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HomeMy WebLinkAboutMiscellaneous - 45 CRICKET LANE 4/30/2018 45 CRICKET LANE 210/107.A-0219-0000.0 i K �. y f North Andover Board of Assessors -Public Access Page 1 of 1 � s MVRYH TOvvn Of Noalh � }1y OrtY� e �ry0 o - L 80VArd Of &ISSC SSACWS Property Parcel ID:210/107.A-0219-0000.0m Record Card Community: North Andover ,\F V Se SKETCH PHOTO 's;�HS Click on Sketch to Enlarge Click on Photo to Enlar e Summary �3e,,c r Detached Structure Condo Commercial Comparable Sales 45 CRICKET LANE ' FOwner n: 45 CRICKET LANE Name: ROBBINS,MELVYN A PATRICIA M ROBBINS ddress: 45 CRICKET LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7-7 Land Area: 1.01 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area:2436 sgft FBuilding IENTS CURRENT YEAR PREVIOUS YEAR 610,900 e: 563,400374,300 348,200 236,600 215,200 Market Land Value:236,600 Chapter Land Value: Sale Price: 0 LATEST SALE Arms Length Sale Code: N-NO-OTHER Sale Date: 12/31/1978 Grantor: Cert Doc: Book: 01410 Page: 0002 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&LinkId=991635 10/4/2007 NORTH qw- OL O D coc.uiNewcw � ��SSACHUS���y PUBLIC HEALTH DEPARTMENT (ommunity Development Division C'(FR2I FICA2E O F CO_1V111'.GI � 'E .A � As of: .A"I il1 S, 2009 7Fiis is to cert that the indi'vidual subsurface disposal system received a SAVS(AC7ORT IMT EMOY of the: Full System Repair of the Subsurface Sewage 1DisposalSystem By: James Kellett At: 45 Cricket .Gane Kap 107.,X; Parcef219 North Andover, 914A 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system will function satisfactorily. r` ,'S n 2'. SawyerZ TW 61 c 9fealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com "TOWN OF NORTH ANDOVER of AONTN � Office of COMMUNITY DEVELOPMENT AND SERVICES ',,�•e •'�° HEALTH DEPARTMENT %�_ e OSGOOD STREET NORTH ,kNDOVER, MASSACHUSETTS 01845 �'ss�c►ws��� Susan Y. Sawyer, REHS/RS 978.688.9540—Phone978.688.8476—FAX Public Health Director E-MAIL: heal thdept,atownofnorthandover.corn WEBSITE: http:.',www.townofnorthandover com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( ) repaired; bia��� (_ 4- (Print Name) located at 6.5- C'YG (4 L--.4 n eF (Installation Address) was installed in.confo ance with the North Andover Board of Health approved plan, originally dated /D / D and last Revised on ✓Y , with a design flow of p 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. l Bed inspection date: p o v r Engine Representative( atur ) And- Print Name Final inspection date: ngineer epresentative( ature) And-Print Nam Installer: (Signature) Date: -- d Print Name Engineer: �� _(Signature) Date: ' And-Print Name DelleChiaie, Pamela i Subject: Septic-45 Cricket Lane Start Date: Wednesday, April 01, 2009 Due Date: Thursday, April 02, 2009 Status: Waiting on someone else Percent Complete: 50% Total Work: 0 hours Actual Work: 0 hours Owner: Ben Osgood 4/17/09 Hi Ben, If you are talking to Jim,please remind him of this. Thanks.--Pam ------------ 4/1/09–Ben Osgood signed installation certification form today. Jim Kellett will be in tomorrow to sign. Left h/o–Mel Robbins a voice mail–978.535.3420 to let him know once I have that signature, I can issue a COC.—p.d. i Commonwealth of Massachusetts ;, J W City/Town of N0. Qoxf - Certificate of Compliance [HEAL T 2 8 2008 Form 3 a, �,,vER �a �.,, 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 the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal System Important: When filling out ❑ Construction of a new system forms on the ® Repair or replacement of an existing system computer,use ❑ Repair or replacement of an existing system component only the tab key to move your cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): use the return key. DSCP Number DSCP Date teb Facilityrpyl,rkd ne.La Street ddresspr Lot#�� I/TL./_�_Io NA bf S City/Town State Zip Code Designer Information: Benjamin C. Osgood Jr., P.E. New England Engineering Services, Inc. Namp"7Name fCom any C z-0 .I D Si reD e Installer Information: Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. Approving Authority Signature Date t5form3.doc°06/03 Certificate of Compliance°Page 1 of 1 AS-BUIL T CHECKLIST 1 LOT NUMBER, STREET NAME / ASSESSORS MAP&PARCEL NUMBER i/ LOT LINES &LOCATION OF