HomeMy WebLinkAboutMiscellaneous - 9 LACONIA CIRCLE 4/30/2018 (2)N
NOTICE OF TITLE 5 DEED RESTRICTION
Property Addreaa: 9 Laconia Circle, North Andover, Massachusetts
This Restrictive Covenant is made by the undersigned, PETER W. MURPHY and
BEVERLY A. MURPHY, of North Andover, Essex County, Massachusetts and having a
mailing address of P.O. Box 734, North Andover, Massachusetts, 01845 (the
being the owners of certain property commonly known as 9 Lac amia Circle, North
Andover, Massachusetts, being shown as Lot 14 on Plan No. 7865 and as more
particularly described in deed dated October 28, 2W, recorded with the Essex North
District Registry of Deeds at Book 9850, Page 136 (the "rMpW).
A. The Owners wish to construct a single-family dwelling with four (4)
bedrooms on the Property and have applied for a building permit for the construction of
such dwelling.
B. The Owner's building permit is subject to the approval by the Town off',
North Andover Hoard of health (the " ") of a plan (the "&g& lar") for a'
Subsurface Sewage Disposal System (the " s� ') forthe PropertY• .
C. The Board has approved the Owner's Septic Plan for a four (4) belt
dwelling, subject to the Owner's agreements as set forth herein.;=�
NOW THEREFORE, the Owners hereby declare a restrictive covenant that sham
run with the land, as follows:
1. The Owners hereby declare: a limitation that the dwelling located on the
Property shall contain no more than four (4) bedrooms, regardless of the actual number of
rooms in the dwelling.
2. Said restriction shall run with the land, but shall automadc ally terminate,
in the event that: (i) the Property is connected to a public sewer system, or (ii) the Board,
in the future, approves an upgrade of the Septic Plan to allow more than four (4)
bedrooms at the Property and the System is upgraded in accordance with such approved
Septic Plan. Upon the occurrence of either of such events, this Restrictive Covenant shall
become null and void, and the Owners, or their successors in title, may record a Release
of this restriction to include a statement of an engineer certifying such fads and which
shall operate discharge and release this restriction of record.
3. This Notice of Deed Restriction shall take effect upon recording with the
Essex County North District Registry of Deeds.
aF
0
.ar
00
REC '.
VAY 1 2 06
TOWN 0 ,,,ER
HEA! •�_NT
Return to BOX 20
Martin J- Arsenault, Esquire
BK 9850 PG 136
Rudolph & Arsenmift
64 Central street, P. O. Box 238
Georgetown, MA 01933
'P20PARTYADDREM' 9LemdaC&d#,Nor&Ax49WMA 01845
L JOHN P, THOMPSON, Successor Trustee purounint to TnldW'S Certificate mcorded Wmw&*
prior hervto, of the 140 A4VIeton Street Realty Trust under a declaration of Trust dated Joe 1, 1994,
recorded with EINorth District Registry of Deeds Book 4060, Pap 148 of North Andover, ESM
for consideration paid and in full consideration of THREE HUNDRED NINETY THOUSAND NINE
HUNDRED-1--0399se )p I 100 DOLLARS
grant to PE' W-Ir"UMY and BEVERLY A. MURPHY, husband and wife, as Tenants by the
Entirety, both
of 4 Red Oak Driye,;Plaidow, NH 03865
with QUITCLAIM COVENANTS ,
The lad in North Andover, Essex County, Massachusetts and being shown as Lot No. 14 an a plan
entitled "Deflaitiv Plan of Land of higgis Crossing, located in North Andover, Massachusetts, Sege, I"
40% dated AOA* J 1. tol.7, Frank C. Gelinas & Associates, Engineers and Architects" and said plan is
recorded withbp%M North District Registry of Deeds as Plan No. 7865 and reference is made to said
pun for a 4i*
Subject to awments mid restrictions of record insofar as the same are still in &m and applicable.
Together with the right to pass and repass and otherwise use the streets and ways in the stibdivision
known asin common with lawfully entitled thereto, for all pur"for
which such W" Ways
` all others are commonly used in the Town of North Andover, Massachuseto
Being the am premifts conveyed by deed of John J. Thompson and Edith S. Thompson ddecy)Wne ig
1994, North District Registry of Deeds Hook 4060, Pop 153.
EXECUTED as an. instrument under seal this 2e day of October, 2005.
rp
OHN P. THOMPSON, TRUSTEE OF THE
`l A
140 APPLETON STREET REALTY TRUST
COMMONWEALTH OF MASSACHUSETTS
Essex, a& October 28, 2003
On this ;8!4ay of October, 2005, before me, the undandped notary public., personally appeared
JOHN P. TROMPSON, Trutee as Aforesaid, proved to me through satisfactory evidence of
identificafionwhkh was his driver's license, to be the person whose name is signed on the preceding or
attached dw#oat,': and acknowledged to me that he signed it voluntarily for its stated purpose.
0 '-"' § � 0
olle
I,
Notary Pfilic
iMUARMW
NWARYFUBW
WCOWAMMOM
AnItm
MAY
1 2 2006
TOWN
, ri ANDOVER
HEA,
zPARTMENT
olle
I,
Notary Pfilic
iMUARMW
NWARYFUBW
WCOWAMMOM
AnItm
MAY
1 2 2006
TOWN
, ri ANDOVER
HEA,
zPARTMENT
-7 -
EXECLiT'F.i} as an instrument under seal as of the a day of November. 2005.
COMMONWEALTH OF MASSACHUSETTS
Emu, SL
On tb S10 day of Novambex, 2005, WHO me, the undersigned notary Public, personally
appeared Peter W. Murphy, who proved to me duough sWdsomy evidence of
identification. which was a Massachtwetts driver's Buenas, to be the person whose name
is signed on the prxeding or allKII +d *C=ent, and achawledvd to me that he signed
it voluntarily for its stated purpose.
Brian G. VaugW Notary public
My Commission Expires: 7/7/11
BRIAN 4. VAUQHAN
1dcAory Public 1
Catnroan�ahh 4 Mmad=s%
11+gr Camn�tti2an
hly 7, 011
RE" ' MED
MAY 12 2006
TOWN �- r i,i)RTH ANDOVER
HEALfn DEPARTMENT
North Andover Board of Asses^rs Public Access Page 1 of 1
Parcel ID: 210/106.11-0119-0000.0 Community: North Andover
SKETCH
�w
r
PHOTO
Location: LACONIA CIRCLE
Owner Name: 140 APPLETON STREET REALTY TRUST
JOHN J & EDITH S THOMPSON, TRS
Owner Address: 140 APPLETON STREET
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 7 - 7 Land Area: 1.01 acres
Use Code: 130 - RES -DEV -LAND Total Finished Area:
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 179,200 170,600
Building Value: 0 0
Land Value: 179,200 170,600
Market Land Value: 179,200
Chapter Land Value:
LATESTSALE
Sale Price: 1 Sale Date: 06/07/1994
Arms Length Sale Code: F-NO-CONVNIENT Grantor: THOMPSON, JOHN J
Cert Doc: Book: 04060 Page: 0153
http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=467743 6/20/2005
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PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
CER7IFICA7E OF C09VPGIANCYE
As of
May 9, 2006
,This is to cert that the
ind viduaCsu6surface duposaf system was.
