HomeMy WebLinkAboutMiscellaneous - 63 CROSSBOW LANE 4/30/2018 T
63 CROSSBOW LANE
210/a 06.B-02U 9-0000.0
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�i North Andover Board of Assessors Public Access t Page 1 of 1
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Property
Record Card
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Parcel ID:210/106.11-0209-0000.0 Community:North Andover
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Sales
U
Summary
Residence " ei
Detached Structure
Condo
I Commercial a..n
\, Comparable Sales r
` 63 CROSSBOW LANE
Location: 63 CROSSBOW LANE
Owner Name: DUFFY,DENNIS P
EDITH M DUFFY
Owner Address: 63 CROSSBOW LANE
City:NORTH ANDOVER State:MA ZIP:01845
Neighborhood: 7-7 Land Area: 1.08 acres
Use Code: 101 -SNGL-FAM-RES Total Finished Area:2464 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 612,300 572,100
Building Value: 396,700 372,700
Land Value: 215,600 199,400
Market Land Value:215,600
Chapter Land Value:
LATEST SALE
Sale Price: 299,900 Sale Date: 12/02/1986
Arms Length Sale Code:Y-YES-VALID Grantor: O'HANLON J.ROSS,JR
Cert Doc: Book: 02367 Page:0334
http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=993105 9/21/2007
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
CERTIFICArrE O1' C09V(Pl- T. 3Xff
As of.-
September
f:September 30, 2008
This is to cert that the individuaCsu6surface disposasystem received a
SATIS'FACYIoRT1XS(�EC770Yof the:
Fud System Repair of the
Subsurface Sewage 1Disposa(System
By.
,john Soucy
At:
63 Cross6ow .Gane
flap 106.B; Parce[209
North Andover, W,4 01845
The Issuance of this certificate shaCC not 6e construed as a guarantee that the system witrC
function satisfactorily.
S an �Y. Sa er
1t 6Cic YfeaCth Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
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a-,PUBLIC HEALTH DEPARTMENT
Community Development Division
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System(4onstructed;( )repaired;
By: hrP' N + S'
(Print Name)
Located at: 3 C Z G S r 67� a'%W L A W C
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
and last revised on 10 •`? Y• 0 7 ,with a design flow of
`l 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.
Bottom of Bed Inspection Date:
Engineer Representative(Signature)
And—Print Name
Final Construction Inspection Date: 7` 3
ngineer Representative(Signature)
J.0 .j
And—Print
Installer ignature) � ,..... �� MDate:
o ,1 - '"�'DD And—Print Name
Engin : ' y� (Signature) Date: 7 , R, a '
And—Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
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DelleChiaie, Pamela
From: Marianne Peters[mpeters@millriverconsulting.com]
Sent: Wednesday, July 16, 2008 3:42 PM
To: 'Daniel Ottenheimer'; Isaac Rowe; Grant, Michele; DelleChiaie, Pamela; 'Randy Burley';
Sawyer, Susan
Subject: Construction Inspection-63 Crossbow-July 8, 2008
,'Attached is the construction inspection report for 63 Crossbow. Please call if you
have any questions.
FK] Right-click here to download pictures.To help protect your privacy,Outlook prevented automatic download of this pictu
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Marianne Peters
'Office Manager
ph 800-377-3044
ph 978-282-0014
fx 978-282-0012
web:www.miUriverconsultin-.com
7/17/2008
NORTH
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 63 Crossbow MAP: 106B LOT: 209
INSTALLER: John Soucy
DESIGNER: John McQuilkin, Jr.
PLAN DATE: 6/22/07
BOH APPROVAL DATE ON PLAN: 10/30/07
INSPECTIONS (fib t\q
TANK INSPECTION. 1 D
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPE TION: 7/8/08
DATE OF FINAL GRADE INSPECTION: �� D
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
® (Raised building sewer at house)
® Moved septic tank closer to SAS
Comments:
SEPTIC TANK
Z 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
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form June 2008
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SSACHUS�
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
H-10 loading 2-piece construction
❑ Water tightness of tank has been achieved by
testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
effluent filter Zabel
® 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
® 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 Ian
pp p
E:1 Retaining wall (boulder/ concrete /timber/ block)
❑ Final cover as per plan
Comments:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Inspection Form June 2008
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SSAC HUSH
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
SOIL ABSORPTION SYSTEM (Gravel-less Chambers)
® Brand & Model of Chamber: Cultec contactor Field Drain
C-4
® Number of chambers per row: 6
® Number of rows (trenches): 2
Comments:
SYSTEM ELEVATIONS
INVERT IN FIELD PLAN INVERT ELEV.
