HomeMy WebLinkAboutMiscellaneous - 980 WINTER STREET 1/6/2016 (2) '
CHECKLIST FOR NORTH ANDOVER-
SEPTIC SYSTEM PLANS
N&]0 Job l
The following isu checklist that incorporates all Title 5 and local regulations for septic plans.
Name ofApplicant: �� 4 Name ofDesigner: 6p
Plan Date: Revision Date: Date ofReview:
Property Address:
B0}IReviewer: Type of Plan(new o«
Number ot Bedrooms 6n Assessor's Records: gpd)Garbage Disposal Allowed:
____________
General Information: 2V./&.=North Andover Septic Regulations Other numbers refer uo Title 5
OlC Problem N/A
___ Street number and map/lot-32O(4)(u)
Maximum scale nfl "=40'for plot plan-22OWA
Maximum scale of1 "=2O'for profile and component details-220(4)
Legal boundaries of the facility being served-220(4)(o)
Names of abutters from recent tax map- NA 8.02j
Number nf bedrooms,design oulnu.,-NA8.O2i
Name 8t address nf record owner&t applicant- NA 8.02k
Name Jt address of designer-NA8.O2l
Holder and location of all easements-220(4)(h)
Date plan drawn&any revision date- NA8.02m
All dwellings and buildings,existing and pnopmxed-220(4)(c) |
Location uf all existing c«proposed impervious areas'220(4)(d) |
All distances on site plan-NA8.83u-c |
|
Elevation of proposed driveway-NA8.02t �
Location and elevation of foundation drain-N\8.O%y
Location and dimensions of the system incl.=*M��(uewc000t.)-ZZO(4)(u)
Limits of excavation uf leach area on site plan-NA8.O2r |
Locus plan-22O(4)(t) (Not ioscale)
�~-
North arrow-%20(4)(&)
Existing and proposed contours'22U(A(g)
Locations and logs of deep holes-23O(4)(h)
Locations and logs of percolation tests'220(4)(i)
Date(u)of soil testing'Z20(4)(b)/b(i)
Existing grade elevation of each deep hole-22O(4)(6)
Elevation of percolation tests-N./1. 8.O2o
Name uf approving authority representative-220(4)(h)8t(i)
Name of soil evaluator-22O(4)0)
Soil logs and pern test logs match BOI{records
Locations ot waterlines,drains,and subsurface utilities-320(4)(o)
Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n)
Complete profile of the system to scale-220(4)(o),NA 8.02c
Cross section of leaching facility NA 8.02w (Not to scale)
—14� Location of benchmark(s)within 50-75 feet of facility-220(4)(q)
— Note listing all variance requests with proper citations
Local upgrade approval request form submitted-403(l)
Original R.S./P.E.stamp,signature&date-220(l)&(2)
If P.E.,discipline specified within stamp. MGL C. 112 s. 8 IM
Location of watercourses,wetlands,wells,etc.Win 150'of system-NA 8.02r
Wetland disclaimer-NA 8.02s
RLS plan reference&certification required(prop line setbacks)-220(3)
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Use approvals/standards checked for I/A system'IEP dooa.,
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3
Inground pool 10 20
Slab foundation 10 10
Deck,on footings,etc. 5 10
Waterline 10 10
— Private drinking well 75 100
Irrigation well 75 100
Wetlands 75 100
Public well 400 400
Wetlands bordering surface 150 150
water Supply or trib.(in Watershed)
M
Trib.To Surface Water supply 325 325
Reservoirs 400 400
_ Tributaries to reservoirs 200 200
Drains(wat.supply/trib.) 50 100
Drains(intercept g.w.) 25 50
Foundation drains 10 20
Drains(Other) 5 10
Drywells 20 25
,
Downhill slope 15'to 3:1 slope
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w/o barrier
Building Sewer
OK Problem N/A
Grease trap required for certain uses(check 230 for details)
Pipe diameter listed(4"minimum)-222(1)
Pipe schedule listed- 2(3)
Pipe cast ir,.-n or �4 PVC—,,,.NA 11.02
Watertigh joints s eci d"-X222(3)&(4)
P' e laid n com act, base-222(5)
i e lai on co nuous ade in straight line-222(7)@
Cl n is prec e all changes in alignment and grade-222(8)
Cleanout provided every 100 ft22 '8 "
Manhole at any 90 degree"alignment change-222(8)
Invert elevatipn,9t building:
Invert ple Lion at septic tank:
4png of run:
Slope: (minimum of 0.01 -0.02 desired)-222(6)
10',offset to private well or suction line-222(2)
1
3
5
Pressure dosed 11 if flow>=2,00 gpd'254(l)(u &254(2)(a)
Cycles per day is consistent with chamber volume-23 l
Volume calculations include Oow6uub volume-%') l(%)
24 hour storage capacity above pump nn elevation'23l(2)
m� �uod�cxofpuo�m� 2iy system serves>2dneDiuguzd�-23l(6)
Capuoityofpoup(u)- 8pm/ @ 'TDR-%20(4)bj
Pump can pass 11/4 "solids(miniomm)-23l(7)
Pump controls specified'22O(4)6j
Alarm equipment specified-231(2)
Alarm iuio building and powered on separate circuit from pump-2') 1(9)
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Pump sequence correct(off-lcmdoo'luguo'ubun-uoo)-33l(0)
Pump performance curves included-228(4)6i
Manual operating switch-DJAl2.Ol |
Check valve,bleeder hole-NAl2.0l �
l childproof,24"riser/manhole un final grade-2'3l(5),
Soil compaction beneath pump chamber specified(if soil ioouo'uubvo -22lCD |
6"of<=3/4"anooe beneath u6oibr.upucdfied-22lCD&c228(D,
Buoyancy calculations if chamber iuuLor below water table-22l(8)@
y" of cover over chamber(odzdnauzu)-228(D
E- lO loading(odu.)-H-2Oit traffic-2%6(')),
�7 ---- --
Chamber ia watertight'22I (l)
Top ofchamber<=36"below grade-22l(7)
Leaching Facilitv"
(general-complete for all designs)
N/A
50%larger if garbage disposal-24O(4)
Trenches iube used whenever possible'24O(6)
Nu vehicle orinnperv. area above L1 unless unavoidable-240(7);NAl3.O2
Vented if under impervious cover-24l (l)
Vented through same pipes uo distribution system-24l (l)(u)
Vent protected from precipitation/animal entry'24l (l)(b) �
^ ^�1V - Vent ix placed beyond�utOoorimpov��uomou-24l (I)(c)
�� -- —�
All lines connected to vent if bed or trenches-24l(l)(d) |
�
9" cover over peuatome-240(9) /
Reserve area provided(new construction)-24Q(0
Reserve 4`from primary leach area-NA0.U4
4'(S'if perorate<=2MPI) separation Vog.m-2l2(u)&(b)
4'(down to2'with variance ozD&-upgrades only)of natural soil under l.0
(W separation iu adjusted tohighest existing grade iy facility cuts into uhillside
Pipe slope minimum of0.UO5 -251(V)
Require 5'nemovul and replacement ifiofiV-255(5)
Top of leach facility<=26" below grade'22l(7)
Boul grade over 11 minimum 0.02 ft/ft-24080
Surface&:subsurface drainage away from U'24O(ll)6t24J(j)
� ��/� � __ Miob�m�uiguflow#ODpdwi�o�de���u��-NAl3.0l
- 3:l slope where grading required'%55(2)
Ionof�D slope u�pu5'8nn
nyroynr�Uouurnwuloioatdlod-255(2) �
Impermeable barrier if<3:l slope or< l5 feet 0u-3:l slope-255(2) |
Impermeable barrier/retaining wall poured concrete-NAA.02 �
Retaining wall stamped byPJS.'255(2)(h) �
Top ofretaining wall>=top ofpoustoneelevation 255(2)(f) �
l0'o�o fmmod&�uf1om����ldy�m1��n��t.�uO-255(�)(� �
�
yorc test(s)don in most restrictive layer- lCWC8
9erc test 4' he}nvv leaching elevation-DJA7.06
Design flow listed and required/provided leach area given-220(4)(f)
Leach pipes 8CH4O PVC-0AlU.Ol
Leach pipes minimum 4"diameter except for dosed system-NA14.04
Leach lines capped,vented,ur connected together-25l(A)
mmuzodosing guidance followed if pressure distribution-%54(2)(u),
_7—__ Pressure dosing required over 2,0U0gpdnr with I6A remedial use-231(l)
5
Project Request Record
Town of North Andover
Date: m '°°� „"�
Client Id:ToNA Card Id:ToNA Client/Company Name:Board of Health
Card, .v-a
Contact Name: Ms.Sandra Starr Phone: 978-688'-9540'r
Title:Director Fax::. 978-688`=9542,
•Ad&ess:. 27'Charles,'Street. Email:
Notes:,
/ Tovz
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n:. North Andover
State. MA Zip Code: 01845
Other contacts if applicable EngineelI�istall'er ?, ,, �,J1
�.Name; 9 �
Titlee:. Fray:
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Addfess Emaik
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Notes:
Town: �
State: "° ��„ .._ Zip Code e,""I 6, "C?.