Fully Constructed
by:
Peter Oreen
At:
9 Laconia Circle
North Andover, VA 01845
9fiie Issuance of this certC
ficate shaft not 6e construed as a guarantee that the system wiCC
function satisfactorily.
Zan�'TYSawyer, REXSI1�kS
Tu6Cic Yfeafth Director
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 fox 978.688.8476 Web www.townofnorthandover.com
INVERT. ELEVATIONS
OUT OF HSE =129.38
INTO TANK= 129.05
OUT OF TANK= 128.80
INTO D. BOX 128.32
OUT OF D. BOX=128.16
END OF PIPE= 127.53
END OF PIPE= 127.55
N)
N
co
io
LA CONIA
PROP. WATER
51'+/-
SEPTIC AS -BUILT
PLAN OF LAND
IN
NORTH ANDOVER, MASS.
OWNED BY
PETER MURPHY
SCALE. I"= 20' DATE. 12/5/2005
Scott L. Giles R.P.L.S.
Frank. S. Giles R.P.L.S.
50 Deer Meadow Road
North Andover, Mass.
R=705.43'
EXPANSION AREA
EX1�T• 201X55
CIRCLE
N
N
- EclsT.
-ds
30'
EXIST. DIST'�N F{
BOX X55
- �IST.
20
EXfST�O GAL, SEPTIC TANK
B.M.=7
EXIST. HSE.
FNO.
J LOT #14
43,840 S.F.
PLAN #7865 N. E. R. D.
ASSESSORS MAP 1668,PARCEL 119
I CERTIFY THAT THIS AS—BUILT INFORMATION
WAS TAKEN ON 1215/2005 BY ME.
RECEIVED
ED
MAY 12 2006
TOWN OF NORTH ANI 1r I
HEALTH DEPARTIVL:1
33'+A
H Of
ti
(z (v 7ioo�
9.
"OWN OF NORTH ANDOVER raA . °t MOeTN 1
Office of C0174MUNITY DEVELOPMENT AND VICES o 't�2D
HEALTH DEPARTMENT '
400 OSGOOD STREET #
+► o� sass. a
NORTH ANDOVER, MASSACHUSETTS 01845 'Ss4C1Ug
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.8476 — FAX
Public Health Director E-MAIL: healthdept(a,townofnorthandover.com
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;
by
(Print Name)
located at ' La 0 C AQ; A C i 2C le
(Installation Address)
was installed in conformance with the North Andover Board of Health approved plan, originally
dated ,��G./Z, Z«�s' and last Revised on Y/Sel2,w -� , with a design flow of
i65440 gallons per The materials used were in conformance with those
day.
specified on the approved plan; the system was installed in accordance with the provisions of 310
CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the
approved plan. All work is accurately represented on the As -built which has been submitted to
the Board of Health.
Bed inspection date:
Final inspection date:
Installer:
_, �`-�; -
/211_5/Zoa.S"
Cru' 2 6
And - Print Name
Engineer:
And - Print Name
Engineer Representative (Signature)
And -Print Name
Engineer Representative (Signature)
And - Print Name
(Signature) Date:
j ---FRE XCEIVED
l L��
(Signature) Date: Z 20
MAY 12 W '
pwe Al 11",q-57
IVA OF NORTH ANDD,
Page 1 of 2
DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.com]
Sent: Tuesday, May 09, 2006 1:23 PM
To: DelleChiaie, Pamela
Subject: RE: soils for 14 Laconia Circle - 9 LACONIA CIRCLE
PAMELA,
HERE'S THE FILE FOR LACONIA CIRCLE.... I'M GOING TO ASSUME THAT THIS WAS WHAT MICHELLE WAS
CALLING ABOUT YESTERDAY (TRIED TO REACH HER, BUT IT WAS BUSY ALL AFTERNOON....)
LET ME KNOW IF YOU NEED ANYTHING ELSE.
MARIANNE
From: DelleChiaie, Pamela [mailto:pdellechiaie@townofnorthandover.com]
Sent: Tuesday, May 09, 2006 10:07 AM
To: Daniel Ottenheimer (E-mail); Lisa LeVasseur (E-mail); Marianne Peters (E-mail); McBrearty Andrew (E-mail)
Cc: Grant, Michele
Subject: FW: soils for 14 Laconia Circle - 9 LACONIA CIRCLE
Importance: High
Mill River ..... Hi Guys --
Remember this one? This was Lot 14 Laconia Circle, now known as #9. I'm waiting on a deed restriction from
the homeowner and Final Construction Notes from you all, as the original format did not come through in readable
format.
Michele - PENDING - I WILL LET YOU KNOW WHEN ALL SET.....
Please note that Peter Murphy, H/O called this morning, and stated that the tank is ready to be checked. Just FYI
- Peter used to work for Peter Breen, who did the installation, so he speaks the "lingo." Michele, I will let you
know when I have a copy of the deed restriction and the certification from from Peter Breen. At that point, please
call Peter Murphy, h/o, at 978.973.9305 to schedule a time to go out and check the tank. Thank you.
Pamela D.
-----Original Message -----
From: Andy McBrearty[mailto:amcbrearty@millriverconsulting.com]
Sent: Tuesday, December 20, 2005 11:27 AM
To: Sawyer, Susan; DelleChiaie, Pamela; dano@millriverconsulting.com
Cc: Lisa LeVasseur
Subject: Re: soils for 14 Laconia Circle
Oops, what we meant to send was the construction inspection. Sorry for my mis-communication with
Lisa...
Did not check for even flow at D -box - no water on site. Final grade was to leave d -box exposed for test
at that time.
-andy
Lisa LeVasseur wrote:
5/9/2006
Page 2 of 2
Here are the soils for 14 Laconia Circle. No water test on the D box was performed.
Lisa LeVasseur
Mill River Consulting
Your Complete Source for Onsite Wastewater Management
2 Blackburn Center
Gloucester, MA 01930-2259
978-282-0014 or 1-800-377-3044
fax: 978-282-0012
www.millriverconsulting.com
5/9/2006
..e
DelleChiaie, Pamela
From:
Grant, Michele
Sent:
Wednesday, May 10, 2006 12:44 PM
To:
DelleChiaie, Pamela
Subject:
Lot 9 Laconia Circle
Hi Pam,
FYI...
I spoke to Peter Murphy regarding FINAL GRADE. He infact does not need a Final Grade right now due to the
fact he has not loomed or seeded. He does however need a tank inspection as well as a D -Box inspection. I will do those
two inspections when the weather is a little better. I sure it is very muddy. Then, he will have to call back for his final grade
AS WELL AS "Risers need to put on the tank etc... If you could please make a note of that on the inspection form that
would be GREAT!
