HomeMy WebLinkAboutMiscellaneous - 496 Rea Street 495 REA STREET _l
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Lot & Street J.+- 5� Ma /Parcel �3 93
q 'P� Map
/Parcel
APPROVAL
Has plan review fee been paid: NO Permit# a_
Plan Approval: Date: dApZ Approved by:
Designera—y,--& --Pe1//-�L CCkPIan Date:
Conditions:
Water S pply: own> Well
Well Permit: Driller:
Well Tests: Chemical to Approved
Bacteria I Dat proved
Bacteria II Date Approved
Plumbing Sign-Off: Wiring Sign-off:
Comments:
Form "U" Approval: Approval to Issue: YES NO
Date Issued By:
Conditions:
Final Approval:
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other? YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Is the installer licensed? YES NO
Type of Construction: NEW �EPAl
New Construction: Certified Plot Plan Review YES NO
Floor Plan Review YES NO
Conditions of Approval from Form U YES NO
Issuance of DWC permit: YES NO
1 DWC Permit Paid? NO
DWC Permit# Installer:
Begin Inspection: YES NO
Excavation Inspection:
Needed:
Passed: By:
Construction Inspection:
Needed:
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date: By:
Final Grading Approval: Date: By:
Final Construction Approval: Date: By:
Certificate of Compliance: Approval: Date:
Town of North Andover of NORTH q
Office of the Health Department F
Community Development and Services Division
27 Charles Street
North Andover,Massachusetts 01845 �9SSAaeus�tty
Susan Y. Sawyer, RENS/RS 978.688.9540-Phone
Public Health Director 978.688.9542-Fax
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
April 29, 2004
This is to certify that the Sewage Disposal.System was
repaired (X)
by
Todd Bateson
at
495 Rea Street
North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the
North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will function
satisfacte7rily.
�san Y.Sawyer,RE S/RS
Public Health Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
495 REA STREET JS-2004-0071
PYoiect Detail Report
Printed On:Fri Apr 16,2004
Project Name: Septic system upgrade&addition
GIS#: 2075 Project No: JS-2004-0071 Owner of Record CROWE,ADRIAN F&LINDA J
Map: 038.0 Date Submitted: Jul-08-2003 495 REA STREET
Block: 0093 Status: Open NORTH ANDOVER,MA 01845
Lot: Work Category: septic system for addition Work Location: 495 REA STREET
Zoning: Proposed Use: Residential District:
land Use: 101 Proposed Use Detail Single Family Home Subdivision
Description DWC Comments:
of Work:
Department Status
GeoTMS Module: Status File No. Comments: LCDate:
Board of Health GREEN FLAG BHJ-2003-0076 4/16/04-Received Installation Certification and As Built from Bill Dufresne of Merrimack
Engineering. Left for Susan Sawyer to sign off and call homeowner to pick up.
11/10/03-Mr.Crowe,h/o,asked to see where manhole cover was. Told him that we still do
not have the cert forms and As Built on file. H/o needs to contact Merrimack Engineering to
follow-up.
8/25/03-Mon.-Needs Final Inspection. Per Brian,forward to Dan O.--p.d.
8/20/03-Todd Bateson called re:Bed Bottom Inspection. Call 978.815.2703 to setup.--p.d.
7/8/03-DWC signed
Permit History
Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work:
Septic System BHP-2003-0194 Jul-08-2003 SIGNED OFF JS-2004-0071
i
Inspection History
Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment:
System final Septic System BHP-2003-0194 Aug-25-2003 NEW Dan Ottenheimer JS-2004-0071
Bed Bottom Septic System BHP-2003-0194 Aug-20-2003 NEW Brian LaGrasse JS-2004-0071
GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page 1 of 1
Page 1 of 1
DelleChiaie, Pamela
From: Pamela DelleChiaie [pdellechiaie@townofnorthandover.com]on behalf of DelleChiaie, Pamela
Sent: Friday, April 16, 2004 4:05 PM
To: 'Dufresne Bill (E-mail)'; 'Dufresne Bill (E-mail 2)'
Cc: Sawyer, Susan
Subject: 495 Rea Street-As Built Items Missing
Hi Bill,
The following items need attention on the As Built that we received from you today for 495 Rea Street:
1. No Reserve Area is indicated
2. There is no Stamp and Signature
Please contact Susan Sawyer at ssawyer@townofnorthand_over.com, or call 978.688.9540 to follow-up with this,
as the homeowner, Mr. Crowe, is anxious for his COC.
Thank you.
Pamela DelleChiaie, Health Dept. Assistant
Town of North Andover
Community Development& Services
27 Charles Street
North Andover, MA 01845
pdellechiaie@townofnorthandover.com
Tel. 978-688-9540
Fax 978-688-9542
4/16/2004
f0VvN OF NORTH
BOARB OF HFAL�t
3 APR 1671
^ '
TOWN OF NORTH ANDOVER SEWAGE DISPLOSAL,SLST M__
INSTALLATION CERTIFICATION
II
The undersigned hereby certify that the Sewage Disposal System( ) constructed;
( repaired:
by--
located at 4f q c� 7i
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit# dated with an approved design
flow of44o gallons per day. The materials used were in conformance with those
specified on the 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.