DWELLINGS LOCATIONS &DIMENSIONS OF SYSTEM, —RqCLUDINU''RI;S-ERA(B -- TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA ✓`" LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM V TOP OF FDN ELEVATION LOCATIONS OF WELLS,DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-B OX ORIGINAL STAMP& SIGNATURE v" IMPER VIOUS AREAS -DRIVEWAYS, ETC. _ NORTH ARROW , LOCATION&ELEVATIONS OF BENCHMARK USED P DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Wednesday, November 05, 2008 10:41 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: Construction Inspection Report-45 Cricket Lane Attachments: Construction Inspection Rpt-45 Cricket Lane.doc Attached please find the construction inspection report for 45 Cricket Lane. Please call if questions. pi Marianne Peters Office Manager ph 800-377-3044 ph 978-282-0014 fx 978-282-0012 web:www.miUriverconsulting.com I 1 tAORT" q 0 �SLEO 16 t° to O •ww 116cx.ac«ew¢«`� Ar D SSACNUs�t�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 45 Cricket Lane MAP: 107A LOT: 167 INSTALLER: Jim Kellet DESIGNER: Ben Osgood PLAN DATE: 10/12/07 BOH APPROVAL DATE ON PLAN: 11/15/07 INSPECTIONS TANK INSPECTION: )01 4A I of DATE OF BED BOTTOM INSPECTION: I DATE OF FINAL CONSTRUCTION INSPECTION: 10/17/08 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base ® Cleanouts per plan ® Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading mono construction ❑ Water tightness of tank has been achieved by testing 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 _* t►ORT,N O��t`E D .6 0 t � O n eb O COCN[l-KM y1 p0RATf D �? SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (circle one: gas baffle) ® 24" cover to within 6" of final grade installed over one access port, must be to grade and over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX ® Installed on stable stone base ❑n/a Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) �] Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan N/A ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townotnorthandoverarn Inspection Form June 2008 NORTH ,69ti0 O � n ee � f OCNKNIwKw V SAC NUS���� PUBLIC HEALTH DEPARTMENT Community Development Division ® Brand and Model of Chamber: Infiltrator Chamber ® Number of chambers per row: 8 ® Number of rows (trenches): 5 Comments: 40 chambers total SYSTEM ELEVATIONS INVERT IN FIELD AS-BUILT INVERT DESIGN INVERT ELEV. ELEV. Benchmark 103.96 Building Sewer OUT 2.18 102.80 103.64 Septic Tank IN 245 102.53 102.30 Septic Tank OUT 273 102.25 102.05 Distribution Box IN 319 101.79 101.69 Distribution Box OUT 336 101.62 101.52 Lateral 1 TOP 358 Lateral 1 INVERT 101.40 101.42 Lateral 2 TOP 357 Lateral 2 INVERT 101.41 Lateral 3 TOP 356 Lateral 3 INVERT 101.42 Lateral 4 TOP 357 Lateral 4 INVERT 101.41 Lateral 5 TOP 358 Lateral 5 INVERT 101.40 BED BOTTOM ELEV 452 100.81 100.75 CRITICAL SETBACK DISTANCES 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 NORTH q O '1t,eo ,, 4. 6 X00 � � a L O � t � O,q cec.�uieiwKw`��• "SAC HUS���y PUBLIC HEALTH DEPARTMENT (ommunity Development Division Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ❑n/a Inground pool 10 20 -- ❑n/a Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ❑n/a Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 1 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 ' DelleC iaie, Pamela From: Ben Osgood Jr. [bosgood@neengineeringinc.com] Sent: Tuesday, October 14, 2008 4:35 PM To: DelleChiaie, Pamela Subject: 45 Cricket Lane Pam, We inspected 45 cricket lane and it is fine for your file. Ben Benjamin C. Osgood Jr. P.E. President New England Engineering Services, Inc. 1600 Osgood Street Suite 2-64 North Andover, MA 01845 978-686-1768 www.neen ing eerinizinc.com i Commonwealth of Massachusetts Map-Block-Lot 107.A-0219- a Q Board of Health Permit No R w North Andover BHP-2008-0202 P.I. FEE s34CWu F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted -James-Kellett toC(:Re *-ra_n1nd�ividuaI Sewa e Dis os , S stem. g P Ya CRIET LANE----- w - ------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2008-0202 Dated September 30 2008 Issued On: Sep-30-2008 ---------------------- Board of Health t! q i. . pORTN Awlication for Septic Disposal System . "o .0, • pConstruction Permit - TOWN OF TO AY'S ATE * .