HomeMy WebLinkAboutHealth Permit # 7/3/2014 I
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Commonwealth of Massachusetts
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� '�1 //�°��r� BOARD OF HEALTH Permit No
BHP-2014-0691
North Andover -----------------------
P.I. FEE
$250.00
F.1.
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DISPOSAL WORKS CONSTRUCTION PERMIT
Permission
Matthew Manning _- ____ -_ -----
Permission is hereby granted -- -- -------- - --
to(Construct)an Individual Sewage Disposal System.
at No 26 STANTON WAY __-- - ------ -- � ---
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pp - ---- ... 4
as shown on the application for Disposal Works Construction Permit No. BHP-2014 I7t
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Issued On: Jul-03-2014 BOARD OF HEALTH
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PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET,HAVERHILL,MA 01830
CS
tel:978-373-0310 www.csi-engr.com fax 978-372-3960
Soil Borrow Management
Title 5 sand at the Stanton Woods subdivision
0
Date: May 7, 2014
1(1 { Y
(Note: revisions and new items are in blue text)
1. Sand that is intended to be used shall be stockpiled prior to sampling. Sand
from each source location shall be placed in separate stockpiles for inspection
and sampling. If during excavation the sand from a single source contains
variations in color, consistency, or gradation a separate stockpile of each
variant shall be made. A plan shall be prepared showing the locations of the
stockpiles and the sources of the material. The project engineer (Christiansen
& Sergi, Inc.) shall provide a base map to the site contractor/installer that the
installer will update whenever sand is excavated, stockpiled, or moved. Copies
of the updated plan shall be submitted to the Health Department within 43
hours of any new sand excavation, stockpiling, sampling, testing, or filling.
2. Prior to the sampling of sand from a stockpile an inspection shall be made by
the Health Department or their designated representative to ensure the
consistency of the stockpiled material and to ensure that the sample is a valid
representative of the material in the stockpile. The Health Department may
authorize a representative of the site contractor/installer, such as the project
engineer(Christiansen & Sergi, Inc.)to inspect and approve the sampling.
3. Samples to be tested shall be clearly labeled as to the source of the material
and the location of the stockpile.
4. On-site sand shall not be used as the "System Sand" for the Presby Enviro-
septic systems to be constructed on Lots 1 and 4.
5. If necessary, stockpiled sand shall be screened prior to placement in the
disposal area to ensure that no material larger than 2 inches is present.
6. If during the placement of sand in the disposal system it becomes necessary to
use sand from two or more stockpiles an inspection shall be made by the
design engineer, Health Agent, or Mill River Consulting prior to the placement
of the sand from the second (or subsequent) stockpiles.
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May 7,2014
7. A log book shall be kept by the site contractor/installer to document all activities
relating to sand excavation, stockpiling, sampling, testing, and filling. Copies of
all test results shall be kept in the log book. A copy of each new log entry shall
be submitted to the Health Department within 48 hours of any new sand
excavation, stockpiling, sampling, testing, or filling.
8. The Soil Borrow Management Plan will be incorporated into each DSCP issued
for this project so it is acknowledged by the licensed installer as to the plan and
procedures to be followed.
9. The site contractor/installer shall inform the Health Department which testing
lab will be doing the testing prior to the sample being taken.
10. The Health Department will plan to take composite confirmatory samples at
some or all of the onsite wastewater systems during installation. In addition to
usual fees a regular"additional inspection fee" of$50 will be calculated per trip
to the site; along with the ongoing soil sample charges. Outstanding payment
shall be made prior to issuance of each Certificate of Compliance.
11. The installer is apprised that a Certificate of Compliance cannot be issued if a
soil sample is taken at a particular onsite wastewater system until such time as
the laboratory results confirm compliance with Title 5 fill specifications. Failure
will result in removal of all sand in that particular system bed.
Page 2
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MICHAEL 90S
SERGI
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I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO
THE HORIZONTAL SETBACK REQUIREMENTS OF THE LOCAL
A
FOUNDATION S-BUILT APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED.
(THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER
RESTRICTIONS SUCH AS COVENANTS,WETLANDS,EASEMENTS,
GREEN
ORDERS OF CONDITIONS,ETC.)THIS DRAWING SHALL NOT BE USED
CLIENT. COMPANY BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED
ABOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN
&SERGI INC.FURTHERMORE THIS DRAWING IS THE COPYRIGHTED
THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT PROPERTY OF CHRISTIANSEN&SERGI INC.AND ANY
UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN&SERGI TAKES
LOCATION: NORTH ANDOVER,MA. NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS
DRAWING OR ANY INFORMATION CONTAINED HEREON.
DATE:2/11/14 SCALE: 1"=100'
PROFESSIONAL ENGINEERS & LAND SURVEYORS
CHRIS TIA NSEN & SERGI INC.