Many Thanks to you
Michele
TOWN OF NORTH ANDOVER NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES 3?�� +`� �"°oma
HEALTH DEPARTMENT p
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 ��SSno 51�
Susan Y. Sawyer, REHS/RS
Public Health Director
wCNU
978.688.9540 — Phone
978.688.9542 — FAX
SEPTIC SYSTEM CONSTRUCTION NOTES
ADDRESS: 64�_A44- MAP: LOS
INSTALLER:
DESIGNER:
PLAN DATE: i r j �5� . , t
BOH APPROVAL IYATE ON P N:
DATE OF BED BOTTOM INSPECTION: so/ /-5
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SELECT SYSTEM TYPE ! Vu
/ I
GRAVITY DISTRIBUTION
PRESSURE DISTRIBUTION
PRESSURE DOSING
HOLDING TANK
ADVANCED TREATMENT
OTHER
COMPONENT SUMMARY FROM PLAN
GALLON TANK= -il�w .
LOADING OF SEPTIC TANK =
GALLON PUMP CHAMBER = L_
LOADING OF PUMP CHAMBER =
TYPE OF SAS =
DIMENSIONS AND DETAILS OF SAS:
SITE CONDITIONS �Lla) '
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑
Comments: Topography not appreciably altered
Page 1 of 4
A
TOWN OF NORTH ANDOVERof pORTN
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss;;�M„5
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
SEPTIC SYSTEM CONSTRUCTION NOTES
ADDRESS: Lot 14 Laconia Circle MAP: LOT:
INSTALLER: Peter Breen
DESIGNER: Neve -Morin Group
PLAN DATE: August 12, 2005/Rev. September 30, 2005
BOH APPROVAL DATE ON PLAN: 10/5/05 'A4 C.-
�9 � 4vt✓,rl
DATE OF QED BOTTOM INSPECTION: / 2-.1 5�s '`1- t
DATE OF FINAL CONSTRUCTION INSPECTION: 12/7/05
DATE OF FINAL GRADE INSPECTION: 61 y DL
SITE CONDITIONS
❑x Existing septic tank properly abandoned
D Internal plumbing all to one building sewer
D Topography not appreciably altered
❑ Photos taken
Comments:
New benchmark used, but not on plan.
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
1500 gallon tank
(H-10 Commercial) (2 piece)
❑ Watertightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
El Inlet tee installed, under access port
❑x Outlet tee installed, under access port
Page I of 4 — Sept, 2005
FIELD
h
TOWN OF NORTH ANDOVER °t Moo*�
Office of COMMUNITY DEVELOPMENT AND SERVICES
f z P
HEALTH DEPARTMENT
` F
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01.845 �'ss"„CHU t�
Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone
Public Health Director 978.688.9542 — FAX
D Effluent filter installed?
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
D Hydraulic cement around inlet & outlet
Comments:
Told installer that he needed to fill tank to outlet and we would verify water -tightness.
D -BOX
0 Installed on stable stone base
❑ Inlet tee (if pumped or >0.08'/foot)
D Hydraulic cement around inlet & outlets
❑ Observed even distribution
❑ Speed levelers provided (not required)
Comments:
No water on site — D -Box to be left exposed and tested at final. Installer mav install
speed levelers.
SOIL ABSORPTION SYSTEI� (General)
Bottom of SAS excavated down to 6 in into C soil
layer, as provided on plan
D Size of SAS excavated as per plan
Title 5 sand installed, if specified on plan
❑ 40 Mil HDPE barrier installed
❑ Retaining wall (boulder / concrete / timber/ block)
Final cover as per plan
Comments:
SOIL ABSORPTION SYSTEM (Stone & Pipe)
0
3/4-1 'h" double washed stone installed
❑O
1/8-1/2" (peastone) double washed stone installed
D
Laterals installed and ends connected to header (and
vented if impervious material above)
D
Orifices @ 5 & 7 o'clock positions
D
Elevations of laterals installed as on approved plan
Comments:
Page 2 of 4 — Sept, 2005
FIELD
TOWN OF NORTH ANDOVER E NORTF
Office of COMMUNITY DEVELOPMENT AND SERVICES 3 �._``,0- -- - �
V, °
� y A
HEALTH DEPARTMENT
400 OSGOOD STREET','. r +"
NORTH ANDOVER, MASSACHUSETTS 0 184 �'Ss4CHU �
Susan Y. Sawyer, REHS/RS
Public Health Director
SYSTEM ELEVATIONS
Benchmark:
Rod at Benchmark:
Height of Instrument:
978.688.9540 - Phone
978.688.9542 - FAX
Sketch of SAS Lateral #s:
Page 3 of 4 - Sept, 2005
FIELD
PIPE SIZE
INVERT ON
DESIGN
PLAN
ROD READING
ELEVATION AT
TOP OF PIPE
INVERT
ELEVATION
AT TOP OF
PIPE
Building Sewer OUT
.33
128.78
2.55
129.39
Septic Tank IN
.33
128.58
2.90
129.04
Septic Tank OUT
.33
128.33
3.29
128.65
Pump Chamber IN
.33
-
Pump Chamber OUT
.33 OR. 17
-
Distribution Box IN
.33 OR. 17
128.03
3.75
128.19
D -Box OUT
.33
127.86
3.95
127.99
STONE & PIPE
Lateral 1 Start*
.33 OR .17
127.77
4.10
127.84
Lateral 1 End
.33 OR. 17
127.50
4.51
127.43
Lateral 2 Start
.33 OR .17
127.77
4.09
127.85
Lateral 2 End
.33 OR .17
127.50
4.51
127.44
Lateral 3 Start
.33 OR .17
127.77
4.09
127.85
Lateral 3 End
.33 OR .17
127.50
4.51
127.43
Lateral 4 Start
.33 OR. 17
127.77
4.11
127.83
Lateral 4 End
.33 OR .17
127.50
4.50
127.44
Lateral 5 Start
.33 OR .17
127.77
4.09
127.85
Lateral 5 End
.33 OR. 17
127.50
4.51
127.43
GRAVEL -LESS
Chamber 1 _ Inv
.33 OR .17
Chamber 1 Top
Chamber 2 _ Inv
.33 OR .17
Chamber 2 Top
Chamber 3 _ Inv
.33 OR. 17
Chamber 3 Top
Chamber 4 Inv
.33 OR .17
Page 3 of 4 - Sept, 2005
FIELD
TOWN OF NORTH ANDOVER Of NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT '°
400 OSGOOD STREET",
NORTH ANDOVER, MASSACHUSETTS 01845 �'ss"„CN„s
Susan Y. Sawyer, REHS/RS
Public Health Director
Chamber 4 Top
Chamber 5 _ Inv .33 OR .17
Chamber 5 Top
978.688.9540 — Phone
978.688.9542 — FAX
CRITICAL SETBACK DISTANCES (measure in the field only those which are at
setback limits or for which variances or LUAs have been requested)
Distances in italics are specific to North Andover
Page 4 of 4 — Sept, 2005
FIELD
Building
Septic Tank
SAS
Sewer
Check if
Required
Provided
setback per
setback per
setback per
Setback
distance
distance
code
code
code
Limit, LUA,
indicated on
measured in
or Variance is
the plan
the field
on the plan
Property Line
10
10
Cellar Wall
10'
13'
10
20
In round Pool
10
20
Slab Fndtn
10
10
Deck on
5
10
footings
Water line
10
10
10
Private well
50
75
100
Irrigation well
75
100
Surface water
25
50
BVW
75
100
Wetlands @
150
150
water supply
or trib
Trib to water
325
325
supply
Drains to
50
100
water supply
or trib
Drains
25
50
intercept gw
Drains —
10
20
foundation &
other
Drywells
20
25
Page 4 of 4 — Sept, 2005
FIELD
DelleChiaie, Pamela
Subject: Updated: MG -Bottom of Bed Inspection
Location: 9 Laconia (Lot 14)
Start: Tue 11/29/2005 10:30 AM
End: Tue 11/29/2005 11:00 AM
Show Time As: Tentative
Recurrence: (none)
Meeting Status: Not yet responded
Required Attendees: Grant, Michele
Peter Breen's site. This is the 2nd required hole. See file.