�,r` ORTH ANDOVER, MA 01845 $ 250.00—Full Repair At... �' $125.00 -Component �SS�1CMUS Important: Application is hereby made fora permit to: When filling out ❑ C struct a new on-site sewage disposal system* forms on the computer, use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component—What? cursor-do not use the return A. Facilli/ty Info/r�matioLn key. / (i�JLF�� Address or Lot# Al. Acleve City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump WGravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ C entional System (pipe and stone system) FL;Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. Y ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information 7� ��1„�� Name 41S_ Crt ckc4 L ,,e, Address(if different from above) n . Ard City/Town State Zip Code Telephone Number 3. Installer Information rkGak ” Ve 0 �jlil/ Name of Company � S Address 1,,7 ` r ` / eqydJ Cit own -State Zip Code 7J-/ -- 91) - -21L14 Telephone Number(Cell Phone#if possible please) 4. Designer Information oQ /V EES Name I Name of Company Address Al. Aiylo"✓ IJ JA J City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 N°RT►,. Application for Septic Disposal System f, O`,tao;a 1NO Construction Permit - TOWN OF TODAY'S DATE $250.00-Full Repair ORTH ANDOVER, MA 01845 9SSACHVSEt $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building0esidential 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 No ndover, and no to pl a the system in operation until a Certificate of Compliance has bee sued by this a f alth. Date Applicati Approved By: oard of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes �_// No 2. Project Manager Obligation Form Attached. Yes No 3. Pump System? Ifso,Attach copv ofElectrical Permit Yes No, 4. Foundation As-Built. (new construction ronly); Y s No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 ,SEPTTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS �IV ., As the North Andover licensed installer for the construction for the septic system for the property at: I!; C rKU—+ U YVC (address of septic system) For plans by Al EE f ��/ � (Engineer) Relative to the application ofcr)r-, C l (Installer's name) And dated �� (` /Z aha 7 nguia ate Dated 30 e 0 (today's ate With revisions dated (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 prior 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 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 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—Generally, this is the first (1 s 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: healthdeptntoxvnofnorthandover.com) 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 than simile excavation)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 ofHealth 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 soler 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: y (Today's Date) 7/_3 a e— rintSigned) Date., P/. pORTM i u',,�•° ..��o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� This certifies that . .� .�. • • • •t. . . . . . • .• • • • • • has permission to perform . . . . . .tri•�-•�f �l• • � plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . • • • • • at. . .x,1.5. . .C.I?I.t.c hz . .Le. . . . . . . . . . . ., North Andover, Mass. Fee� r a J . . . . .Lic. No.. .'N).f . . . . . . . . . . . . . ' PLUMBING INSP TO Check # p 7857 /� C /��G NEw ENGLANDENGINEEMNG SERVICES, INTC. 1600 Osgood Street Building 20 Suite 2-64 North Andover, MA 01845 Tel: (978) 686-1768 • Fax: (978) 327-6138 www.neengineeringinc.com November 14,2007 Susan Sawyer North Andover Board of Health 1600 Osgood Street North Andover, MA 01845 Re: 45 Cricket Lane North Andover TQ�N�7H goEPA�TM T Hf:A Septic system design Dear Susan: Enclosed are 5 copies of revised plans for the above referenced septic system design. Changes have been made to address comments in your E-mail we received Tuesday, November 13. The changes/comments are as follows: 1. General note#6 included a note indicating the dwelling is not serviced by a foundation drain. 2. An infiltrator end connection detail has been added to the plan to clarify. 3. Test pit log label for tp2 has been corrected. 