_ .� 160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
WWW.CSI-ENGR.COM TEL. 978-373-0310 FAX. 978-372-3960
D W G.N O.: 12007.001.012
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pplication for Septic Disposal System 6 /2,o /,L/
TODAY'S DATE
Construction Permit - TOWN OF
ORTH ANDOVER, MA 01845
$ 35U.0U—Full Repair
$12S.00 -Component
Important: Apl2licationis hereby made for a permit to:
When filling out O'Cunetnucto new on-site sewage disposal system*
forms unthe
computer,use Repair or replace nn existing on'akaaexvogmdisposal ayatenn°
only the�ukey
--
tv move your [7 Repair or replace on existing system component—VVhot?
cursor uonot
��
use the return
key. A. Facility |MfoyrMat|o0
VQ Address or Lot#
*TYPE OF SEPTIC :
E P_., R_-- y(choose_ _-'
°°If pump system, attach copy mf electrical permit boopp|ioetiun°°
El System (pipe and stone system)
6"Infiltrator or Biodiff user(Gravel-Less)(Attach a copy of your certification to install this type of system.
L�
Pressure Distribution S.A.S. (No D'Box)(Attach Draft Maintenance Agreement)
Pressure Dosed (O'Boo Present)S.A.S. |
2. Owner Information �
Name
Address(if different frorh,dbove)
City/Town State Zip Code
|
Telephone Number
3. Installer Information
Name Ic ) (x Name of Company
Address
City/Town Sra'o Zi Code
T�Iepho,Ae Number(Cell Phone#if possible please)
4. Desinner Information
Name N Name of Company
160 -Suennes-
Address
City/Town State Zip Code
(0, 7 3 — 0,31 k 0
Application for Disposal System Construction Permit^Page 1mu
pplica ion for Septic Disposal System
A
Construction Permit — TOWN OF TODAY'S DATE!
$260.00—Full Repair
ORTH ANDOVER, MA 01845 $125.00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of uilding,: Residential Dwelling or Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
been issued by this Board of Health.
Name Date
Applicatio Approved By: ( and of Health Representative)
Date
Na pPrication Disapprove taor the following reasons:
For Office Use Only:
L Fee Attached.? Yes No
2. Project Manager Obligation Farm Attached.? Yes No
3. Pump System? If so,Attach cop,E ofElectdcal Permit Yes No
4. Foundation As-Built?(new construction ronly): Yes No
(same scale as approved plan)
5. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit•Page 2 of 2
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SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS J
As the North Andover licensed installer for the construction for the septic system for the property at:
(Wdress of Septic System) For plans by � �r
t (la""ar�arrees}
Relative to the application of M Gt;-�~°C-`�tL"/ /�X41 i n �...
(Installer's narne) And dated A,A<,,V l ,- O
f�)rigma sate.
Dated 66(-)Z(� y J 2
��>ca) s sate With revisions dated Lit Su 13- Ac d
(Last revised date)
I understand the following obligations for management of this project:
1. As the installer,I am obligated to obtain all permits and Board of Health approved plans Pdor to
performing any work on a site. I must have the approved plans and the permit on site when any work is
being done.
2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any
other person not associated with my company schedules an inspection and the system is not ready,then
item three shall be applicable.
3. As the installer,I am required to have the necessity work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
my company
a. Bottom of Bed—Gonerally, this is the first (1'� inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc.
As-built of verbal OK (or e-mail to: i:tealtlxdc pt(cr)tc:7%vtiofn<>rila<iticiover.cot-i) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work(other tharl s alple excauation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of
North Andover; significant fines to all persons involved are also possible
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer,I understand that I am solely responsible for the installation of the system as per the
approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: f (Today's Date)
(Name— IIrtnt)
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North Andover Health Department
Community Development Division
July 1, 2013
Green & Company
11 Lafayette Road
North Hampton,NH 03862
i
RE: Re: Subsurface Sewage Disposal System Plan for Lot 16-8 Saracusa Way Salem
(Map 61,Lot 16-8)
Dear Applicant,
The North Andover Board of Healtl Jhas completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by the Christiansen& Sergi, Inc.
dated May 1, 2013, and revised June 19, 2013. The design has been approved for use in the
construction of a new 4- bedroom, on-site septic system. This plan is good for 3-years from the
date of approval.
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.
1. Prior to the issuance of the Disposal Works Installers Permit, the applicant must
submit a foundation as-built at the same scale as the approved plan.
2. Prior to the issuance of the Disposal Works Installer's Permit,the applicant must
submit the floor plans of the home showing no greater than four bedrooms or a total
of nine rooms.
3. 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(l)).
4. 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
Page 1 of 2
Noah Arldove,r I lealdi l: eparlmer7t, 1600 Osgood `�trcct, IitfildiilLY 20, `bite 20-35,
North Atidovcr„ Iv1A 01845 ]''boric: 978.088.9540 1'ax: 978.088.8476
Lot 16 a Lac,(i s,,,,i Jay JLI I y I, 201.3
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.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 979-699-9540 with any questions you
might have.
Since y'
,Sujsn Y S,, e, HS/RS
li
/*"PU He H a erector
cc: Phil Christiansen, PE
file
encl: Licensed Installers list
Page 2 of 2
Nortb Andover 1ealt1i Departinent, 1600 Osgood Stl'C& Building 20, SuiLc 2035,
NorthAndover. MA 01845 Nione: 978.688.9540 Fax: 978.688.8476