Town of North Andover r
Health Department Date: /-Kbl'�r.� :,
p,
Location:
(Indicate Address, Oesidential, or Na a of Business)
Check #:
%ice-
Tvpe of Permit or License: (Circle)
➢ Animal
$
➢ Dumpster
$
➢ Food Service - Type:
$
➢ Funeral Directors
$
➢ Massage Establishment
$
➢ Massage Practice
$
➢ Offal (Septic) Hauler
$
➢ Recreational Camp
$
➢ SEPTIC PERMITS:
❑ Septic - Soil Testing
$
❑ S :c - Design Approval
Septic Disposal Works Construction
$
(DWC) $0
❑ Septic Disposal Works Installers (DWI) $
➢ Sun tanning
$
➢ Swimming Pool
$
➢ Tobacco
$
➢ TrasWSolid Waste Hauler
$
➢ Well Construction
$
)0- OTHER: (Indicate)
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Application )r Septic Disposal Syst(
Construction Permit — TOWN OF TODAY'S DATE
NORTH ANDOVER, MA 01845 $125.0 = calmpo anti
Application is hereby made for a permit to:
EJ Construct a new on-site sewage disposal system*
❑ Repair or replace an existing on-site sewage disposal system*
❑ Repair or replace an existing system component
A. Facility Information
Address or Lot #
City/Town /V
2.- *TYPE OF SEPTIC SYSTEM*:
❑ Pump N -Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
Conventional 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
Name
Addres's (if different from above)
City/Town tate Zip Code
f�Telephone Number'
3. Installer Information
Name Name of Company
Address
City/Town S to 4hon
Telephone Number (Cell fpossib/e please)
4. Designer I formation
Name Name of Company
Addres�,�
City/Town
15;�121!� ---
State w��,r Zi ode��
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
Application for Septic Disposal System
(Construction Permit - TOWN OF
NORTH ANDOVER, MA 01845
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: E�Residential Dwelling or ❑Commercial
B. Agreement
TODAY'S DATE
$ 250.00 - Full Repair
$125.00 - Component
The undersigned agrees to ensure the construction 4n, ance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and not to place the system in operation until a Certificate of Compliance has
been issued by this Board of Health. K13�-
Name Date
Application Approved By: (Board of Health Representative)
Name Date
Application Disapproved for the following reasons:
For Office Use Only: /
1. Fee Attached? Yes
2. Project 'ect Mana er Obligation Form Attached? Yes l�
%
3. Pump So sy tem? If so, Attach cogy of Electrical Permit Yes_
4. Foundation As -Built? (new construction ronly):
(Same scale as approved plan)
5. Floor Plans? (new construction only):
Yes_
Yes
No
No
Nom/
CM
No
C! Application for Disposal< Nem Construction Permit • Page 2 of 2
INSTA,.LER PROJECT MANAGEMENT OBNATIONS
As the North Andover licensed installer for the construction of the septic system for the
6-
Z-0
property at A e o'2 /'_':1 relative to the application
of dated.
dated with revisions dated
for plans by and
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
manger, 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 Tile 5 and the Board of Health Regulations may
result in a $50.00 fine being levied against my company.
a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done
first. Installer must request the inspection but does not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or
verbal OK from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer must be present for this inspection. With pump system all electrical
work must be ready and able to cause pump to work and alarm to function.
c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be
on site.
4. As the installer I understand that only I may perform the work (other than simple excavation)
required to complete the installation of the system identified in the attached application for
installation. I further understand that work by others unlicensed to install septic systems in
North Andover can constitute reasons for denial of the system, and/or revocation or
suspension of my license to operate in the Town of North Andover; significant fines to all
persons involved are also possible.
5. As the Installer I understand that I must be on site during the performance of the following
construction steps:
a) Determination that the proper elevation of the excavation has been reached.
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff or consultant.
d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer I understand that I am solely responsible for the installation of the system as
per the approved plans. No instructions by the homeowner, general contractor, or any other
persons shall absolve me of this obligation.
Undersigned Licensed Septic Installer
Date:
L
Essex North County Registry of Deeds
391 Common Street
Lawrence, Massachusetts 01640
11/16/05
PETER MURPHY KA
p �g; 73, 9'3 s-
# 47, Rec; Type RESTV 50.00
DOC. 44160 C. P. 20.00
R. D. 5.00
Total x.00
# 44 Payment Check 75.00
THANK YOU'. Thomas J. Burke
Register of Deeds
RECEMED
NOV 16 2005
TO�O"'a'"
HEALTHld"' `
DEPARTMENT R
rvKm U - LU 1 KGLCAOC lCm
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
1,oards and Departments having jurisdiction have been obtained. This does not relieve
`T the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTION
APPLICANT—[ w li l GV6 . t PHONE 2 Z - -- �'
� L� y
LOCATION: Assessors Map Number_ 1 PARCEL
SUBDIVISION LOT (S) 1_!
STREET 1_r'YY r— , .r `_ ST. NUMBER '
c0
TOR
OFFICIAL USE ONL
DATE APPROVED
nATC DC ICf+Ten
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT_ /�/fie/1 J
IC r;
'ECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 JM
1_;
y
October 26, 2005
Town of North Andover
Health Department
Main Street
North Andover, MA 01845
Town of North Andover Health, Department:
This letter is a confirmation of an agreement made with the Town of North Andover
Health Department regarding the lot on 9 Laconia Circle. The agreement states that I,
Peter Murphy, understand that the Septic Installation Permit for 9 Laconia Circle cannot
be obtained until I submit evidence that the deed restriction for this lot has been recorded.
Sincerely,
/Peter Murphy
SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6)
W9rkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit. +
signed affidavit Attached Yes .......❑ No.......:
SECTION 5 Description of Proposed Work check au applicable)
New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
_ � G � �f" t.� �` r� ly., � Lt.� t.� �'J't:�'`��L� 11� C:L ��ll 1�✓(�..+� " I C.%i� .`) r.
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item I Estimated Cost (Dollar) to be I OFFICIAL USE ONLY
1. Building (a) Building Permit Fee
i4 ' ; Multiplier
2 Electrical(b) Estimated Total Cost of
") CCC' Construction
3 Plumbimp, Building Permit fee (a) , (b)
4 Mechanical (HVAC) C
5 Fire Protection
o Total (1 -t2+3+4 -t5) Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner/Authorized Agent of subject property
Hersh\ :ndhorize __ to act on
M) behalf, in Al matters relati:�e to work authorizc;d b} this building permit application.
