u � �' C � rlt� 0 aai m °' m <D cn N (A a cr a vD n n Z x NU) OL (n =r I `° m O rt C d N• ® 0 c0c 0�/� C S C n C=i 0 0 cr V� ro ro O N (D (D1 ((D N O O c = a CD CL OL o w U) (D cn cn C N a OD a. 0 s D a U, w ry (°� o o m rn ,) °a ® r 0 G) r ® -t -� s� o at o @ °� r„ = ai o n 3 m _ = = ' Q 0 (n Ga � 0 Co N ® (D (D " :3 (D (D m pp O p cfl N (D n O ®a _+ O (D a :3 C (D C ® CD 0) 0 U) 0 N � W CD m d � 0 OD e < -* (p d U)al 0 n O m @ oo ro m o 0)' "' oo o 0) cn N m ❑ tD ,- ry D c'D 3 Q. o ;7 M' 3 0 c� 3 ' � c ,< a I s N 1 V1 (S fn Q MIL 2. (D 0 0 ( CD Cl) 0 O m (D p O (D /q c Vr ❑ p) N 7 a CL w N cn (D CD N (D N Err co N 3 0 (�D (D O p Q -r Q Q Q -1 ® N C `t r• N � .�-' = ne fD n q s :3 (n 0 (D @ pV/p� N (D ❑ v u�i V ° m e a B (D �. m (n @ ® cn ? M C/) U) W ❑ v U S' w W @ v - ® m � N (n cD (u 0 Z rt c w (D = O N O O= (p (D o i o a P, b Q o o @ 09 (12 'C) p �! CL Q N 000 W v O F rt = = O v ° ® CO) N Z Or1 = CD (D 1 m W b N O (D co 7 :3 Q� �' A ®fi E o O *• :3® ® ro Q AJ !Q O C) Z C O N R. O G N 0) C) W e. 3 W rt C7 as =3 ®o C O fD ®. (o Q O OND V W CL C) 3 N O a 3 C�1J1 ® t7 G 3 o ro '.. Nw C (n m o rt � -n —n N U) 3 (D c0 ,C W-1 �p1� I O > �+ 2 D° 3 3 y fD cn Cl) C G) °° K m T RO n O @ NN Wo ca ® a m ° (p o co We O o� CO) 10 4 in c e n U"1 rt u) v c� fD ° °. 0 N (D w ° lD CD v O C K w cD ° co EP Yi z 0 -n -n o o o 0 ;;: 0 M l< z z 5T ,:� 0 T Q) D_ (D 0 -1 :� m — 0 o ig CD < =r rol 3 Q) Q C m 0 w m 0 M m M a) q E o cg (v®N i m o 0 0 0 0 & Rz M. (D :3 03 0 C: (D , = 0 * M. C_ - E3 CL =3 =r 0 0) 0 0 0 0) 0 CD 0) M 0 21 m C/) 2. 0 CL z 21 3 0 rq- m z Xwr* =r w a C) 0- 3 CL m 3 =r ots 0 P, (D =3 9: —W =r 3 T 0 �, > CD n x cn :3 =r g 0 (/) 0) 0 0 (D C CL(D m 0 0 (0) w 0 co ®1 < (a O(D m 0 o (D A) 0) 0 < 91) -1 0 o :r -4 CD cr (D a) — c CD <p=j o (D 0 :3 =r =r U) (D T m 0 rl) 0 =r =r (D -;« 0 M M CD Er K a (1) 0 70Z r-r (D 941, M -0 & - � � M 3 cp =3 - ,-a 3 C =r M D '4� ca C) CD =3 71 cr =r 0 (n 0 m 0 3 3 CL CD m 3 3 3 =) _h cr =r cr < 0 0 5-11 OL 0—_ (D - R 0 (D -n E r -.4 U) 0 — co Z CY) 0 > 3 0 o D) to CF) D < N) U) (D cn !Z > C3 M 2. M CL a) 6 o 0) C) (D < 0 C: CD C) co (A (D 0 5* @ > OL W -0 U) 3 ElF Qa ® (D 1 0 0) 0 (D 0 U) ro 0 0 (D 0 1 X -0 U) =r al m =r (D M (D CL a (n (0 U) CD (D (D 2. 0) 0 0 0 <M 0 M® X =3 E o ca: cD ill (D 0 0-n :3 =3 0 C- 0 D* W (D -4 0) 0 CD 0 co 3 i o y 1 Z s D o _ o o K O C ro O co oCD z o � ® (D y Q CO) :3 ° ® N oa Cr ®. cn tD ch CA (D N (A tD O -„ 0 3 0 CA 0 v> wr 0 c v (D D w m 3 rt _ O gy�p/I�° V Cp O cn fD r{ pl iD Q O O N AI tD co O -n co I Commonwealth of Massachusetts City/Town of North Andover - - - Percolati®n 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 A Site Information filling out forms on the computer, use only the tab Frank Villalbos key to move your Owner Name cursor-do not 440 Boston Street use the return Street Address or Lot# key. North Andover Ma. 01845 City/Town State Zip Code Contact Person(if different from Owner) Telephone Number 'E B. Test Results Aug 20 2015 10:18 Date Time Date Time Observation Hole# P-1 Depth of Perc 64" Start Pre-Soak 10:18 End Pre-Soak 10:33 Time at 12" 10:33 Time at 9" 10:40 Time at 6" 10:49 Time (9"-6") 9/3 = 3 i Rate (Min./Inch) 3 min per inch Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Doug Smith Test Performed By: Issac Rowe Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 TOWN OF NOR'I'Il AP I)OVEI, Office (A I IJ NI.. 1 Yl ; I . l.l . l.lIN l' ND SERVICES HE A1,11-1 DEPARTMENT 1 1600 Ow"'9VGOOD STREET; St'ATE 20 NORTH ANDOVEIZ, MASSA4_'H6.1SF T"I 01845 978A8.9540 Phone Small Y Sawyer,RHIS/Rs 9 78.tflf8.8476 FAX Public Health Director �°°;-P��4L @ret/It@a�kc_hr��ar t���wjaolr},cl�t��aK�GI�7vc� alt BSIAI;'E,: kattt�>//Nvww,townof_iio