Bed inspection date: C o
Engineer Representative
Final inspection date: .
Engineer Represe tative
Installer: 0-a`' Lic.#: Date: 0-3
Design Engineer: u---� Date: . - ��
r
Town of North Andover NORT,,
AF�t`eD ie 9ti
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover,Massachusetts 01845 9SsacHus��
Susan Y. Sawyer,REHS/RS 978.688.9540-Phone
Public Health Director 978.688.9542-Fax
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
September 30, 2003
This is to certify that the Sewage Disposal System was '
repaired (X)
by
Todd Bateson
at
495 Rea Street
North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the
North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will function
satisfactorily.
S san Y.Sawyer,R S/RS
Public Health Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO 'ti s
A. Bottom of Bed /
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation,etc.
Comments: q //
B. Retaining Wall
1. Wall height and width as specified
2. Waterproofed
3. Wall minimum 10'to leaching facility
4. Wall meets specifications of plan
Comments:
C. Building Sewer
1. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Watertight joints
4. Inlet to tank cemented
5. Slope minimum 0.01 or 1/8"per foot minimum
6. Pipe properly set on compact firm base -
7. Pipe laid on continuous grade in straight line
8. Cleanouts precede all change in alignment and grade
9. Manholes at any 90°change
10. 10' minimum offset to water line
Comments:
D. Septic Tank
1. Level
2. 1,500 gal minimum
3. Gas baffle present on outlet
4. Manhole to grade
5. Manholes over center and each tee
6. 3-20"manholes
7. Inlet tee minimum 12"under invert
8. Outlet tee minimum 14"under invert
9. Outlet line cemented
10. Air space 3"above tees
11. 2"-3"drop from inlet to outlet
12. Pipe set
13. Compact base with 6"of'/4"crushed stone under tank
14. Tank is watertight
Comments:
Yes NO
E. Pump Chamber
1. If separate from tank,compact base with 6"of 1/4"stone underneath
2. Minimum 2"pipe to d-box if gravity system
3. 20"access manhole
4. Tank level
5. Watertight
6. Tank sizc agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm in building on separate circuit
10. Alarm functions
It. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level
2. Minimum 0.1 T'(2")drop from inlet to outlet
3. Minimum 6"sump
4. Outlet pipes show equal distribution
5. Compact base with 6"of stone beneath box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe -
Comments:
G. Soil Absorption system
I. All stone double-washed-'/4"= 1 %z"
-pea stone
Bucket test done?
2. Minimum 2"of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution lines capped or connected together
5. Grading meets 3:1 slope
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then swale.
Comments:
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agree with plan. (Max. length 100')
3. Width of trenches agree with plan-Minimum 2';maximum-4'.
4. Vent present if<50 feet or specified
5. Distance between trenches minimum 4'and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of 6".
Yes NO
9. Pipes set on stable base.
Comments:
I. Leach Field
I. Maximum length of field 100'
2. Pipe slope minimum 0.005 or 6"per 100'
I Separation between pipe 6'maximum
4. Pipes connected at end
5. Separation between adjacent fields 10'minimum
6. Pipes set on stable base
7. Maximum 4'separation from edge of field to first line
8. Minimum two distribution lines
9. Maximum perc rate 20 mpi
Comments:
I Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
Comments:
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9"soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
Town of North Andover, Massachusetts Form No.3
f NoRT" BOARD OF HEALTH
,sa
L
1O A
S DISPOSAL WORKS CONSTRUCTION PERMIT
SACHUS
Applicant �o Z'OL-, /9
NAME ADDRESS TELEPHONE
Site Location_
Permission is hereby granted to Construct ( ) or Repair ( n Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No. rl
CHAIRMAN,BOA D OF HEAL
Fee ���' D.W.C. No. ��
t
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE#
LOCATION: �IJ�` e
LICENSED INS ER: ��/�SdP✓
SIGNATURE: TELEPHONE# 3�2�rl -� t7a3
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTRUCTION,PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$175.00 Fee Attached? Yes l.�rr No
Foundation As-built? Yes No
Floor plans on file? Yes No
Approval Date:
0
d
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed install-eyrr for the construction of the septic system for the
property at '7��r S / relative to the application
Of dated A-3_a,�- for plans by r f eµpa J _ and
dated with revisions dated /0 4'OL-
I understand the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger, or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable.
2. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection,. without
completion of the items in accordance with Tile 5 and the Board of Health Regulations may
result in a$50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With 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. Does not have to be
on site.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work 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 in the Town of North Andover plus
significant fines to all persons involved.
4. 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.
d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other
components.
5. 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 r/
�' tY A-�QSo/ - Date: < 2-"— 0 3
Disposal Works Construction Permit#
SEPTIC PLAN SUBMITTAL FORM
LOCATION:—!" [� "
NEW PLANS: & $160.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: NO
DATE:
DESIGN ENGINEER: �,��/, ��
DATE TO CONSULTANT: Z ��
When the submission is all in place, route to the Health Secretary.
i
NOONAN & Mc DOWELL, INC.