Signature of Ox+ner
Date
JL�t1Vid ;n uW.V L'IC/.'l:+in�/n1LL'L .yvi:"i�i �JIJV V(11�I11�v.
1
as Owner/Authorized Agent of subject
property
Hereby declare that tlae tatenicnts onad information on the foregoing application are true and accurate, to the best of my knowledge
aims belief
Print N:mie
Sinlature of Oxx ner;.-\,zent
Date
OF STORIES
SITE S .
�NO.
OR SLB
.-Be"SEMENT
1 SIZE OF t-L.00R TLktLd-RS 17, ;Z X 1,
2 t 3
�
SP, -N
D13\4E SIGNS OF SILLS n +
DII\tENSIONS OF POSTS
Dr-MENSiONS GF GIRDERS
IE--IGHT OF FOU'_`TDATION i1' �� " �`
T UCKNESS
SIZE OF FOOTING 1G, � ;
X ^ "
NL Ti— -LL OF CIJM9NFY
IS BL; iLDING ON ~OLID OR i ILLED L.'"ND
TQ n: err :-,rr.ir. (r)X1RrFC'TPn T() NATI 1u.AT. CTAS 1,1NF
_._.
TOWN OF NORTH ANDOVER - o< „oRr►,
Office of COMMUNITY DEVELOPMENT AND SERVICES
e• , t.
HEALTH DU MMEiNT ;
400 OSGOOD STREET ' .
NORTH ANDOVER. MASSACHUSETTS 01845 'SS,CHUS�`
Susan Y. SaN�ier 978.688.9540 - Phone
Public Health Director 978.688.95=42 - FAX
October 5, 2005
John and Edith Thompson
1725 Great Pond Road
North Andover, MA 01845
RE: Subsurface Sewage Disposal System Plan for Lot 14 Laconia Circle, Assessor's map 106B, Parcel 119
North Andover, Massachusetts
Dear Property Owners,
The North Andover Board of Health has completed the review of the septic system design plans, for the above
referenced property. These plans, dated August 12, 2005, have been approved for a four (4) bedroom, maximum g-
room home.
The design has been approved for use in the construction of a new onsite septic system. 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.
This approval is subject to the following conditions:
1. Title V regulation section 102C - requires 2 deep hole observation tests in the primary and secondary
disposal areas. The lot primary and secondary areas only have a total of 2 deep -hole tests. This plan
approval conditions that upon construction, the BOH is requiring a confirming test hole prior to
allowing the installer to move forward with the system construction. If conditions prove to be
different than anticipated a new plan will have to be submitted to the Health office for review and
approval.
2. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation
as -built of the dwelling. The as -built must be in a scale of 1" = 20`. —
3. If siteconditions are ound 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 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 and/or imply compliance with any of the
aforementioned requirements. t,
5. The distance from the foundation to the tank is shown as 10 feet as required by code. The Town of N.
Andover requires that if a foundation drain exists, the drain itself must be 10 feet from the septic
tank. The drain is not shown, however it is anticipated that there will be one. The installer must
ensure the minimum 10 feet is adhered to. A hand written note has been added to the plan.
Your effort to provide a properly functioning septic system for your dwelling is & ,atly appreciated. The Health
Department may be reached at 978-688-9540 with any questions you might have.
Sind ,
n awyer,
blic Health Director
cc: Isaac Rowe, Neve -Morin Group
t4 1
AT
he
Neve -Morin
Group, Inc.
September 30, 2005
Ms. Susan Y. Sawyer, REHS/RS
Public Health Director
400 Osgood Street
North Andover, MA 01845
Re: Lot 14 Laconia Circle (Map 106B, Parcel 119)
Dear Ms. Sawyer:
OC i 3 2005
TOWN OFI
HEALTH DEs�Ht ,
We are in receipt of your review comments dated September 15, 2005 for the sanitary disposal
system for the above -referenced lot. Find enclosed 3 copies of the revised plan. We offer the
following additional information for your review. Our numbered responses coincide with your
numbered comments for easy reference:
1. The assessors map and parcel have been added to sheet 1 of 2.
2. The owner's mailing address has been added to sheet 1 of 2.
3. The scale of the site plan has been added to sheet 1 of 2.
4. The full name of the witness has been added to the plan on sheet 1 of 2.
5. The plan now states that the design will not accommodate a garbage disposal (see note on
sheet 2 of 2).
6. Please refer to the variance approval granted by the Board of Health at their regularly
schedule meeting on September 26, 2005 to allow the dwelling elevations as shown.
7. A north arrow has been added to the plan view on sheet 1 of 2 and the north arrow shown
on the locus map has been corrected.
8. A note has been added to sheet 2 of 2 reflecting the outlet elevations at the D -Box shall
be at the same elevation.
9. A note has been added to sheet 2 of 2 reflecting that the soil beneath the D -Box be
compacted in accordance with Title 5.
ENGINEERS e SURVEYORS • ENVIRONMENTAL CONSULTANTS • LAND USE PLANNERS
447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480
Providing Professional Services Since 1978
www.nevemorin.com
IN
Ms. Susan Sawyer
September 30, 2005
Page 2
10. A note has been added to sheet 2 of 2 reflecting the size of the stone being used beneath
the D -Box.
11. If trenches were used for this design (3 trenches — 62' length, 4' wide, l' deep) it would
result in excessive grading and require an impervious barrier and a retaining wall in order
to meet the grading requirements. This would result in an excessive cost to the system
that is not necessary.
12. A note has been added to the vent detail on sheet 2 of 2 to specify how the vent will be
protected from animal entry.
13. Proposed grades have been modified on sheet 1 of 2 and a note has been added on the
profile view on sheet 2 of 2 to ensure a minimum slope of finish grade over the system of
2.0%.
14. Note 19 has been added to sheet 2 of 2 stating that no wetland resource areas exist within
150 feet of the proposed SAS.
15. A note has been added to the system centerline profile, shown on sheet 2 of 2, that there
shall be no more than 36 inches of cover over any system component. Please note, the
profile view does show the proposed finish grades above all the system components.
16. A note has been added to sheet 1 of 2 that an additional benchmark shall be added prior
to construction.
17. The profile view shows access covers on either end of the single compartment septic
tank. For clarification purposes the note has been modified to indicate that the access
covers are in fact above the inlet and outlet end of the septic tank.
18. A groundwater gradient was used between OP 05-2 and OP 05-3. The resulting
groundwater elevation on the southerly side of the leach bed (in the vicinity of the 126
contour) is elevation 123. Therefore, a 4 foot separation from the bottom of the leach bed
to the estimated seasonal high water table has been provided.
I believe this additional information satisfies your concerns. If you have any further questions
please do not hesitate to contact me or John Morin of our office.
Ms. Susan Sawyer
September 30, 2005
Thank you for your time and consideration in this matter.
Sincerely,
THE NEVE-MORIN GROUP, INC.