4. General note#12 has been added to explain the reason for a bed design in lieu of trenches. If you have any questions, or need additional information,please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., P.E. President tWITH • Ott{4•D I�•t� aACMU � Health Department November 13, 2007 Mr. Melvyn Robbins 45 Cricket Lane North Andover, MA 01845 RE: Wastewater System Plan for 45 Cricket Ln, Map 107A Lot 219 Dear Mr. Robbins, The North Andover Board of Health has completed review of the onsite wastewater treatment and dispersal system design plans for the above referenced property submitted on your behalf by New England Engineering Services dated October 12, 2007 and received by this office on October 23, 2007. The design has been approved for use in the construction of a replacement onsite wastewater system. This plan includes an approval of a local upgrade approval for the reduction of the tank outlets to be less that 1.2 inches. But greater than 1 inch from the estimated ground water table. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. The time period for which this plan is valid is reduced to two years from the date of an inspection of the current wastewater system which did not meet the acceptable criteria in the state regulations. The time period for which this plan is valid may be reduced by the North Andover Board of Health in the event an imminent health problem such as sewage backup into the dwelling is occurring. This approval is subject to the following conditions: 1. Please be advised that this plan includes the installation of a new foundation invert and therefore a plumbing permit should be pulled and the work should be done by a licensed plumber. 2. Keep the attached Form 9b for your records ds 1600 Osgood Street - HEALTH DEPARTMENT Page 1 of 1 Building 20;Suite 2-36 E-Mail: healthdept@townofnorthandover.com North Andover,MA 01845 Phone:978.688.9640 Fax:978.688.8476 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(1)). 4. It is the responsibility of the applicant and/or the applicant's designer, installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation 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. 5. The plan does not call for installation of a primary(septic) tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use, if you choose to install one. Your effort to provide a properly functioning onsite wastewater treatment and dispersal system for your property is greatly appreciated. The Health Department may be reached at 978-688- 9540 with any questions you might have. S/incere f awy RE S/RS;7' th Director encl: List of licensed installers form 9b cc: New England Engineering Services File • Commonwealth of Massachusetts City/Town of Tu Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information ott 1. Facility Name and Address far.. oe thecomputuseMelvyn Robbins only the tab key Name to move your 45 Cricket lane cursor-do not Street Address use the return key. North Andover MA 01845 CRylTown State Zip Code 2. Owner Name and Address(if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 td S. System Designer Ben Osg0od,Jr Name ® PE ❑ RS 1800_Ods ood St North Andover 01845 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for. ❑ Reduction in setback(s)—specify: ❑ Reduction in SAS area of up to 2596: SAS size,sq.ft. 96 reduction 45 Cricket Ln form 9b 11.13.07•rev.7106 Local Upgrade Approval-pprovah Page 1 of 2 Commonwealth of Massachusetts Cityrrown of Local Upgrade Approval Form 90 B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater Separation reduction Percolation rate rnin/lmh Depth to groundwater ❑ Relocation of water supply well(explain): ® Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Dept. Approving Authority Susan Sawyer, REHS/RS a- Nov. 13,2007 Print or Type Name and Tme ignature Date 45 Cricket Ln form 9b 11.13.07•rev.7/o6 Local Uppnde Approval-Page 2 of 2 TOWN OF NORTH I ANDON'ER �ciary Office of t.OINXI NII. r I)E'G ELOPM NT ANf) SERVICES HEALTH DEPARTMENT 1600 OS A)OD STREET.til ET. BUIL DING 20; SUITE 2-36 `rr � �,Fr•`"ti NORTH.ANIS?OV R. %1ASS-1.C::1-RJSETTS 01545 «,�£< 9719,6W9540-Phone Susan 1'.Sa rover, X31<;9ts/1�4 97ti.688.?47t>..._1 A\ Public Health Director E;-J IA1L 11e«lihde;?t;i ti��G�lt3fi�ot"t[aF:ra�-er.cc��1 1�'�`FBSITF.:.htto.