tli iii(iovc co'ti SEPTIC PLAN SUBMITTAL FORM ` '' I Date of Submission: ' 2-0 1 511,11" 1 (") ,110 � Site Location: C �, 1°G�.../�,1m��b Dt..!1AR i%,",�J r s Engineer: �uG� New Plans? Yes_Z$225/Plan Check# (includes Is'submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes l/ No Local Upgrade Form Included? Yes V' No Telephone#: 620S H � 2-29 9 Fax#: E-mail:—(-3 o 1 L 0 L_ U I Name:owner g1)-til V l l I o OFFICE USE ONLY When the subm' Sion is complete(including check); ➢ Date stamp plans and letter ➢ � Complete and attach Receipt F Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database i TOWN OF NOR"I'll ANDOVER Office of'COMMNITY DEVELOPMENTAMD SERVICES HEAUTH DEPARTMENT 1600 OSGOOD s,rult,T; SUITE 2035 NOR`FI ANDOVER, MASSACT IUSE.,f TS 01845 97 .688,9540 -Phone Susan Y, Sawyer,REHYRS Public Health Director E-MAIL: @igal_hade (c)oNNtic)9``il)t,tliatit;lover.co�ii SEPTIC PLAN SUBMITTAL FORM Date of Submission: ��' 2-0 15 Site Location: � � 0 6 os-i-OVl si ee Engineer: ✓i S - �1 I �so) Ls New Plans? Yes _Z$225/Plan Check# review only) Revised Plans.Yes $75/Plan Check# Site Evaluation Forms Included? Yes V No Local Upgrade Form Included? Yes V No Telephone#: &d S H R-� 2 2.9 9 Fax#: E-mail; ©ti L s m O L.. b CC) I/Y7 Homeowner Name Fr y+vl "l Vi L I V-) L6 6, D � c Li q0 S-t"t-e�f n m'-0 RVJ 0(ICA OFFICE USE ONLY When the submission is complete (including check): Date stamp plans and letter Complete and attach Receipt > Copy File; Forward to Consultant );> Enter on Log Sheet and Database 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 ofHealth 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 CIVIR 15.404(l), 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 CIVIR 15.000, require a variance pursuant to 310 CIMR 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 15.0M A, Facility Information Important:When filling forms 1. Facility Name and Address: on the computer, key m move your Name cursor-do not 44D Boston St | use the return \ key. Street Address � w� North Andover K8o 01845 \ Cityrrown State Zip Code � 2. Owner Name and Address (if different from above): � Name Street Address � City/Town State Zip Cnda Telephone Number 3. Type of Facility (check all that opp|y): E Residential El Institutional 0 Commercial El School 4. Describe Facility: existing 3 bedroom house 5. Type ofExisting System: El Privy Fl Cesspool(s) F-1 Conventional Other(describe be|ovv): � existing tank and system G. Type of soil absorption system (trenches, chambers, leach field, pits, etc): unknown t5fonnga upgrade 1 NORTH ANDOVER 44o BOSTON`rev.n/06 Application for Local Upgrade Approval, Page 1uf4 i i Commonwealth of Massachusetts City/Town of North Andover Approval Form 9A - Application for Local Upgrade t 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: 330 gpd Design flow of proposed upgraded system 330 gpd Design flow of facility: 330 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: date of inspection 2. Describe the proposed upgrade to the system: 1500 gallon 2 compartment tank, 1000 gallon pump chamber, and a 600 sq. ft. stone and pipe system 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: 1' Separation reduction ft Percolation rate 3 min./inch " Depth to groundwater 28ft t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval• Page 2 of 4 i Commonwealth of Massachusetts City/Town of North AQdOV8[ ������� ��� ,� � ����Q~�����"<��� ��� Local Upgrade �� ����������U Form~~^ ~~~ ~ Application ~~-^ ��~�~-~�~ ~~n~��~~�~~~~ 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 asthat provided here. 8afona using this form, check with your local Board cf Health to determine the form they