, 1, g�'—
Isaac Rowe, RS
Environmental Sanitarian
IR/km
Enclosures
cc: 140 Appleton Street Realty Trust
2435_NABH.doe
Page 3
n) At
AThe
Neve -Morin
Group, Inc.
September 26, 2005
Ms. Susan Y. Sawyer, REHS/RS
Public Health Director
400 Osgood Street
North Andover, MA 01845
Re: Lot 14 Laconia Circle
Assessors Map 106B, Parcel 119
Owner/Applicant: 140 Appleton Street Realty Trust
Dear Ms. Sawyer:
REdE1V
SEP 2 7 2005
TOWN OF NOrT
HEALTH DEPA f�, ..)OBER
R1'=.ENT
We are in receipt of your review of the sanitary disposal system for the above -referenced lot
dated September 15, 2005. We are in the process of revising the design plan in accordance with
your review. The majority of the revisions are minor notes providing clarification to the plan.
I do have one item that I would request clarification on. Item 6 of your review references
Section 5.04 of your local Board of Health regulations which requires that for new construction,
which this project is, the basement floor must be one (1) foot above the maximum groundwater
elevation in that area. The existing topography of our site rises from the street to a knoll roughly
in the middle of the property. Test pit 05-5 was conducted near the top of this knoll resulting in
an estimated seasonal high water table, based on redoximorphic features, 28 inches deep with a
resultant elevation of 127.0 feet. Other estimated seasonal high water tables in the area ranged
from 28 inches deep to 46 inches deep. As you are aware, Title 5 does not distinguish between
perched water tables or actual water tables when it discusses the determination of the estimated
seasonal high water table elevation relative to septic system designs. Based on the soil
evaluations and visual observations on site we feel that the estimated seasonal high water table
elevations determined on site are based on a perched water table.
Section 5.04 of the local Board of Health regulations states that the basement floor must be one
(1) foot above the maximum ground water elevation. Your regulations have a definition of
seasonal high ground water table elevation which is the height of the groundwater table when it
is at its maximum or the determination of groundwater using redoximorphic features. Does
Section 5.04 distinguish between perched water tables vs. actual water tables?
If we were to design the basement floor 1 foot above the water table determined in Pit 05-5, the
basement floor would be at elevation 128 feet which is approximately 1.5 feet lower than the
ENGINEERS 9 SURVEYORS • ENVIRONMENTAL CONSULTANTS • LAND USE PLANNERS
447 Old Boston Road (U.S. Route 1), Topsfield, MA 01983 978-887-8586 FAX 978-887-3480
Providing Professional Services Since 1978
www.nevemorin.com
Ms. Susan Sawyer Page 2
September 26, 2005
highest point on the lot. This would require an extensive amount of fill which we believe would
not be necessary.
We understand why regulation 5.04 was created and agree with the design parameter that the
basement floor be designed 1 (one) foot above the actual estimated water table. All our design
plans for new construction incorporate a foundation drain which discharges to daylight just as a
precaution even though we design the basement floors a minimum of 1 foot above the water
table. The foundation drain will also mitigate any possible impact the perched water table may
have.
If it is determined that the water table elevation as determined in Section 5.04 of the local Board
of Health regulations is based on location of redoximorphic features, whether perched or actual,
then we would request a variance from Section 5.04 to allow the basement floor to remain as
proposed on the original design plan. Raising the basement floor to elevation 128 feet will result
in the need for a 4 foot high retaining wall to the rear of the driveway turnout as well as the need
to provide an additional 3 feet of fill in the front and rear of the dwelling even with a proposed
walkout basement and garage under design.
We believe that the proposed dwelling elevations, as designed, with the incorporation of the
foundation drain, will not result in any adverse impact to the dwelling based on the water table
elevations nor will it have an impact on the estimated seasonal high water table elevations used
for the septic design.
If you have any questions please do not hesitate to contact me. Thank you for your time and
consideration in this matter.
Sincerely,
THE NEVE-MORIN GROUP, INC.
John M. Morin, PE
Executive Vice President
93viuvris
cc: John Thompson
2435_NABH.doc
TOWN OF NORTH ANDOVER of NoerN
Office of COMMUNITY DEVELOPMENT AND SL:RVICES
HEALTH DEPARTMENT _ p
400 OSGOOD STREET ' �•-�''''
NORTH ANDOVER, MASSACHUSETTS 01845 'SS^CHUs�t
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.8476 — FAX
Public Health Director E-MAIL: healthdeptctownofnorthandover.com
WEBSITE: http:/,Iwww.townofnorthandover.com
September 15, 2005
John M. Morin, P.E.
The Neve -Morin Group
447 Old Boston Road
Topsfield, MA 01983
Re: Lot 14 Laconia Circle
Dear Mr. Morin:
The proposed septic system design plans for the above site dated August 12, 2005 and received
on August 22, 2005 has been reviewed. Unfortunately, it cannot be approved until the following
items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000 or
North Andover regulations which are not met by this design.
1 Please provide the assessor's map and lot on the title page. -220(4)(u)
Please provide the owner's mailing address on the plan. —NA 8.02k
The scale of the site plan is not stated. -220(4)
. The design data should state the full name of the witness to the soil evaluation:
1"Andrew McBrearty"-220(4)(h)&(i)
5. The plan states that the design can accommodate a garbage disposal, yet there is only
a single compartment septic tank and the leach area is not 50% larger than otherwise
required. Please clarify this discrepancy. -223(1)(c), 240(4)
For new construction, the basement floor must be at least 1' above the ESHGW. The
current plan has the basement floor 3' below the ESHGW.-NA 5.04
�A north arrow is needed on the site plan. Also, the north arrow located on the locus
map appears to be incorrect. -220(4)(g)
✓8� Notation is needed regarding the distribution box outlet elevations all being the same. -
/ 232(3)(b)
9. Soil compaction is required beneath the d -box since, according to the site plan, the soil
beneath will not be native. -221(2)
U10. Please specify the proper size (< 1-1/2") for stone that is to be used beneath the
distribution box. — 221(2)
1-4-� Trenches are the type of soil absorption system required whenever possible. Please
design using this system or explain why they cannot be used. -240(6)
12'. Please specify how the vent will be protected from animal entry. -241(1)(a)
f1.3. The final grade over the leach area should slope at a minimum of 0.02 ft/ft -240(10)
�14. Please provide a statement regarding the presence or absence of wetland resource
areas within 150' of the proposed soil absorption system. - NA 8.02r
15. Please clarify the maximum depth of cover material al_ able over the soil
absorption system and other components. - 221
16. Please provide a second benchmark on the site which is not subject to dislocation
during construction of the septic system.
L_',0. Please clarify the indication on the design plans regarding access covers over the
septic tank to include specifications required such as manhole covers, etc.
Additionally, please clarify which access ports are to have risers and covers.
L',A8. Please provide a minimum of 4' separation from the entire bottom of the soil
absorption system to the Estimated Seasonal High Ground Water. The contour
elevation 126 runs through the SAS yet was not used as the basis for ground water
separation determination- 212
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a septic system which will be in compliance with all regulations and
assure protection of public health and the environment of North Andover.