25 Bridge Street, Suite 6, Billerica, MA 01821-1023
Voice (978) 667-9736 Fax (978) 671-9565
Email: nm(i�netway.com
July 17, 2002
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System
Plan Review, 1770.A/011
495 Rea Street
Assessors Map 38, Lot 93
Dear Members of the Board,
Please be advised that Noonan &McDowell, Inc. has reviewed the plan dated June 20, 2002,
By: Merrimack Engineering Services.
It is our opinion that the proposed design will meet the requirements of Title 5 and the North
Andover Board of Health`By-Laws" if the following is addressed:
1) Adjust bottom of field elevation to highest ground grade water table. (89.6'). 220 (4)(r)
2) Extend leaching lines to end and add vent. 251(9)
3) State the existence or not of wetlands within 150 feet. NA 8.02r
4) Provide garage floor elevation. NA 8.02t
5) Identify water service as either pressure or suction. 220 (4)(M)
6) The profile does not have the bottom of stone at the proper elevation.
7) State the existence or not of surface supplies within 400 feet,public wells within 200 feet.
220(4).
8) Outlet of septic tank is 3 inches higher than the inlet. 227(5)
9) Toe of fill slope does not stop 5 feet from property line. 255(2).
Respectfully
John L. Noonan, P.L.S.-P.E.
G:office/forms/1770.A/011
Land Surveyors Civil Engineers Environmental Planners
SEPTIC PLAN SUBMITTAL FORM
LOCATION:_ Ute- !!= 1
NEW PLANS: YES $160.00/Plan
REVISED PLANS:
SITE EVALUATION FORMS INCLUDED: YES RY ow�t7
DATE:
DESIGN ENGINEER
DATE TO CONSULTANT:
When the submission is all in place, route to the Health Secretary.
TOV N OF r q ANDOVT--R/
RQARD OF HEALTH
2002
j
27 Charles Street
North Andover,MA 01845 Andover
Telephone#(978)688-9540 North
FaA978)688-9542 Board Health
To: /Z'
Fax: - Pages.-
Phone:
ages.Phone: / Dater
Re: CC:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
• Comment 11V�o ,vJ � j.'/D
e
J-
Town of North Andover, Massachusetts F°'"'"'o•z
NORrM BOARD OF HEALTH
DESIGN APPROVAL FOR '4
VSs CN°SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant 4a)y Cent-J,6 Test No,.
Site Location's �!
• Reference Plans and Specs. U �
• ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
r'
CHAIRMAN,BOARD OF HEALTH
f•
i• .
d.
Fee Site System Permit No. cA
FORM U - LOT RELEASE FORM 'a
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT Dh,)i U (KC H A-i PHONE 7 7e-66v-576 3/.
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT(S)
STREET S-F N- AnJJ o V ST. NUMBER�9S-
************************************OFFICIAL USE ONLY****************** ** ** ********
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION AD ISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS " L-///;, UD
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
OOD INSPECTOR-HEALTHDATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED D
DATE REJECTED. -A_ t..
COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
a
SECTION 4,WORKERS COMPENSATION(ALG.L C 152' § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application; Failure to provide this affidavit will result
in the denial of the issuance of the.building permit.
Signed affidavit Attached Yes.....A.. No......:C —'
SECTION 5 Description of Pro`osed Work(check aIla` livable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alteratiorts(s) ❑ Addition
Accessory Bldg, ❑ Demolition 0 Other ❑ Specify
i
Brief Description of Proposed Work:
iX in Z S�`�FC C��T�� Ak
'
V .
- 2(9 'n z7' A-3e A,7 ,'ked. a
SECTION 6-ESTIMATED CONSTRUCTION COSTS _
Item Estimated Cost(Dollar)to be'
Completed by pit applicant
1. Building (4) Building Permit Fee
D 1Vluitt'`1%er
2 Electrical (b) Estimated'Total Cost.of
Z.: ^O d Construction °
3 Plumbing 006 Building Permit fee(a)x(u) j
4 Mechanical AC }
5 Fire Protection
6 Total 1+2+3+4+5 3 0 O Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED W199
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING°PERMIT s
I, &j7J2'1114Y 'F 6t2o w-r ,as Owner/Authorized Agent of subject property
"DAV t D I#G61�lll(K
Hereby authorize_ to act on
My behalf,in all matters relative to work authorized by this/building permit application-
Signature
pplicationSi nature of Owner Date
t
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
as Own Authorized A t of subject
property
Hereby declare that the statements-and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print NTe
0012,
Si ture of Own er/R ent lj o :1
NO. OF STORIES-a - - SIZE `'Z 4 X Z? 5-'i ti Rr ,
BASEMENT OR SLAB S A-h
SIZE OF FLOOR TIMBERS / 0 T 3-oi 5 r- l 2 3RD
SPAN / 1 _ -
DIMENSIONS.OF SILLS YX (a
DEVIENSIONS OF POSTS 4<K r
DIMENSIONS OF GIRDERS , y -
HEIGHT OF FOUNDATION THICKNESS .40
SIZE OF FOOTING Z-0 X.