Benchmark 99.9
Building Sewer OUT 101.36 101.05
Septic Tank IN 100.27 100.18
Septic Tank OUT 100.06 99.93
Distribution Box IN 99.94 99.83
Distribution Box OUT 99.76 99.66
Chambers IN 99.64 99.66
Bottom SAS 99.32 99.41
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Inspection Form June 2008
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SSACHUS�
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
CRITICAL SETBACK DISTANCES
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 --
® Deck, on footings, etc 5 10 --
Waterline 10 10 101
® Surface Water 25 50
® Bordering Vegetated Wetland ,
Salt Marsh,Inland/Coastal Bank2 75 100
Suction line 222(2)
2 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 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
Inspection Form June 2008
t3
AS-BUILT CHECKLIST
L II
_ OT NUMBER, STREET NAME
✓ ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLI�i3�T ���
TIES TO LOT LINES &DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES &PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
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-BOX
ORIGINAL STAMP& SIGNATURE
_ IMPERVIOUS AREAS -DRIVEWAYS, ETC.
[/ NORTH ARROW
✓ LOCATION & ELEVATIONS OF BENCHMARK USED
r=
f KCR*" Commonwealth of Massachusetts Map-Block-Lot
106.6-0209-
Board of Health Permit No
' North Andover BHP-2008-0106
P.I.
�r �'•..<s�''� FEE
iss�cwust� F.I. $250.00
-----------------------
Disposal Works Construction Permit
Permission is hereby granted John_Soucy- --- ---_-_ _--_- -
-- ------- --------------------------------------------------------------
to(Repair)an Individual Sewage Disposal System.
at No 63 CROSSBOW LANE
as shown on the application for Disposal Works Construction Permit No. BHP-2008-010 Dated May 29,2008
Issued On:May-29-2008
------------
Board o ea t
Commonwealth of Massachusetts Map-Block-Lot
106.6-0209-
Board of Health -------------------
North Andover
s$�cMus Certificate of Compliance
THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair)
by John Sou ---------------------------------------
---------------------------------------------------------------------------
Installer
at No 63 CROSSBOW LANE
has been,installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. BHP-2008-010 Dated---May 29,-2008
-----------------------------------------------------------------
Printed On,:May-29-2008
------------------------------------------------------ ----------------- ----- Board of Health
— —
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Town of North Andover
HEALTH DEPARTMENT
CMUSt�
CHECK#: /z3 3' DATE:
LOCATION: 4/s ( J�
H/O NAME:
CONTRACTOR NAME:
Type of Permit or License: f heck box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
J1-'Septic Disposal Works Construction(DWC) $Gl��
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
i
plication for Septic Disposal System ; 691
00%- uct o Permit TO Y'S D T
Con r i n P
o st e t — TOWN OF E
b' • ORTH ANDOVER, MA 01845 $ 250.00—Full Repair
...�
,sa^no $125.00 -Component
CHU
Important: Application is hereby made for a permit to:
When filling out ❑ nstruct 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. Facility Information
key. q
a us w v— L �
C ��
ISI Address or Lot#
- 406V.4A • 0,74-
, „ Cityrrown
2.-*TYPE OF PTIC SYSTEM*:
❑ Pump Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
❑ C nventional System (pipe and stone system)
Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D-Box Present) S.A.S.
2. Owner Information
01t ZZ A
Name
Address(if different from above)
Cit !Town State i
y to Z p Code
Telephone Number
3. Installer Information
oe
Name Name of Company
b
Address J
�?\ _ n!? 7® e 3(2-7
City/TownState Zip Code
Telephone/Number(Cell Phone#if poskible lease)
4. Designer Information
S
Name _ Name of Company
Address_
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
r6"°oT"gti *`Application for Septic Disposal System V
o
• c
n Construction Permit - TOWN OF TODA S DAT
$250.00-Full Repair/
ORTH ANDOVER, MA 01845 $125.00 -Component
9SSACHUS�t
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: Residential Dwelling or❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Mdover, and not t place the system in operation until a Certificate of Compliance has
b77 by this B d of Health.
ovc 6W
am Date
Applica i n Approved By: (-oard of Health Representative)
Z � � 2Yleor
Name Date
/ Application Disapproved for he following reasons:
L
For Office Use Only:
I Fee Attached. Yes ✓ No
2. Project Manager Obligation Form Attached. Yes No
J. Pump S stem? Ifso,Attach coQK ofElectrical Permit Yes No, /
4. Foundation As-Built?(new construction ronly). Yes No
(Same scale as approved plan)
5. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit•Page 2 of 2
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SEPTIC SY$'IEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
APs the North Andover licensed installer for the construction for the septic system for the property at:
e�3 an S c Cao 4,--- 1 -�_ F
(Address of septic system) For plans by TM� 250C
(Engineer)
Relative to the application of b cl, QO C
(Installer's name) And dated Q
n a ae
DatedG 'b le
(today s ate With revisions dated
(Last reviled date)
I understand the following obligations for management of thisproject:
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 (VS 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: healthdept@townofnorthandover.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 simple 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 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 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: (Today's Date)
Wa—eo a– rmt (NaeSigned)
NORTH
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��SSACHus
PUBLIC HEALTH DEPARTMENT
Community Development Division
October 30,2007
Dennis Duffy
63 Crossbow Lane
North Andover, MA 01845
RE: Septic System Design, 63 Crossbow Lane,North Andover,Map 106B,Lot 209
E IPORTANT: Please be advised that all permits for subsurface disposal systems this year
must be issued by November 15th and the systems are to be completed by November 30a`,
The installation season begins March 1t of each year depending on weather conditions.