//www, wnofiiorthand"Over.coin SEPTIC PLAN SUBMITTAL FORM Date of Submission:Ot^f d,Z(orl 0 C T 2 3 2007 �( & 'C; Vtjr FH ANDOVER Site Location: 7�jnK � ( f W 0 '{� rr_—Tri DEPARTMENT Engineer: _ $ New Plans? Yes 225/Plan Check# (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form�Included? Yes No Telephone #: / 1U A -[ W Fax#: 9 7d jd /- E-mail: �' U 17MW q(�&ft j n C • �/1�, Homeowner Name: OFFICE USE ONLY When the sub fission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ 'V Copy File; Forward to Consultant ➢ +� Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of NO�Z 1� A'�'�0UE 2 Form 11 - Soil Suitability Assessment for On Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information 613tA19 -7 Owner Name Map/Lot tl S C RICems/ - StrtfD�res A,-Do Vt IR_ / /Q CX �� State Zip Code City/Town B. Site Information 1. (Check one) New Construction ❑ Upgrade ❑ Repair qj?. Published Soil Survey available? Yes ® No El If yes: VI& I S�KC� Mcg 9 Year Published Publication Scale Soil Map Unit /�lfM1TAv 1Z F t N� S�AtiD1� LOAM P W�6� w E LL DRAwE l) S NAL w A Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ NoA If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary. Yes ❑ No ® Within a Velocity Zone? Yes ❑ No [� 5. Wetland Area: National Wetland Inventory MapName i Map Unit Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 1 of 7 Commonwealth of Massachusetts C ity/Tovvn of/J61Z 1 H A v DO OC Z, Fora 11 - Soil Suitability Assessment for On-Site Sewage Disposal 52 e*t&r OO-)Range: Above Normal ❑ Normal � Below Normal EJ6. Current Water Resource Conditions (USGS) � 2 g Month/Year 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TP/ to- 7' 5`0 10!06 7Z� Date Time Weather 1. Location p Ground Elevation at Surface of Hole !gd 5 Location (Identify on Plan ) F-CA9-- Y01 K D, 66-v-m1-Z 2. Land Use: 2CSr Dt /T(AL (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) CkASS QZou�vD A0T?,fl1Af_ oiA�K PE Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body Soot Drainage Way 5'00fi Possible Wet Area 250 feet feet feet Property Line 50 Drinking Water Well Z60r . Other feet feet 4. Parent Material: A 9CATtOti TIC-L. Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ i 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit tOG Depth Standing Water in Hole Estimated Depth to High Groundwater: RCDox) 46`1-7 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 2 of 7 Commonwealth of Massachusetts City/Town of ,Nor�1J A4,DovtiZ Form 11 - Soil Suitability Assessment for ®n-Site Sewage Disposal inches elevation Deep Observation Hole Number: TQ I Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Texture % by Volume Consistence Other Horizon/ Color-Moist (mottles) ex (Moist) Depth Layer (Munsell) (USDA) (in.) Depth Color Percent Gravel Cobbles &Stones 0-16,0 Y3 �L 12-IIs, C. S�6/4 28 7--5 Z Additional Notes 1,Ud CZE"ALC. 14Pw6 C0� I I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7 Commonwealth of Massachusetts City/Town of?U oR'M1 A�vDovE12 a Form 'I 1 - Soil Suitability Assessment for On . Sewage Disposal e C. On-Site Review (Cont.) T[E Deep Observation Hole Number: Date Time Weather 1. Location Ground Elevation at Surface of Hole Location (Identify on Plan ) Y �S � DE�i�'v9c- iV� f3 2. Land Use: Surface Stones Slope(%) (e.g.woodland, agricultural field,vacant lot,etc.) GRASS G YZovv 1� M ORA w� alCx 5C PE Position on landscape(attach sheet) Vegetation Landform 3. Distances from: Open Water Body 50C.t Drainage Way5'00""t o0Possible Wet Area feet r-So feet Property Line 3 S Drinking Water Well Other feet feet 4. Parent Material: /4 8L ATI 0 A.) Tf L(_ Unsuitable Materials Present: Yes ❑ No [it If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ I If Yes: Depth Weeping from Pit l00 /Depth Standing Water in Hole Estimated Depth to High Groundwater: 'L8 �R��oX 94,7F inches elevation I! I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of W 0 RTW Ati 100 V9 R, ' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 9C - Deep Observation Hole Number: TP Soil Coarse Fragments Soil Soil Soil soil Matrix: Redoximorphic Features Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (in.) Depth Color Percent Gravel Cobbles &Stones a.