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND So l i
IS BUILDING CONNECTED TO NATURAL GAS LINE f
NOONAN &Mc DOWELL, INC.
25 Bridge Street, Suite 6, 'Billerica; MA 01821-1023
Voice (978) 667-9736 Fax (978) 671-9565
Email: nm@netway.com
Date zLzd Z_
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, MA 01845
RE: Subsurface Sewage Disposal System
Plan Review, 1770 Q//
Assessors Map -3R, Lot 5' -:5
Dear Members of the Board,
Please be advised that Noonan &McDowell,Inc. has reviewed the plan dated ,. ,r 4W e7-(7z p p Z
by% e, er-/ -rtf rr� ��Gr.✓ � �moo— S�� v< c 65—S
It is our opinion that the proposed design will meet the requirements of Title 5 and the North
Andover Board of Health `By-Laws"if the following is addressed:
1, llaj,? V-PS% 2�r n r-727Alr-- 2-o /ylctc�'j
17-01 7 7/77C
��o v / o E �r1Syc�1 G E �`o U�2 L�syy Tio N
P�� 7' /=
5 / �� � � v r c-� 45
Respectfully, '
,,P-TY �
John L. Noonan, P.L.S.-P.E.
G:office/forms/tonarev
5,
7 7/ ��- ?l>�-��C / S j7i roc E PGS 47 r?
t-✓ i �/ ¢oma r- P0113 L/ G- 6'�iA:;'7i L � Z S Q
Z asp/1�)
Land Surveyors Civil Engineers � Environmental Planners
M 9) 7-,;2 r? F J-1/.� L 5 Lc7oa, _` Q'!!ES STQR.
CHECKLIST FOR NORTH ANDOVER
N&M Job 1770/�doil
SEPTIC SYSTEM PLANS
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant: C—.' 2^Name of Designer: e4-
Plan Date: 2- v Revision Date: Date of Review:
Property Address: f -5 2 6=-r--7 /''� Map: Lot:
BOH Reviewer: i./ e—' Type of Plan(new orgrade
Number of Bedrooms in Assessor's Records: 2!!�: gpd)Garbage Disposal Allowed: P
General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 -
OK Problem N/A
G Street number and map/lot-220(4)(u)
Maximum scale of 1 "=40'for plot plan-220(4)
Maximum scale of 1 "=20'for profile and component details-220(4)
Q� Legal boundaries of the facility being served-220(4)(a)
Names of abutters from recent tax map- NA 8.02j
Number of bedrooms,design.calcs.,-NA 8.02i
.� Name&address of record owner&applicant NA 8.02k
Name&address of designer-NA 8.021
Holder and location of all easements-220(4)(b)
Date plan drawn&any revision date- NA 8.02m
All dwellings and buildings,existing and proposed-220(4)(c)
Location of all existing or proposed impervious areas-220(4)(d)
All distances on site plan–NA 8.03a-c
' Elevation of proposed driveway-NA 8.02t
Location and elevation of foundation drain-NA 8.02y
Location and dimensions of the system incl.reserve(new const.)-220(4)(e)
Limits of excavation of leach area on site plan-NA 8.02z
Locus plan-220(4)(t) (Not to scale)
�^ North arrow-220(4)(g)
G� Existing and proposed contours-220(4)(g)
Locations and logs of deep holes-220(4)(h)
_ Locations and logs of percolation tests-220(4)(i)
Date(s)of soil testing-220(4)(h)&(i)
Existing grade elevation of each deep hole-220(4)(h)
Ems' Elevation of percolation tests–N.A. 8.02n
y' Name of approving authority representative-220(4)(h)&(i)
2– Name of soil evaluator-220(4)0)
r�Tv� Soil logs and perc test logs match BOH records
Locations of waterlines,drains,and subsurface utilities-220(4)(m)
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)
Location of benchmark(s)within 50-75 feet of facility-220(4)(q)
Note listing all variance requests with proper citations-220(4)(p)
Local upgrade approval request form submitted-403(l)
Original R.S./P.E.stamp,signature&date-220(1)&(2)
If P.E.,discipline specified within stamp. MGL C. 112 s. 81M
7 --- sfc.supplies(w/in 400'),pub.wells(w/in 250'),pvt. wells(w/in 150')-220(4)(
�j Location of watercourses,wetlands,wells,etc.Win 150'of system–NA 8.02r
3 Wetland disclaimer–NA 8.02s
RLS plan reference&certification required(prop line setbacks)-220(3)
-
"C' Use approvals/standards checked for I/A system-DEP docs.,
i
i
I
i
i
2
Perc rate>30 MPI-not allowed for new,LUA for upgrade-245(1)&('3)
Perc rate>60 MPI-must use modified tight tank or IIA technology-245(4)
Proposed system_qualifies as "shared" system-002(definitions)
Flow is over 2,000 gpd-No R.S.allowed-220(1)
Design flow was set in accordance with code-203
Existing system location and note on proper abandonment-354
- Leaching facility at least 1' above Base Flood elevation.—NA 9.05
All piping Sch 40 minimum—NA 10.01
Basement floor minimum F above groundwater elevation—NA 5.04
Foundation drain present with elevation—NA 8.02y
On-site Soil and Groundwater Review
OK Problem N/A
Proper deep observation hole logs on plan-220(4)(h)
All deep holes and peres shown,including aborted tests—NA 8.02n
y� Soil evaluation forms submitted within 60 days of field work-018(2)
�^ Proper percolation test log-220(4)(i)
Ample deep observation holes in primary disposal area(minimum 2)- 102(2)
y,,v arr' Ample deep observation holes in secondary disposal area(minimum 2)- 102(2)
FrV Ample perc testing(one in each disposal area,3 in prim.>2,000 gpd)- 104(4)
Deep hole testing conducted within two years—NA 7.05
y^n�L itq?/CkC
Hole Identification Numbers:
ground elevation el.