Dear Mr. Duffy,
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by JM Associates, dated June 22,
2007, last revised October 24, 2007. This approval includes a Local Upgrade Approval for the
request to have only one test pit within the area of the proposed system. This plan is valid for two
years from the date of this approval.
The design has been approved for use in the construction of an onsite septic system for a 4-
bedroom house(maximum 9-room). 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. In the event an imminent health problem
such as sewage backup into the dwelling is occurring,the North Andover Board of Health may
reduce the time period for which this plan is valid.
This approval is subject to the following conditions:
1. 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.
2. 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 Commission, Zoning
Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector.
The issuance of a Disposal System Construction Permit shall not construe or imply
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
I
c
compliance with any of the aforementioned requirement.
3. Please keep the attached Form 9b for your records.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
may have.
Sincerely,
zY. Sawyer, HS/R
Public Health Director
Encl: list of licensed septic system installers
Cc: JM Assoc.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth of Massachusetts
CityRown of
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
Whe�g
When filling out 1. Facility Name and Address
forms on the
computer,use Dennis Duffy
only the tab key Name
to move your 63 Crossbow Lane
cursor-do not
use the return Street Address
key. North Andover MA 01845
City/Town State Zip Code
or
2. Owner Name and Address(if different from above):
'"001 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
90
5. System Designer John McQuilkin Jr. PE F1 RS
Name
325 Main St N. Reading MA 01845
Address Cityrrown State,ZIP
B. Approval
1. Local Upgrade Approval is granted for.
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
63 Crossbow Lane 9b•rev.7/06 Local Upgrade Approval• Page 1 of 2
Y
r
Commonwealth of Massachusetts
Cityrrown of
Local Upgrade Approval
Form 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater.
Separation reduction ft
Percolation rate mindinch
Depth to groundwater ft
❑ 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. 42 /19
Approving Authority
Susan Sawyer, Health Dir. 10/30/07
Print or Type Name and Title S' nature Date
63 Crossbow Lane 9b♦rev,7/06 Local Upgrade Approval* Page 2 of 2
i
TOWN OF NORTH ANDOVER r t ORYJi�
Office of COAIMUNITY DE ELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET: BUILDING 20; SUITE 2-36
NORTH ANDOVER.. MASSACHUSETTS 01845
978.688.9540—Phone
Susan Y.Sawyer,RENS/RS 978.688.8476—FAX
Public Health Director E-MAIL: healthdeftCi;tov,inofiiorthandover.com
WEBSITE:lzttp://xvw\v.to\�-noftloilhandover.com
SEPTIC PLAN SUBMITTAL FORM
Date of Submission:
OCT 15 2007
Site Location: 63 CRnSS$O-W LANE
TO%'a'P�r,,F%10147?X'DOV'R
Engineer: JOHN MCOUILKIN, JM ASSO .TATE. `t":*�L�"'Ar�l.^F �!T
New Plans? Yes $225/Plan Check# (in es l"submission and on re-
review only)
GU,
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yeses No
Telephone#: (978) 664-6668 Fax#: (978 ) 664-8155
E-mail: JM ASSOCIATES @ VERIZON;net
Homeowner
Name: DENNIS DUFFY
.._..,.. ..µ..,....ms_.,..- .w w�..-�.. .,...-.r...,.«....,........ w......_...._........... ..:...... .. ... ,. -.....,.. ..., ,.._. ...w.,.
OFFICE USE ONLY
When the submission is complete(including check):
➢ Date stamp plans and letter
➢ Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
{II
Commonwealth of Massachusetts
------ City/Town of
w
o Form 9A — Application for Local Upgrade Approval
,> DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
15.404(1), is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.415.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-sites stem constructed in accordance with either h 1
Y the 978 Code or 310 CMR 15.000.
i
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms on the
computer,use DENNIS DUFFY
only the tab key Name
to move your
cursor-do not 63 CROSSBOW LANE
use the return Street Address
key.JL FORTH ANDOVER IA 1Q A
City/Town State 2ip ode
IV U4 .