- i4 to Ig L Ig- 11a G Z-51-5/ 8 1.5Y Additional Notes .A)O C, wg E p" ie too" DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of xagN" A�v b oV(_RL a Fora 11 - Soil Suitability Assessment for ®n-Site Sewage Disposal I D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. inches B inches ❑ Depth weeping from side of observation hole A. B. inches inches ®- Depth to soil redoximorphic features (mottles) A.inches B itches ❑ Groundwater adjustment (USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes Nq No ❑ t z t 2 b. If yes, at what depth was it observed? Upper boundary: lZ re Lower boundary: 111? t to inches inches F. Certification I certify that I have passed the soil evaluator examination"approved by the Department of Environmental Protection and that the above analysi was perfor edby me consistent with the required training, experti e an experience described in 310 CMR 15.017. Gam. 101 a/b-7 Signature of soil Eva for I Date 'i'Fto�tA S N Cc1a Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam o iZ'M A v D o IvE fL Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 I DEP Form 11 Soil Suitability Assessment for on-Site Sewage Disposal - Page 6 of 7 Commonwealth of Massachusetts C ity/Town of N o 1` IN-) A A/Do v 9, Form 11 - Soil Suitability Assessment for ®n-Site Sewage Disposal Use this sheet for field diagrams: See PLAN II. l i i I DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7 Commonwealth of Massachusetts City/Town of N©tZTt H Avbo vEZ Percolation Test o Form 12 4M 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. ImpoWhen filling A. Site Information When filling out forms on the computer,use Melvyn Robbins only the tab key Owner Name to move your 45 Cricket Lane cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code r�7 Contact Person(if different from Owner) Telephone Number B. Test Results 10-5-07 10:00 Date Time Date Time Observation Hole# PT1 Depth of Perc 30"/18" Start Pre-Soak 10:20 End Pre-Soak 10:35 Time at 12" 10:35 Time at 9" 10:52 Time at 6" 11:15 Time(9"-6") 23 minutes Rate(Min./Inch) 8 min. /inch Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Thomas Hector Test Performed By: Armond P r a razzo, Mill River Consultants Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 � jd �-. ~ T�]yV� {l� N[)RTH AND�VER Th (>�iC��� jN\TY [}��EL[}�K E��T �\M[) SER\/[(��� F\Ep4'�TK��NT�DODO��O[)DE3REETBU|L0NG 20� SU|TE2_3O NORTHAND�V �� � kX ��\CHUSETT8D184� EF �ys=.n � s»'yo ��|iC. HS �7868G9640 P�u�n FAX w^wvimano�nor�����overuom ' APPL|CATION FOR SOIL TESTS .DATE: 3�_ MAp& pARCEL: 211 LOCATION OFSOIL TESTS OWNER: Contact 2-2- !�hvv1� � APPLICANT: ��w°' '^-- Contact# ADDRESS —» ED CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision amily�Ho Commercial SEP 14 2007 IsThis. Repair Testing".. Undeveloped Lot Testing: Upgrade for Addition. TOWN OF?,K)RIH ANDOVER Inthe Lake CmchichewiokWatershed? YeeNo HEALTH D�-.'�ARTMENT > Proof nfland ownership[7oubill,uvletter from owner permittingtmst> / ~ > 8.5—x 11—Plot plan& Location of Testing(please indicate test pit siteson theplan) > Fee of$425.00 per lot for new construction. This unvermtheminimum two deep hdeoand two percolation testoraquiedfor each disposal area. F000f$}G8Iper lot for repairsor upgrades. GENERAL INFORMATION > On|yCert\fiodSui| EvaivaLoramay porformdeep hn|einopections. > On\yMass.Regi stmredSanitmians.and Profamsiomal Enginearscan dosignsepti uplans. � At least two deep holes and two percolation tests are required for each septic system disposalarea. � Repairs required least two deep holes and at least one percolation test, dthediscretionof theBOH representative. > Full paymontwi|| berequired for ail additional tests within two weeks oftesting. � @8thin45dmyeoftesting, aooAedplan(noamai|erthan 1_�1O0Jahal| besubmitted tothe Board ofHealth showing the location ofall tests(indudingaborted tmsts) � Within 6Odaynoftmstingooi| evaluation formanhaU boaubmitted. Please DoNot Write Below This Line NA, Con Signature mConservation Agen Date back tnHealth Department: (stampin): /n/7 / "��' -�lZ� |\�� [�\ [ | �� � , , r r r >; _ j yyG 4 S e a 3 r x, r. T 167 Is ., .. ]S LE - +J� u 1 t 44�j 47 +t 8th c! '�► Y%l t t S � - AWE I IJV- PIPE OUT OE H5F=- E5 uiL-r [m V. Ptpe I NTD TAbLy- 0 1isiy PF—QUTOF rA&j INV- PIJFE INT it4v. r>I pE nl :[ o.p ox t tit..' +• a r `�"� ''^'1 J C)o ( 7 CV 4,rt p,S r A g Svc t n-r+E=S �r �,.,..1. ��s G�N�.>-.a!2s� ,A.t2c.►-t