acceptable soil el.,
Leach facilitv invert el.
ground water el.
refusal el.
bottom of leach facility el. l
thickness of acceptable soil C�
before&after soil R&R
separation to groundwater t/
separation to refusal
soil class
perc rate _
loading rate
septic tank below g.w.table U (yes or no)
pump tank below g.w.table (yes or no)
11 in fill !/ -255(l)
Setback Distances(Given in feet) 15.21 1
YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02
OK Problem N/A
Septic Tank Leach Facility
Property line 10 10
Cellar wall 10 20
2
CHECKLIST FOR NORTH ANDOVER
N&M Job 1770/A ( oil SEPTIC SYSTEM PLANS
J
The following is a checklist that incorporates all Title 5 and local regulations for septic plans.
Name of Applicant: C:,"Name of Designer:
Plan Date: L/ Z V, V ZZ_Revision Date: - Date of Review:
Property Address: -�' .% /27— � - �� �`� Map: —3 9�' Lot:
BOH Reviewer: l/ e-- Type of Plan(new or grade
Number of Bedrooms in Assessor's Records: 24: gpd)Garbage Disposal Allowed:
General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 -
OK Problem N/A
Street number and map/lot-220(4)(u)
d—� Maximum scale of 1 "=40'for plot plan-220(4)
Maximum scale of 1 "=20'for profile and component details-220(4)
fry Legal boundaries of the facility being served-220(4)(a)
Names of abutters from recent tax map- NA 8.02j
Number of bedrooms,design.calcs.,-NA 8.02i
Name&address of record owner&applicant NA 8.02k
A� Name&address of designer-NA 8.021
Holder and location of all easements-220(4)(b)
Date plan drawn&any revision date- NA 8.02m
All dwellings and buildings,existing and proposed-220(4)(c)
Location of all existing or proposed impervious areas-220(4)(d)
All distances on site plan-NA 8.03a-c
Elevation of proposed driveway-NA 8.02t
Location and elevation of foundation drain-NA 8.02y
per_ Location and dimensions of the system incl.reserve(new const.)-220(4)(e)
Limits of excavation of leach area on site plan-NA 8.02z
Locus plan-220(4)(t) (Not to scale)
�~ North arrow-220(4)(g)
Existing and proposed contours-220(4)(g)
Locations and logs of deep holes-220(4)(h)
�C Locations and logs of percolation tests-220(4)(i)
Date(s)of soil testing-220(4)(h)&(i) .
Existing grade elevation of each deep hole-220(4)(h)
Elevation of percolation tests-N.A. 8.02n
�-' Name of approving authority representative-220(4)(h)&(i)
2'-"' Name of soil evaluator-220(4)0)
rTo� Soil logs and perc test logs match BOH records
;,,1W. Locations of waterlines,drains,and subsurface utilities-220(4)(m)
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)
Location of benchmark(s)within 50-75 feet of facility-220(4)(q)
Note listing all variance requests with proper citations-220(4)(p)
Local upgrade approval request form submitted-403(1)
Original R.S./P.E.stamp,signature&date-220(l)&(2)
If P.E.,discipline specified within stamp. MGL C. 112 s. 81M
sfc.supplies(Win 400'),pub.wells(Win 250'),pvt.wells(w/in 150')-220(4)(
Location of watercourses,wetlands,wells,etc. Win 150'of system-NA 8.02r
3 Wetland disclaimer-NA 8.02s
RLS plan reference&certification required(prop line setbacks)-220(3)
� 'liiS"lleSlgireP-S-e Y -
"�, Use approvals/standards checked for I/A system-DEP docs.,
3
Inground pool 10 20
Slab foundation 10 10
Deck,on footings,etc. 5 10
Waterline 10 10
Private drinking well 75 100
y Irrigation well 75 100
�'— Wetlands 75 100
Public well 400 400
'- � Wetlands bordering surface 150 150
water Supply or trib. (in Watershed)
Trib.To Surface Water supply 325 325
J ~�~ Reservoirs 400 400
Tributaries to reservoirs 200 200
�-- Drains(wat.supply/crib.) 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
- w/o barrier
Building Sewer
OK Problem N/A
A— Grease trap required'for certain uses(check 230 for details)
Pipe diameter listed(4" minimum)-222(1)
Pipe schedule listed-222(3)
Pipe cast iron or Sch 40 PVC-NA 11.02
�— Watertight joints specified-222(3)&(4)
4-- Pipe laid on compact,fin base-222(5)
Z-- Pipe laid on continuous grade in straight line-222(7)@