use. B. Proposed Upgrade of System (continued) 0 Relocation of water supply well (explain): Reduction of 12-inch separation between inlet and outlet tees and high groundwater Fj Use of only one deep hole in proposed disposal area Fl Use ofa sieve analysis aoo substitute for mpenntest Fl Other requirements of 310 CIVIR 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 to31OCK8R16.4O5(1)(h)(1). The spilwmalumtormnmst be nnmonber or agent of the local approving authority. High groundwater evaluation determined by: Douglas Smith August 20 2015 Evaluator's Name(type orprint) Signature Date ofevaluation C. Explanation Explain why full compliance, am defined in31DCK4R154O4(1). is not feasible. (Each section must be completed) | 1. Ao upgraded system in full compliance with 31OCK0R15.00Oh* not feasible: This iU allow system to fit in desired location and fit the landscape nicely 2. An alternative system approved pursuant to 310 CIVIR 15.283 to 15.288 is not feasible: this is the best option for this property t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON-rev.7/06 Application for Local Upgrade Approval* Page 3 of 4 Commonwealth of Massachusetts C of North Andover . Form 9A — Application for Local Upgrade Approval OEP has provided this form for use by |000( 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. Ashared system is not feasible: A shared system is fea ibi| 4. Connection boopublic sewer ie not feasible: muncipal sewer is not available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (oheoh the appropriate boxes): 0 Application for Disposal System Construction Permit Z Complete plans and specifications | Z Site evaluation forms � El 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, mocuraba, and complete. | 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 vio|aUona." Facility Owners Signature Date _~ Print Name � � Doug Smith Sept 1 201 Name ofPrepomr Date � 15 Foxberry Drive New Boston Pnepmmr'ooddmoe City/Town NH 03070 6034872298 Gmke/Z|PCode Telephone t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON rev.7/06 Application for Local Upgrade Approval*Page 4 of 4 � � Commonwealth of Massachusetts C of North Andover � Application for Local Upgrade A provaU Form �A i | OEP has provided this form for use by boo( Boards of Health. Other forms m y be used, but the � information must be substantially the same as that provided here. Before using this form, check with your � |000| Board of Health to determine the form they use. | Form )A is to be sub he 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 CIVIR 15.404(l), is not feasible. - - 0yoham upgrades that cannot be performed in accordance with 310 Ck8R 15.404 and 15.405. or in full | compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 GIVIR 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 CIVIR 15.000. . A. Facility Information Important:When filling out forms 1. Facility Name and Address: on the computer, use only the tab r."..°V key m move your momo ~ oursor-dvnm 44U Boston St use the return key. _ __ North Andover K8o 01845 City/Town State Zip Code 2 Owner . � Name Street Address State Zip Code Telephone Number 3. Type of Facility(check all that gpp\y): Z N$midenUn\ n Institutional F1 Commercial [] School 4. Describe Facility: existing 3 bedroom house 5. Type of Existing System: n Privy El Cesspool(s) [l Conventional Other(describe bo|ow): existing k and system 8. Type of soil absorption system(trenches, chambers, \aooh Ua|d' pits, eh): unknown � imbnnVa upgrade 1 NORTH ANDOVER 44O BOSTON^rev.r06 Application for Local Upgrade Approval*Page 1pf4 1 i I Commonwealth of Massachusetts City/Town of North Andover a 0 Form 9A ® Application