2. Owner Name and Address (if different from above):
SAME
" Name
I
' Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
__FOII__R RED_R0 M DWFT T TNC'
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) Conventional Other describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
CHAMRFR S
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 1 of 4
Commonwealth of Massachusetts
City/Town of
W
a o Form 9A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: 440
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: 440
gpd
B. Proposed Upgrade of System
1. Proposed p d upgrade Is (check one):
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301:
date of inspection
2. Describe the proposed upgrade to the system:
Replace existing pipe and stone system with chamber system
3. Local Upgrade Approval is requested for(check all that apply):
❑ Reduction in setback(s)—describe reductions:
i
❑ Reduction in SAS area of u to 25%:
p SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
LOCALUPGRADEAPPROVAL10307.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 2
Commonwealth of Massachusetts
City/Town of
a
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and
high groundwater
® Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Randy Burley 6-12-07
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
system is fully compliant the exception of 1 deep hole.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
system is fully compliant the exception of 1 deep hole.
LOCALUPGRADEAPPROVAL10307.doc•rev.7/06
Application for Local Upgrade Approval* Page 3 of 3
Commonwealth of Massachusetts
City/Town of
== o Form 9A - Application for Local Upgrade Approval
A0 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
NOT AVAILABLE
4. Connection to a public sewer is not feasible:
NOT AVAILABLE
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
Application for Disposal System Construction Permit
I
[ Complete plans and specifications
Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
Facility Owner's Signature Date
DENNJ-S_DIJFFY _ _
Print Name
,7nHN Mr.C')TiTi.KTN, JMAS�(1C'TA" �_
Name of Prep arer Date
3 MA.I_N TR FE' -NC�ZTH SADIST ---
Preparer's address City/Town
MA, 01864 (978) 664-6668
State/ZIP Code Telephone —
t5form9a.doc•rev. 7/06
Application for Local Upgrade Approval, Page 4 of 4
r
i
t .d
TOWN OF NORTH ANDOVER of�►ORtk
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENTCgsw
1600 OSGOOD STREET;BUILDING 20; SUITE 2-36 "o
NORTH ANDOVER,MASSACHUSETTS 01845 ' �;;, `r
978.688. 40—Phone
Susan Y.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthde t a,townofnorthandover.com
WEBSITE:hq://www.tovai—ofnorthandover.com
ofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM
RECEIVED
AUG 1 5 2007
Date of Submission: �/-�O TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Site Location: 63--rRc3S.�nw �A�tg
Engineer: JOHN MCOUILKIN, JM ASSOCIATES
New,Plans? Yes X $225/Plan Check# (includes I"submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yeses_ No
Telephone#: (978) 664-6668 Fax#: (978) 664-8155
E-mail: JM ASSOCIATES @ VERIZON;net
Homeowner
Name: DENNIS DUFFY
OFFICE USE ONLY
When the subnI ion is complete(including aleck):
Date stamp plans and letter
➢ — Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of
o Form 9A - Application for Local Upgrade Approval
^M ,,•~ DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
15.404(1), is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.415.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms the DENNIS DUFFY
computer,use
only the tab key Name
to move your 63 CROSSBOW LANE
cursor-do not Street Address
use the return
key. NORTH ANDOVER MAmeq.
City/Town State flip ode
2. Owner Name and Address(if different from above):
JkAf
SAME
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility(check all that apply):
[� Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
FOUR BEDROOM DWFT T TNG
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) FC] Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
CHAMRERS -
I
t5form9a.doc•revs 7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
-- City/Town of
W Form 9A - Application for Local Upgrade Approval
�M y,•� DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
,A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
440
Design flow of existing system: gpd
Design flow of proposed upgraded system 440
gp
Design flow of facility: gp440
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
❑ Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection
2. Describe the proposed upgrade to the system:
REPLACE EXISTINGPIPE ANDSTONESYSTEM
WITH LEACHING CHAMBER SYSTEM
3. Local Upgrade Approval is requested for(check all that apply):
❑ Reduction in setback(s)—describe reductions:
❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction
Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
t5form9a.doc•rev.7/66 Application for Local Upgrade Approval* Page 2 of 4
1
1
Commonwealth of Massachusetts
City/Town of
a
a Form 9A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
RADDY BURLEY 6-I�-��
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
A FULLY Y COMPT IANT SYSTEM WOULD REQUIRE. A
"PUMPED" SYSTFM
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
A FULLY COMPLIANT SYSTEM WOULD REQUIRE A
"PIIMPFD11 SYSTEM-
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4
e
Commonwealth of Massachusetts
City/Town of
a
a Form 9A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
NOT AVAILABLE
4. Connection to a public sewer is not feasible:
NOT AVAILABLE
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
J Application for Disposal System Construction Permit
Complete plans and specifications
Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
�D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
C��� K'>. 1��-j- 4 I l i IL,-?