Cleanouts precede all changes in alignment and grade-222(8)
Cleanout provided every 100 feet-222(8)
Manhole at any 90 degree alignment change-222(8)
Invert elevation at building:
Invert elevation at septic tank:
f-� Length of run:
Slope:p (minimum of 0.01 -0.02 desired)-222(6)
10'offset to private well or suction line-222(2)
3
4
Septic Tank
OK Problem N/A
Tank is accessible-228(3)
_ No structures above tank—(228(3)
Tank can accommodate both primary&reserve—NA 9.04
200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a)
2-3"drop from inlet to outlet-227(5)
�'— Minimum of 4'liquid depth-223(2)
3"air space above tees/baffles(minimum)-227(4)
9"air space above flow line(minimum)-227(4)
Tees are not to be replaced by baffles-227(1)
-- Tees extend 6" above flow line-227(1)
t--- Inlet tee extends 10"below flow line(minimum)-227(6)
Outlet tee extends 14"below flow line(more for deeper tanks)-227(6)
-- Gas baffle installed on outlet-227(4)
Access manhole cover above center of tank&each tee(except 2 compart)228(2)
d� 3-20" manholes-228(2)
1 childproof,24" riser/manhole Win 6"of final grade if<1000gpd-228(2)
Inlet and outlet tees on center line-227(1)
Soil compaction below tank specified(if soil is non-native)-221(2)
6"of<=3/4"stone beneath tank specified-221(2)&22 8(l)
If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp. -223(1)(b)
If plan specifies disposal must be 2 tanks in series or 2 compart.tank-223(1)(c)
Buoyancy calcs.required if tank at or below water table-221(8)
Tank is watertight-221 (1)
9"of cover over tank(minimum)-228(1)
H- 10 loading(min.)-H-20 if traffic-226(3)
Top of tank<=36"below grade-221(7)
All pumping to tank(if applies)in accordance with-229
"�— Tank is set to keep old system in service during install if possible
Distribution Box(Check here if not present:
OK Problem N/A
Inlet elevation:
Outlet elevation:
0.17'drop from inlet to outlet(minimum)-232(3)(b)
6" sump(minimum)-232(3)(e)
C_ All outlets at same elevation-232(3)(b)
Outlet pipes laid level for first 2 ft.-232(3)(c)
Pipe Sch 40-NA 10.01
Number of outlets: Number of laterals:
Size of outlets:
Inlet baffle/tee min. 1"over outlet invert for all d-boxes-232(3)(a),
Soil compaction below distribution box specified(if soil is non-native)-221(2)
_ 6" of stone beneath distribution box specified-221(2)
c� Box is watertight-221 (1)
Top of box<=36"below grade-221(7)
Buoyancy calculations required if box is at or below water table-221(8)
Pump Chamber(Check here if not present: )
OK Problem N/A
Volu ci ied: 220(4)(r)
ump on elevation- 220(4)(r)
Pump off elevation: 22
Alarm on elevation: 220(4)(r)
Number of er day-220(4)(r)(also 254(1)(d)if gravity from d-box)
mum 2" delivery line to d-box if gravity-254(1)(c)
4
5
Pressure dosed 1-fif flow>=2,000 gpd-254(1)(a)&254(2)(a)
Cycles pe is consistent with chamber volume-23 1
Volume calculations include flowback volume-2') 1(2)
hour storage capacity above pump on elevation-231(2)
le-2141umber of pumps: 2 if system serves>2 dwelling units-231(6)
Capacity of pump(s)- gpm @ 'TDH-220(4)(r)
Pump can pass 1 1/4"solids(minimum)-231(7)
Pump controls specified-220(4k;::te
Alarm equipment specified-23
Alarm is in building and po circuit from pump-2') 1(9)
Pump sequence correc -lead on-lag on-alan-n on)-231(8)
Pump performanc urves included-220(4)(r)
Manual oper g switch-NA 12.01
Check v e,bleeder hole-NA 12.01
1 c ' proof,24"riser/manhole to final grade-2'31(5),
oil compaction beneath pump chamber specified non-native)-221(2)
6"of<=3/4"stone beneath chmbr.specifi (2)&228(1),
Buoyancy calculations if chamber i or below,water table-221(8)@
9"of cover over chamber( um)-228(1)
H- 10 loading(min.)- 0 if traffic-226(')),
Chamber is wate ' t-221 (1)
Top of chain er<=36"below grade-221(7)
Leaching Facility(general-complete for all designs)
OK Problem N/A
�✓�''�/�� 50%larger if garbage disposal-240(4)
Trenches to be used whenever possible-240(6)