7Since ,
usan Y. Sawyer, REHS/
Public Health Director
cc: Owner
File
/L
Towdof North(And ver
Health Department Date:
Location:
(Indicate Addres , f Residentia �.gr,Name of Business)
Check #: / 6
Type of Permit or License: (Circle)
➢ Animal $
➢ Dumpster $
➢ Food Service - Type: $
➢ Funeral Directors $
➢ Massage Establishment $
➢ Massage Practice
$
➢ Offal (Septic) Hauler
$
➢ Recreational Camp
$
➢ SEPTIC PERMITS:
❑ Septic - Soil Testing
$
,; /,15 tic - Design Approval
$�
❑ Septic Disposal Works Construction (DWC) $
❑ Septic Disposal Works Installers (DWI) $
➢ Sun tanning $
➢ Swimming Pool $
➢ Tobacco $
9 TrasIVSolid Waste Hauler $
➢ Well Construction $
➢ OTHER (Indicate)
c
4 C O Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Town of North Andover
HEALTH DEPARTMENT
27 Charles Street AW2� 2�0�
North Andover, MA 01845
978.688.9540
healthdepWownofnorthandover. com
SEPTIC PLAN SUBMITTAL FORM
DATE OF SUBMISSION: 8/18/05
SITE LOCATION: _ Lot 14 Laconia Circle
ENGINEER: John M. Morin / The Neve—Morin Group, Inc.
NEW PLANS: YES X
REVISED PLANS: YES
$225.00/Plan Check #:
(Includes Is'( ) and one Re -Review Only)
$ 75.00/Plan
SITE EVALUATION FORMS INCLUDED:
LOCAL UPGRADE FORM INCLUDED:
Telephone #: 978 887-8586
E-mail: Joan@nevemorin.com
Check #:
ES NO
YES
Fax #: 978 887-3480
HOMEOWNERNAME: John & Edith Thompson, Trustees
140 Appleton Street Realty Trust
OFFICE USE ONLY
When the submission is complete (including check):
1. c/ Date stamp plans and letter
2.�
—�Py
mplete and attach Receipt
3. o File • Forward to Consultant
4. Enter on Log Sheet and Database
FORM 11 — SOIL, EVALUATOR FO
No. 2435
TOHEALTH DEPARTM TER
'ommonwea th of Massachusetts
North Andover, Massachusetts
RE-CEIVED
AUG 2 2 2005
Date: 6/22/05
Pagel of 3
Soil Suitability Assessment for On-site Seware Disposal
Performed By: Isaac Rowe Date: 6/21/05
Witnessed By: Andy (Mill River Consulting) Date: 6/21/05
Location Address or Lot 14 Laconia Circle
North Andover, MA
Lot #
Owner's Name John Thompson
Address and 1725 Great Pond Rd.
North Andover, MA 01845
Telephone # 978-688-0183
New Construction �_ Repair 0
Office Review
Published Soil Survey Available: No = Yes 0
Year Published 1981 Publication Scale 1" = 1320'
Drainage Class C
Soil Limitations
Surficial Geologic Report Available: No 0 Yes
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:�'
Above 500 year floodbtiuntiary 1490 Yes X
Within 500 year flood, boundary ' o X Yes
Within 100 year flood boundary" No X Yes
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range: Above Normal Normal Below Normal
Other References Reviewed:
Soil Map Unit MsD
I
FORM 11 — SOrIL EVALUATOR FORM
Location Address or Lot No. Lot 14 Laconia Circle
On -Site Review
Deep Hole Number OP 05-1 Date 6/21/05
Location (identify on site plan) See Plan
Land Use Residential
Slope (%)
15-25%
Vegetation Woods
Soil Color
Soil
Landform Drumlin
Surface (Inches)
Position on landscape (sketch on the
back) See
Plan
Distances from:
Open Water Body
100'+
feet
Possible Wet Area
1001+
feet
Drinking Water Well
100'+
feet
Page 2a of 3
Time 8:00 am Weather Sunny 75
Surface Stones Few 1-3' dia.
Drainage Way feet
Property Line 10' + feet
Other
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 46"
DEP APPROVED FORM — 12/7/95
Document2
Document2
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (Inches)
(USDA)
(Munsell)
Mottling
(Structure, Stones, Bounders,
Consistency, % Gravel)
0-81'
A
FSL
10YR3/2
8-24"
Bw
FSL
I0YR4/6
24-120"+
Cl
FSL
2.5Y5/6
ESHWT
@ 46"
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 46"
DEP APPROVED FORM — 12/7/95
Document2
Document2
FORM 11 — SO'IL EVALUATOR FORM
Page 2b of 3
Location Address or Lot No. Lot 14 Laconia Circle
On -Site Review
Deep Hole Number OP 05-2 Date 6/21/05 Time 8:00 am Weather Sunny 75
Location (identify on site plan)
Land Use Residential Slope (%) 15-25% Surface Stones Few 1-3' dia.
Vegetation Woods
Landform Drumlin
Position on landscape (sketch on the back) See Plan
Distances from:
Open Water Body 1001+ feet Drainage Way feet
Possible Wet Area 1001+ feet Property Line, 10' + feet
Drinking Water Well 1001+ feet Other
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 28"
DEP APPROVED FORM — 12/7/95
DocumenO
DocumenQ
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (Inches)
(USDA)
(Munsell)
Mottling
(Structure, Stones, Bounders,
Consistency, % Gravel)
0-8"
A
FSL
10YR3/2
8-22"
Bw
FSL
10YR4/6
ESHWT
22-98"+
C I
SL
2.5Y5/6
@ 28"
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 28"
DEP APPROVED FORM — 12/7/95
DocumenO
DocumenQ
FORM 1 I — SOIL EVALUATOR FORM
Page 2c of 3
Location Address or Lot No. Lot 14 Laconia Circle
On -Site Review
Deep Hole Number OP 05-3 Date 6/21/05 Time 8:00 am Weather Sunny 75
Location (identify on site plan) See Plan
Land Use Residential Slope (%) 15-25% Surface Stones Few 1-3'dia.
Vegetation Woods
Landform Drumlin
Position on landscape (sketch on the back) See Plan
Distances from:
Open Water Body
1001+
feet
Drainage Way feet
Possible Wet Area
1001+
feet
Property Line 10' + feet
Drinking Water Well
100'+
feet
Other
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 34"
DEP APPROVED FORM — 12/7/95
DocumenC
DocumenQ
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (Inches)
(USDA)
(Munsell)
Mottling
(Structure, Stones, Bounders,
Consistency, % Gravel)
0-10"
A
FSL
I OYR3/2
10-29"
Bw
FSL
IOYR4/6
29-90"+
CI
SL
2.5Y5/6
ESHWT
34"
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 34"
DEP APPROVED FORM — 12/7/95
DocumenC
DocumenQ
FORM 11 — SOIL EVALUATOR FORM
Location Address or Lot No. Lot 14 Laconia Circle
On -Site Review
Deep Hole Number OP 05-4 Date 6/21/05
Location (identify on site plan) See Plan
Land Use Residential
Slope (%)
15-25%
Vegetation Woods
Soil Color
Soil
Landform Drumlin
Surface (Inches)
Position on landscape (sketch on the
back) See Plan
Distances from:
(Structure, Stones, Bounders,
Open Water Body
1001+
feet
Possible Wet Area
1001+
feet
Drinking Water Well
1001+
feet
Page 2d of 3
Time 8:00 am Weather Sunny 75
Surface Stones Few 1-3' dia.