Facility Owner's Signature Date
DFNNTS nUFFY
Print Name
JOHN Mr-QTjTT•K—TL, ;7M AS.(;f1.CTATES
Name of Preparer Date
rr_
325 MAIN STREET NO-�-'Iu READ��-IFb
Preparer's address City/Town
MA, 01864 ( 978) 664-6668
State/ZIP Code Telephone
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 4 of 4
Commonwealth of Massachusetts
C ity/Town of
a
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (Cont.)
Deep Observation Hole Number: Z 6' ��' �;GG A h1
Date Time Weather
1. Location
Ground Elevation at Surface of Hole `1 f,D
Location (Identify on Plan ) S a; S r' �' A10 'j ,
2. Land Use: P4 0 7 _
(e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope (%)
( 04 UJ 1-J
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body ��, Drainage Way Possible Wet Area 00 {-
feet feet feet
Property Line /a '::" Drinking Water Well Other
feet feet
4. Parent Material: t'j r ``° '^� r Unsuitable Materials Present: Yes ❑ No Lam'
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes [� No ❑
If Yes: Depth Weeping from Pit Depth Standing Water in Hole S '
Estimated Depth to High Groundwater: 31 '%'S (
inches elevation
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (Cont.)
Deep Observation Hole Number: I G- It, C�C' A A-i
Date Time Weather
1. Location
Ground Elevation at Surface of Hole Z t
Location (Identify on Plan ) S '' =� �' ' ' `-' 4-V &
2. Land Use: L .'A w N 0 � `� 7-
(e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones Slope (%)
(. 0 k," N
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body I Drainage Way Possible Wet Area /
feet feet feet
Property Line 345 ` Drinking Water Well Other
feet feet
4. Parent Material V1% s-'o N Unsuitable Materials Present: Yes ❑ No L�"
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes E� No ❑
t
If Yes: Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 't 6 l t(' 4 f
inches elevation
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 4 of 7
Commonwealth of Massachusetts
C ity/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
7 inches elevation T° .
Deep Observation Hole Number: Z
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil
Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other
Layer (Munsell) (USDA) (Moist)
(In.) Depth Color Percent Gravel Cobbles
&Stones
S4 ►L l� ��
[a♦avtc�-
33� `tCt Z.s 5 A p I Sy�U
lion.IF O.
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7
Commonwealth of Massachusetts
City/Town o
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
M
814 inches elevation Cr Er• Z y C
Deep Observation Hole Number:
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil
Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other
Layer (Munsell) (USDA) (Moist)
(In') Depth Color Percent Gravel Cobbles
&Stones
-Z9P33 , ,
AAG
C 7.SYSl� Lou s
33-S& , SA a
S&'af3'Yt C L Z.S Y, �,�3 S-,O 13 C p s
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7
4 . r
,Commonwealth of Massachusetts
- City/Town of
- _ W Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:
When filling out A. Site Information
forms on the
computer, use
only the tab key Owner Name
to move your C, r C 4e 6 r r fi r.. �.g L e;� r,
cursor-do not Street Address or Lot#
use the return
key. G . �' ry/I G v '•'dt Wi �+ `P f4
City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
Date Time Date Time
Observation Hole# d
Depth of Perc 8 +
Start Pre-Soak
End Pre-Soak
: c5
Time at 12" paZ
Ec�. aG
Time at 9"
Time at 6" �G 'Q
Time (9"-6")
Z /-r
Rate (Min./Inch)
Test Passed: (�/ Test Passed: ❑
Test Failed: ElTest Failed: ElJPc4- lt`cc IL 4- IQ
Test Performed By:
j<- AN 'Yf ��" tt�Ccey - � r L V ' t?
Witnessed By:
Comments:
t5form U.doc•06/03 Perc Test•Page 1 of 1
�10RT//
10- 7�°D
,SSACMUSE�
Health Department
September 4, 2007
Mr. John McQuilkin Jr. P.E.
JM Associates
325 Main Street
North Reading, MA 01864
Re: Septic System Repair Plan for 63 Crossbow Lane
Map 1068, Lot 209
Dear Mr. McQuilkin:
The proposed wastewater system design plan for the above site dated June 22, 2007 and
received on August 15, 2007 has been reviewed. Unfortunately, the plan cannot be approved
until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or
North Andover (NA) regulation that has not met by this design follows each item for your
convenience.
1. 1 Please revise the design to meet the five (5) foot ground water offset as required. Non-
compliance with the regulations for the purpose of maintaining gravity is not sufficient to
warrant a ground water offset reduction LUA (15.404(1))
2. Please indicate magnetic marking tape to be installed around the required system
components (15.221)
3. Please provide a detailed description of the methodology to be used to ascertain the
suitability of the existing primary (septic) tank to determine if it sufficient to be re-used.