No vehicle or imperv.area above l.f.unless unavoidable-240(7);NA 13.02
Vented if under impervious cover-241 (1)
Vented through same pipes as distribution system-241 (1)(a)
Vent protected from precipitation/animal entry-241 (1)(b)
Vent is placed beyond traffic or impervious area-24 1 (1)(c)
All lines connected to vent if bed or trenches-241(1)(d)
9"cover over peastone-240(9)
-� Reserve area provided(new construction)-248(1)
Reserve 4'from primary leach area-NA 9.04
I� 4'(5'if perc rate<=2 MPI)separation to g.w. -212(a)&(b)
4'(down to 2'with variance or I/A-upgrades only)of natural soil under 11
GW separation is adjusted to highest existing grade if facility cuts into a hillside
c� Pipe slope minimum of 0.005-251(9)
Require 5'removal and replacement if in fill-255(5)
Top of leach facility<=36"below grade-221(7)
Final grade over 11.minimum 0.02 ft/ft-240(10)
Surface&subsurface drainage away from 11-240(1 1)&245(5)
Minimum design flow 440 gpd without deed restriction-NA 13.01
3:1 slope where grading required-255(2)
9 Toe of fill slope stops 5'from property line or swale installed-255(2)
Impermeable barrier if<3:1 slope or< 15 feet to-3:1slope-255(2)
—� Impermeable barrier/retaining wall poured concrete-NA 9.02
�--- Retaining wall stamped by P.E.-255(2)(b)
R-- Top of retaining wall>=top of peastone elevation-255(2)(f)'
` 10'offset from edge of leach facility to edge of ret.wall-255(2)(g)
- Perc test(s)done in most restrictive layer- 104(2)
Perc test 4' below leaching elevation-NA 7.06
�-" Design flow listed and required/provided leach area given-220(4)(f)
—�� Leach pipes SCH40 PVC-NA 10.01
Leach pipes minimum 4"diameter except for dosed system-NA 14.04
Leach lines capped,vented,or connected together-251(9)
Pressure dosing guidance followed if pressure distribution-254(2)(c),
Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1)
5
f
6 ,
Leaching Trenches(Check here' notes present. )
OK Problem N/A
umber of trenches:
Minimum of 2 trenches-NA 9.01(2)
Depth of trenches(max eff.2'): -247(l)
Width of trenches(2'min.,4'max -251 (1)(b)
Length of trenches(100'max. . -25 1 (1)(a)
Trenches are venteies he 50')-251 (11)
_1 Trenches follow colines-251(2)
Trench spacing 3 effective width or depth minimum-
Trench
In fill or reser e'between trenches, 10'min.-NA 14.0 X14.03
Available e ch area given(Min.500 s.f.)-NA (2)
B tom=L x W x# – s.f.
Sidewall=L x D x#-x2= s.f.
ffective leach area given
Loading factor:
Effective area=total ea s.f.x LTAR = 9/day
Effective area is>=d gn flow of facility being served
2"of 1/8"- 1/2"2 ashed peastone.-247(2)
Trench depth of 3/4"to 1 1/2" double washed stone 47(1)
Leach Fields(Check here if not present: )
OK Problem N/A
Number of fields: (need dosing chamber if> 1,231 (1))
Length(100'max.): -252(2)(b)
Width:
Total area:L x W = s.f.
Minimum 900 square feet-NA 9.01(1)
Distribution lines connected with solid pipe–NA 15.01
Effective leach area given
Loading factor:
l� Effective area=total area s.f x LTAR = g/dav
—11- Effective area is>=design flow of facility being served
Minimum of two distribution lines-252(2)(a)
6'line separation(max.)-252(2)(d)
4'maximum separation from edge of field to line-252(2)(e)
10'minimum separation between adjacent leach fields-252(2)(f)
— Between 6" and 12"of 3/4- 1 1/2" stone beneath field-252(2)(g)&-247(2)
2"of 1/8"-1/2"2x washed peastone.-247(2)
Final Grading
OK Problem N/A
Slope over leach area minimum of 0.02 feet/foot–240(10)
Grading shall divert drainage away from leach area–240(l 1)
Grading slopes away from dwelling
4/01 f:/office/forms/tonackltr.doc
6
NOorh Town of North Andover, Massachusetts
Form No. 1
OF 94, BOARD OF HEALTH
h��t bcb0 1
R `ATEDh APPLICATION FOR SITE TESTING/INSPECTION
�9SSACHU5E��
Applicant
NAME ADDRESS
TELEPHONE
Site Location
Engineer NAA
ME A DRE
'
Test/Inspection Date and Time �a, �a� TELEPHONE
i
I
i
I
/ CHAIRMAN,BOARD OF HEALTH
Fee /
Test No. J�
1
S.S. Permit NO.-D.W.C. No.
C.C. Date Plbg. Permit No.