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Project Id: 1770 Project Title: Town of North Andover Board of Health
(JOB NO) (PROJECT NAME&STREET ADDRESS)
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Manager:NOW Billing Group: Billing Code:Fixed Fee
Contract Info.,Project Description:for,each billing,group
BGZ � �� A licant� �r
Assessors Map '" Lot "" ,.
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Type of service 'Ile
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Office/forms/jbrqutona
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MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
bb PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng @aol.com
TO: North Andover Board of Health
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FROM: Bill Dufresne/Merrimack Engineering
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DATE:
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TL:
OWNER(NAME& ADDRESS) A 06 Members of the Board:
An upgrade sewage disposal system plan dated: -7- 1601--01 has been
submitted for the above referenced site. Pursuant to Title 5, and the North Andover
Board of Health Regulations, Local upgrade approval and/or variances are being sought
from the following sections.
1) PA
2) T .s� rzac��t�1�J -75' -f-d-iu-
3)
Please consider these requests for approval on your earliest available meeting agenda.
We respectfully request your consideration of these matters.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
William Dufresne
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Location: I, I I,(" , owner's Name:_____��
lYlap/Parcel: ( Address:
Installer: Tel#: �r /
ew tsisol Repair .I
Date: (0 1 Wl__Wetlands P")Zone If Soil Symbol��Soil lQame
Soil Class
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Deep Observation Hole Logs
Elevation Depth p Soil Horizon Soil Texture Soil Color Soil hfottlinQ
d /a Gravel,Stones,etc;
VAC L"5. IoY ��, X22 1e may ` urn
7'5� I1tJ �vbblS :�`
Parent Material -"Uto Depth to Bedrock Standing-Wuter in the Hole: fG eCPinr from Pit Face ��ESH 't
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I L'/TW 045 ftw
102 �ct9
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Perry/ t,f���''JS�yy.�R, p�M1ry
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Date Percolation Tests _. .
Observation Hole r _
Depth of Pere
Start Pre-soak 10 t 31 iq 4P)
Time at 12" p
Time at 9'1 ,
Time at 6" r p E D
Time (9"-6") .. I I
Rate MIn/Inch
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BOARD OF HEALTH TEL. 666-9540
ANDOVER,NORTH A 1
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APPLICATION FOR SOIL TESTS
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LOCATION OF SOIL TESTS,
DATE:
Assessor's map & parcel number: -ZL ,...
OWNER: / _ TEL. NO.:
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ADDRESS: (Vel �.w_._.
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ENGINEER: HE12#Zl",oxv.--IG- Cnl U IyF;TEL. NO.:_
CERTIFIED SOIL EVALUATOR: LP,I--I..-
r6pir "0ntial subdivision, single family home, commercial
testing Undeveloped lot testing
.msµ... .
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of$21-6-0 per lot for 1]-construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of 75 0 per lot for
re airs or uggrgks.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"A 00') shall be submitted to
the Board of Health showing the location of all tests (Including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
I
SEPTIC PLAN SUBMITTAL FORM
LOCATION: `10
NEW PLANS: YES 160.00/P
REVISED PLANS: YES .00/Plan
SITE EVALUATION FORMS INCLUDED: S NO
DATE:
DESIGN ENGINEER: o6r,4 Nr—
DATE TO CONSULTANT: j
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When the submission is all in place, route to the Health Secretary.
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WELL OWNER RESPONSE CARD
My private drinking water well is within 100 feet of a right-of-
way and I request that my well location be incorporated in the
operating plan of herbicide applicators who maintain the corridor .
TYPE OF RIGHT-OF-WAY: l� l b ems.
NAME of WELL OWNER:
LOCATION OF WELL
(Street Address ) --
SIGNED
IF AVAILABLE PLEASE COMPLETE THE FOLLOWING INFORMATION: {
Well Depth : „� feet
Installation Date:
Distance Between Well Head and Edge of Right
-of-Way: feet
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