Please provide images of the components which should be present and a method for
assuring the proper construction and operation of the tank. Prior to the Board of Health
approving the design the inlet and outlet invert elevations, a hydraulic capacity of 1,500
gallons, water tightness confirmed by vacuum testing, and the material (and pipe
schedule if applicable) of the building sewer must be verified
4. "Cultec" Gravel-less chamber systems require the use of"Cultec No. 410 Filter Fabric".
Please provide notation that this material is part of the chamber system
5. Please provide dimensions for relevant distances to system components (NA 8.03 (a-c))
6. Please amend the proposed contour 98.41 to depict contours in two foot intervals as
specified at other locations throughout the plan. You may wish to add spot grades at
locations where exact elevations are relevant (15.220(4)(g))
7. Please provide the location and elevation of the foundation drain. If there is no drain,
please provide notation on the plan. (NA 8.02y)
8. Please specify that all connections are to be watertight (15.222 (3) & (4), NA 11.02)
9. Please specify pipes to serve the system to be laid on compact, firm base where
applicable (15.222(5))
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 2
Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
10. Please specify pipes to serve system to be laid on continuous grade and in a straight
line where applicable (15.222(7))
15.223(2))
11. Please provide a primary (septic) tank detail (15.227(1)(4)(6)(7),
12. Please specify soil compaction and stone base below distribution box (15.221(2))
13. Please provide an effluent filter maintenance schedule (15.227(7))
14. Please depict the necessary manhole cover to grade required over the effluent filter for
the primary tank in the details and profile (15.221 & 15.228(2))
15. Please provide notation that all outlets of the distribution box shall be at the same
elevation (232(3)(b))
16. Please provide notation that the distribution box is to be water tight (15.221(1))
17. Please specify and depict where appropriate, a riser to within 6" of final grade for the
distribution box (15.232(3), 221(13), 228(1))
18. Only one (1) deep observation hole is utilized in the primary soil absorption area.
Please request a Local Upgrade Approval (15.102(2))
19; As leaching trenches are the preferred mechanism for a soil absorption system please
provide and explanation as to why a design utilizing trenches was not chosen
(15.240(6))
20. Please specify the ends of the distribution chambers to be tied together with solid pipe
(NA 15.01)
21. Please specify that excavation for the soil absorption system is to extend at least 6" into
natural soil (NA 9.02)
22: Please provide specifications for fill material to be used (15.255(3))
23. Please depict inspection ports for the soil absorption system in the scaled profile
24. Please specify final grading over the leach facility to indicate a slope of 0.02ft/ft
minimum (15.240(10))
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sincerer,
San Y. Sawyer, REHS/ S
Public iHealth Director
cc: Owner
File
r
1600 Osgood Street HEALTH DEPARTMENT Page 2 of 2
Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
NORT#f
16 Z.O !/
O �►
� 0
O•pA COC.cm-
Ars
WWKM V .
��SSACH135
PUBLIC HEALTH DEPARTMENT
Community Development Division
October 30,2007
Dennis Duffy
63 Crossbow Lane
North Andover, MA 01845
RE: Septic System Design, 63 Crossbow Lane,North Andover,Map 106B, Lot 209
IMPORTANT: Please be advised that all permits for subsurface disposal systems this year
must be issued by November 15'h and the systems are to be completed by November 3e.
The installation season begins March 1"of each year depending on weather conditions.
Dear Mr. Duffy,
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by JM Associates, dated June 22,
2007, last revised October 24,2007. This approval includes a Local Upgrade Approval for the
request to have only one test pit within the area of the proposed system. This plan is valid for two
years from the date of this approval.
The design has been approved for use in the construction of an onsite septic system for a 4-
bedroom house(maximum 9-room). 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. In the event an imminent health problem
such as sewage backup into the dwelling is occurring,the North Andover Board of Health may
reduce the time period for which this plan is valid.
This approval is subject to the following conditions:
1. 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.
2. 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 Commission, Zoning
Board,Planning Board,Building Inspector,Plumbing Inspector and/or Electrical Inspector.
The issuance of a Disposal System Construction Permit shall not construe or imply
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com
I
compliance with any of the aforementioned requirement.
I Please keep the attached Form 9b for your records.
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
may have.
Sincerely,
zY. Sawyer, S/R
.-A
Public Health Director
Encl: list of licensed septic system installers
Cc: JM Assoc.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth of Massachusetts
Cityffown of
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
portant:
When filfing out 1. Facility Name and Address
forms on the
computer,use Dennis Duffy
only the tab key Name
to move your 63 Crossbow Lane
cursor-do not Street Address
use the return
key. North Andover MA 01845
QCity/Town State Zip Code
2. Owner Name and Address(d 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
gpd
5. System Designer John McQuilkin Jr. PE E] RS
Name
325 Main St N. Reading MA 01845
Address Cityrrown state,ZIP
B. Approval
1. Local Upgrade Approval is granted for.
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%: SAS size,sq,ft. %reduction
63 Crossbow Lane 9b•rev.7/06 Local Upgrade Approval*Page 1 of 2
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater.