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: 1j - I L4;-o7, MAP &PARCEL:
LOCATION OF SOIL TESTS:
OWNER: 6&02 6KOL06- TEL. NO.: cbi — mq4
ADDRESS: ��
ENGINEER: I�� /� TEL. NO.: �j
CERTIFIED SOIL EVALUATOR: 1'zxt*-
Intended Use.of Land: Residential Subdivision I �yHo Commercial
Is This: /
Repair Testing: J Undeveloped lot testing:
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. 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$200.00 per lot for repairs or
u rades. (If time is not critical, fee for repairs is $75.00)
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"-100') 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.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval: 1� 6
Date Received: Check Amount: Check Date:
y Y . 1. '� _
e b
49A R^,.. 8 '�tteet-
Ai �T ''' .: panY + do"r0 .*V,8aChU**LLS
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Scale; I„ , Rtes 1�ebruetry Ib. 1977
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f�:�c•e��•`�T'4�2.7� �j,:. .k; `�`t2: �SiJ i` }�k.yyq�: ,i.r !� {
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tureby certify that the build
thio prop*rty is lgc,&ted showxi on
' F And
Flan And cx�mpltes with the �Uilding'
4onin Laws
K of the T o . .af .Xt,. Andover. i
' ,
-CIVIL UNGUEER
I r r'- LAWRr:. c MASS,
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Location: q � /1 i 1 owner's Name: FktE PP Gym,J e
Map/Parcel:Tk 22 Address: ]
Installer. Tel#: New lsisol Repair k/
Date: G'I'3�� Wetlands_!j!_VZone 11 Soil Symbolz,4-1—Soil 17amCAWA��LSoil Class
Deep Observation Hole Logs
Elevation Depth Soil Horizon Soil Te=ture Soil Color Soil Mottling, % Gravel,Stones,etc:
G► L.S, 2,s�Gia lz ��'' IvO-F
z-� 1�.�tcu,lstNtJP�
en, ��. L,S, 2,5'f(0l3 lov� ft,*4TY-�rLH
'L.1� 6 V.(f y /
11
Parent hiaterial -ft LL. Depth to Bedrock, standin:water in the Hole: Weepin:from Pit FaceEySHGIF:�
Parent Material Depth to Bedrock standing Nater in the Hole•. NVeepin:from Pit Face ESHG%V:
Date �"O2 Percolation Tests
Obsersation Hole" P'I
Depth of Perc d+6
-W I _
Start Pre-soak--i 2 LLA 5 (
Time at 12" ( t o I
Time at 9" 1 l
Time at 6" i 7
Time(9"-F)--
-Rate
Rate Min/Inch I
Performed By: 8r �y r 01 9 Witnessed Br:
6`
17
F-1 01
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1' i i - ----- ------ ��1.- - - - -
LL
_
�-�
Town of North Andover °t kO�tM q
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover,Massachusetts 01845
Sandra Starr Telephone(978)688-9540
Health Director Fax(978)688-9542
April 18,2002
Adrian F. Crowe
495 Rea Street
North Andover,MA 01845
Re: Application for an addition
Dear Adrian:
Your application for an addition at 495 Rea Street has been reviewed by the Health Department. The application was
denied on April 16,2002 for the following reasons:
1. X Missing information
2. X Passing Title 5 inspection of septic system may be required
3. ❑ Location of structure not acceptable
To address the problem(s):
If#1 is checked, please supply:
a. Floor plan of the existing house and the existing house with the proposed addition
b. Certified plot plan showing house,septic system and proposed project in scale
If#2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the
system and whether it is operating properly: OR
b. Tie-in to municipal sewer
If#3 is checked:
a. Relocate the project
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerely,
Brian J.LaGrasse
Health Inspector
Cc: Building Department
David McGlauflin,21 Turner Dr.,North Reading,MA 01864
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
UILDI "res
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AS BIJ LT PLAN
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� DISPOSALSYSTEMSUBSU
LOCATED IN
� H OF nz9ss�0
AS PREPARED FOR �� DANIEL tiN
Eft I KoCIVIL°S co
G12oI,4. co
DATE: 61-5�i!5�3 T�-j �No.377520
SCALE: l p ' IS�NA
C�) �
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
60 PARK STREET ANDOVER. MASSACHUSETTS 01810 or TEL (617) 475-3535. 37 Snl
i
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,'II
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby mak�j application for a permit for a sewage disposal installation at
�1^ /�-- - �Z4 . I will install this system in ac-
cordance with all the laws of the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of / g 0 lineal (square) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed. stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, /Massachusetts. r
DATE % -/ - "7/
� L11
Signature of Health Agent �•.
I have inspected the uncovered system indicated above and find everything done
as descri ed.
DATE 9 Z. I S' A 1F
Signature of I specting Officer
Percolation Test �C�r,G . , (�
Garbage Grinder
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
f � � L A
1. NAME I� /'/ A 5 DATE
L 2. ADDRESS f/ S' // s/ - j /ti f� LOT NO. TEL�
3. NO. OF BEDROOMS 3 DEN YES NO
4. GARBAGE GRINDER YES NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
H. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
g. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE 4/19171
NAME OF APPLICANT Thomas Arsenault
LOCATION 495 Rea Street
Address of lot no.
BUILDING: Dwelling X Other
SYSTEM: New X_ Repair
GENERAL DESCRIPTION OF LAND
SUBSOIL: Clay_ Gravel Sand Clay
PERCOLATION TEST_4 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK I . nnn gallon capacity.
LEACH FIELD Ian lineal feet of drain pipe.
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illiam J. Dr scol1, Engineer
Board of Heal h