for Local Upgrade Approval � t 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. i A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: gpd 9pd Design flow of proposed upgraded syste 330 m gpd Design flow of facility: 9Pd0 B. Proposed Upgrade of System 1. Proposed upgrade is(check one): i ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: 1500 gallon 2 compartment tank, 1000 gallon pump chamber, and a 600 sq. ft. stone and pipe system 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)—describe reductions: i i I ❑ Reduction in SAS area of up to 25%: SAS size,sq.ff. %reduction ® Reduction in separation between the SAS and high groundwater: i Separation reduction 1' Percolation rate 3 min./inch 28" Depth to groundwater tt i t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 ..................... i Commonwealth of Massachusetts Cityrrown 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. 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 i ❑ 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: i 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. I High groundwater evaluation determined by: Douglas Smith August 20, 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: This will allow system to fit in desired location and fit the landscape nicely 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: this is the best option for this property �i t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 I I Commonwealth of Massachusetts City/Town of North Andover 7 Form 9A - Application for Local Upgrade Approval l 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. . l C. Explanation (continued) 3. A shared system is not feasible: A shared system is not feasibile 4. Connection to a public sewer is not feasible: munci p al sewer is 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 ® 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): I D. Certification "l, 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." CX i c /' 0 105 Facility Owner's Signature Date FrankVfli- s V►11Ilabog Print Name Doug Smith Sept 1,2015 Name of Preparer Date 15 Foxberry Drive New Boston Preparer's address City/Town NH 03070 603 487 2298 State2lP Code Telephone t5form9a upgrade 1 NORTH ANDOVER 440 BOSTON•rev.7106 Application for Local Upgrade Approval,Page 4 of 4 i I 1 I f � e, _ c. I 177 � � I �� - ! �., � � ��� �ru�✓��w�, ��J J�G����un „yn�r�wR��l!��l��r,;r�r � � � �' ���,� �us�l��n it � 1�1,. i r^ TOWN OF NORTH ANDOVER Office t1` W.M 1JN 1' p V EL EN p AN SERVICES HEA1,311 DEPARTMENT ` 1600 OSf.GOD S'I"1 .Pal ,r; Sl.i1'I E 2035 N(.)1 "1'1-1 ANDOVER,R, MASSAt`1J11Sp. l-rs 01545 Susan V.Sawvyer,REHS, RS 978.688.9540 Rhone Public health Director 9786888476 I�AX 1 ,��,k,�� �„� �� ' ��� healthd to�vw,tioiijor Gh<urudova r. oiii www.townoli oilhandover,corn ko S ,j APPLICATION FOR SOIL TESTS 'aw � ' ” 8/4/15 107D -3-0 DATE: MAP&PARCEL: LOCATION OF SOIL TESTS: 440 BOSTON ST. OWNER: FLANK VILLALOBOS Contact#: 978-681 -8698 APPLICANT:Frank Vlllalobos Contact#: � " ADDRESS: 440 Boston St. No. Andover, MA 01845 ENGINEER: Douglas Smith Contact#: 603-487-2298 CERTIFIED SOIL EVALUATOR: Douglas Smith Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:X Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X 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: j Signature of Conservation Agent: ..� o 6'�c ��� \\ t Date back to Health Department: (vtamp in): �.n J.s . � � M I,.., caw. _ I,t , I 1 Y 131 UZ [ ° w ` a � a7 adf•£ a'- � 1 bC r� ~ , w. / G w m S-07. s6F�52 F1--1 Q O "Y p 4,-L j N U k fq � 00 yN p ry'n Zb.'i H }A Q 0 N p ryy .r a ryy � s b S�bL, 68F 3 Y g �v vq "ryv bl a 3a h a h o > ] o a a a x w a `�aA i