Separation reduction
e.
Percolation rate minAnch
Depth to groundwater ft
❑ 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, Health Dir. 10/30/07
Print or Type Name and Title S' nature Date
63 Crossbow Lane 9b•rev.7/06 Local Upgrade Approval* Page 2 of 2
Page 1 of 1
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Wednesday, August 15, 2007 3:28 PM
To: Dan Obrzut(E-mail); Daniel Ottenheimer(E-mail); Marianne Peters(E-mail)
Subject: New Septic Plan Submission -63 Crossbow Lane - Prepared by JM Associates, North Reading
Importance: High
I am sending a new plan review in the mail today. Please check the design to be sure it went along with your
recommendations regarding the test pit locations. This is an engineer that we do not usually deal with.
-----Original Message-----
From: Mill River Consulting [mailto:rburley@miliriverconsulting.com]
Sent: Wednesday, June 13, 2007 9:51 AM
To: DelleChiaie, Pamela; Marianne Peter; Sawyer, Susan
Subject:63 Crossbow Lane
it
Good morning,
Please find attached my scanned notes from soil testing.
As per my notes, I advised the designer to use the test pit furthest from the road for data and to design the new
system in'an area of the old system. This is to be done to keep greater than 100 ft. from wetlands on the opposite
side of the street.
Please do,not hesitate to contact me with any questions. 978-282-0014
Sincerely,
Randy Burley
Mill River Consulting
i
8/17/2007
/22/20 12:11 97BG64B155 ,JM ASSOCIATE PAGE 02/02
TOWN OF FORTH ANDOVER rp1ejM
Office of COMMUNITY DEVELOPMENT AND SERVIC1;5 �' •""' t
HEAL'M DEPARTMENT ;
1600 OS6001)STREET; BUILDING 20; SUITE 7-36
NORTH ANDOVER,MASSAMUSETTS 019AS ' ,•�`'
Susan X.Sawyer,RENS,RS 978.688.9540 - Phone
Public Health Director 978.688.8476-!'A)(
hca lthdept(nitrnviio fnorthiindove,.rom
www.towtiol'iiortliatidovcr.com
APPLICATION FOR SOIL,TESTS
GATE: ,),' MAP&PARCEL:
WATION OFSOIL TESTS __ '(_ (�-=/� n�Az�
OWNER.
APPLICANT: o ` Y ; °° Contact
ADDRESS. ; l 's ', w "
ENGINEER.: _,.y, Watt �.S�._:tom.a��
CERTIFIED SOIL EVALUATOR; 3*t<`a<_ i'yi
y
Intended Use of Land. Residential Subdivision %,Single Family Horiie, COMMMial
I8.Rk. Repair Ttsting> Undeveloped Lot Tcattng: _ Upi a-adc for Addttto.k',_i.
In the Lake Cochiehewick Watershed? Ycs
THE FOLLOWING MUST DE MCLUDED WITH TRIS FORM
)a Proof of land oweerthlp(Tax bill,of letter frons owner parmitting tests)
}� �5.�� lE.���d of T �jR a c�tndYcate lesl_nlss�ltec on fhe sleet)
Foe 4f�,per lot for RM cvnxtructiwr. This cavgn the minimum two deep holes and
two percolation tests required for each disposal Bat A, Fee of d per lot for CCwt_ s 9Xyilmde&.
GENERAL INFORMA71ON
Only Certified Soil Evaluators may perforin deep hole inspections.
Only Mass.Registered Sanitarians artd Professional Engineers can design septic plans.
> At least twn dmp holes and two percolation tests arc required for each septic system disposal area.
k Repairs require at least two deep holes and at tent one percolation test,at the discretion of the BQH
mprescotative.
> Pull payment will be required for all Additional tests within two weeks of testing,
> W iMin 45 days of testing,a scaled plan(no smaller than I"-100')shall be submitted to tho hoard of Health
showing the location of all tests(including aborted tests).
}� V Mln bit dacrya of testing soil evaluOloa tonere®hull bo oubmUtad.
%Please Do Not Wrlte Below Thiw line
NA.Comermadon Conodulan Apprmal Date:
�lRe ofCotrverV40o r Agtaaat = �T ,p
,Data back to hfealth Peparrmen[_-(stamp in). Tb(d A NV) (A
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Page 1 of 1
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DelleChiaie, Pamela
From: Mill River Consulting [rburley@millriverconsulting.com]
Sent: Wednesday, June 13, 2007 9:51 AM
To: DelleChiaie, Pamela; Marianne Peter; Sawyer, Susan
Subject; 63 Crossbow Lane
Good morning,
Please find attached my scanned notes from soil testing.
As per my notes, I advised the designer to use the test pit furthest from the road for data and to design the new
system in an area of the old system.This is to be done to keep greater than 100 ft. from wetlands on the opposite
side of the street.
Please do not hesitate to contact me with any questions. 978-282-0014
Sincerely,
Randy Burley
Mill River Consulting
I
6/13/2007
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TOWN OF NORTH ANDOVER MoKrh ,�
APPLICATION FOR PLAN EXAMINATION , ,•�.�. `r1
l4 i • r
Date Recrived ! �ok
NO: �'ahc►+ustc'�'
sued:
IMPORTANT:A licant must com lete all items on this e
;ATION Print
i . . �
)PERTY OWNER Print
NPARCEL: ZONING DISTRICT:
.P O•: �
E OF BUILDING HISTORIC DISTRICT YES :3PE AND USE PROPOSED USE
)E OF IMPROVEMENT identiNon-Residential
Resal
ne family u Industrial
New Building Two or more family
oAddition No.of units: C Commercial
Alteration
G Assessory Bldg
Repair,replacement _ I
Demolition 0 Other C Others: 1
1 MOvin relocation - tas
Foundation onlt '1
"sSCRIPTION OF WORK TO BE PREFORMED C Xaol/
Identification Pkaae Type or Print�Ckar1Y1
t a Phone: t L
WNER: Name:
f
i
ddress: c�
e• r
Ce
'ONTRACTOR Name:
ALIa
►ddress:
� Ex Date'
;uptrvisor's Construction License: p'
UGLY
dome Improvement License:
Exp. Date: v�
XRCHITECT/ GINEE
,. Name: Phone:
Reg.No.
Address:
EE SCHEDULE:dULDING PERMIT*512.00 PFR$JDoo DF THE TOTAL
ESTIMATED COST d1SED ON EJ23.00 PER S.F.S.F
F �.
Total Project Cast :$
Receipt
Check No.: {
Pale Ior4
111 r
Town of North Andover OORTH
Community Development and Services Division oto
Office of the Health Department
1600 OSGOOD STREET ''
A,
North Andover,Massachusetts 01845 "CH c
SACHUS 1
Michele E.Grant
Public Health Inspector (978) 688-9540-Phone
(978)688-8476-Fax
Date: On—,
Address: r0 GJJ b(� Z-4(\L,
Re: i Application for:
Dear:
Your application for a deck at has been reviewed by the Health Department. The application was denied on,
,2005 for the following reasons:
1. C(/ Missing information
2. B' Passing Title 5 inspection of septic system required
3. ❑ Location of structure not acceptable
4. ❑ Undersized septic system
To address the problem(s):
If#1 is c ed, please supply:
Floor plan of existing and proposed addition—all rooms
Certified plot plan showing house,septic system and proposed project in scale" '
If#2�=ave
Pmt_ �,[ the septic system inspected by a certified Title 5 inspector to determine 2 size of✓the system and
whether it is operating properly: OR -, I
b. Tie-in to municipal sewer App If#3 is checked: 5A�` o
a. Relocate the project
If#4 is checked:
a. Provide additional information proving that the existing septic system meetg-cumnt capacity
requirements. Please consult an engineer to determine the flow capacity of the septic system.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have. ryof o ✓�e zc c
� P
Sincerely,
Michele E. Grant .d0�i` ��6�S
Ct— n I
Cc: Building Department r\
FileGd
I,
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
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TYPE OF SEWERAGE DISPOSAL Swimming Pools
Tanning/Massage/Body Art !_1
Public Sewer L�
Tobacco Sales '71 Food Packaging/Sales L,
Well
Permanent Dumpster on Site F1
Private(septic tank,etc. ❑ Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the g ranty fund
Signature of Agent/Owner Signature of contracto
Plans Submitted U Plans Waived U Certified Plot Plan ❑ to ped Plan
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING &'DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
ATE REJECTED DATE AP��PROVED
CONSERVATIO
COMMENTS 'Ali
4.3
DATE REJECTED DATE APPROVED
HEALTH
V
COMMENTSfir,/� vc � c, r��
Zoning Board of Appeals: Variance,Petition No:
Zoning Decision/receipt submitted yes
i I
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection/Si natur &Date Driveway Permit
Temp Dumpster on site yes_no Fire Department signature/date
=TG SE Ph- L�AR6RGci _pAld
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TO: NORTH ANDOVER, MASS 7 196'
BOARD OF HEALTH ' �
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
C°ROSS6Ow L19wE North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
ora F'9l
eg. nor er e nitarian
Tq�'/Ary S1L�S��