Drainage Way feet
Property Line 10' + feet
Other
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA
Estimated Seasonal High Ground Water: 38"
DEP APPROVED FORM - 12/7/95
DocumenU
Weeping from Pit Face: NA
DocumenO
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (Inches)
(USDA)
(Munsell)
Mottling
(Structure, Stones, Bounders,
Consistency, % Gravel)
0-10"
A
FSL
10YR3/2
10-34"
Bw
FSL
10YR4/6
34-110"+
C1
SL
2.5Y5/6
ESHWT
@ 38"
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA
Estimated Seasonal High Ground Water: 38"
DEP APPROVED FORM - 12/7/95
DocumenU
Weeping from Pit Face: NA
DocumenO
FORM 11 — SOIL EVALUATOR FORM
Location Address or Lot No. Lot 14 Laconia Circle
On -Site Review
Deep Hole Number OP 05-5 Date 6/21/05
Location (identify on site plan) See Plan
Land Use Residential
Slope (%)
15-25%
Vegetation Woods
Soil Color
Soil
Landform Drumlin
Surface (inches)
Position on landscape (sketch on the
back) See Plan
Distances from:
(Structure, Stones, Bounders,
Open Water Body
100' +
feet
Possible Wet Area
100'+
feet
Drinking Water Well
100'+
feet
Page 2a of 3
Time 8:00 am Weather Sunny 75
Surface Stones Few 1-3' dia.
Drainage Way feet
Property Line 10' + feet
Other
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 28"
DEP APPROVED FORM — 12/7/95
Documem2
DocumenQ
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (inches)
(USDA)
(Munsell)
Mottling
(Structure, Stones, Bounders,
Consistency, % Gravel)
0-8"
A
FSL
10YR3/2
8-24"
Bw
FSL
10YR4/6
24-120"+
Cl
FSL
2.5Y5/6
ESHWT
@ 28"
*MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material (geologic) Glacial Till Depth to Bedrock: NA
Depth to Groundwater: Standing Water in the Hole: NA Weeping from Pit Face: NA
Estimated Seasonal High Ground Water: 28"
DEP APPROVED FORM — 12/7/95
Documem2
DocumenQ
FORM 11 — SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. Lot 14 Laconia Circle
Determination for Seasonal Himh Water Table
OP 05-1
Method Used:
Depth observed standing in observation hole
Depth weeping from side of observation hole
X Depth to soil mottles
Groundwater adjustment
Index Well Number
Adjustment factor
Reading Date
inches
inches
46 inches
feet
Index Well Level
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
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
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that in Spring 20011 have passed the soil evaluator examination approved by
the Department of Environmental Protection and that the above analysis was performed
by me consistent with the required training, expertise and experience described in 310
CMR 15.017.
Signature �Date Z2.,03—
DEP APPROVED FORM - t 2n195 Document6
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. Lot 14 Laconia Circle
Determination for Seasonal High Water Table
OP 05-2, OP 05-5
Method Used:
Depth observed standing in observation hole
Depth weeping from side of observation hole
X Depth to soil mottles
Groundwater adjustment
Index Well Number
Adjustment factor
Reading Date
inches
inches
28 inches
feet
Index Well Level
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
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
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that in Spring 20011 have passed the soil evaluator examination approved by
the Department of Environmental Protection and that the above analysis was performed
by me consistent with the required training, expertise and experience described in 310
CMR 15.01.7.
Signature 40� Date 401"u-14's—
DEP
0Z.Z. D.s—
DEP APPROVED FORM - 12n195 Document6
FORM 1 I - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. Lot 14 Laconia Circle
Determination for Seasonal High Water Table
OP 05-3
Method Used:
Depth observed standing in observation hole
Depth weeping from side of observation hole
X Depth to soil mottles
Groundwater adjustment
Index Well Number
Adjustment factor
Reading Date
inches
inches
34 inches
feet
Index Well Level
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
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
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that in Spring 20011 have passed the soil evaluator examination approved by
the Department of Environmental Protection and that the above analysis was performed
by me consistent with the required training, expertise and experience described in 310
CMR 15.017. _
Signature 'Ze- _ Date Co/ZZ16s
DEP APPROVED FORM — 12/7/95 Document6
FORM 11 — SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. Lot 14 Laconia Circle
Determination for Seasonal High Water Table
OP 05-4
Method Used:
Depth observed standing in observation hole
Depth weeping from side of observation hole
X Depth to soil mottles
Groundwater adjustment
Index Well Number
Adjustment factor
Reading Date
inches
inches
38 inches
feet
Index Well Level
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
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
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that in Spring 20011 have passed the soil evaluator examination approved by
the Department of Environmental Protection and that the above analysis was performed
by me consistent with the required training, expertise and experience described in 310
CMR 15.017.
Signature Date ca12Z�05
DEP APPROVED FORM- 12n195 Document6
FORM 12 — PERCOLATION TEST
Location Address or Lot No. Lot 14 Laconia Circle
COMMONWEALTH OF MASSACHUSETTS
North Andover, Massachusetts
Percolation Test*
Date: 6/21/05 Time: 9:00 am
Observation Hole #
P-1
P-2
Depth of Perc
26+18
32+18
Start Pre-soak
9:27
9:32
End Pre-soak
9:42
9:47
Tune at 12"
9:42
9:47
Time at 9"
10:08
10:23
Time at 6"
10:47
11:36
Time 9"-6"
39 minutes
73 minutes
Rate Min./Inch
13 min/inch
25 min/inch
*Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed ® Site Failed
Performed by: Isaac Rowe
Witnessed by: Andy (Mill River Consulting)
Comments:
DEP APPROVED FORM — 12/07/95 DocumenO
FORM 12 — PERCOLATION TEST
Location Address or Lot No. Lot 14 Laconia Circle
COMMONWEALTH OF MASSACHUSETTS
North Andover, Massachusetts
Percolation Test*
Date: 6/21/05 Time: 11:00 am
Observation Hole #
P-3
Depth of Perc
36+ 18
Start Pre-soak
11:58
End Pre-soak
12:13
Time at 12"
12:15
Time at 9"
12:38
Time at 6"
1:17
Time (9"-6")
39 minutes
Rate Min./Inch
13 min/inch
*Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed Site Failed
Performed by: Isaac Rowe
Witnessed by: Andy (Mill River Consulting)
Comments:
DEP APPROVED FORM — 12/07/95 DocumenO
No. THE COMMONWEALTH OF MASSACHUS�.'TS FEE
Town
BOARD OF HEALTH
OF
North Andover
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( 9 Repair ( ) Upgrade ( ) Abandon ( ) - M Complete System ❑ Individual Components
Lot 14 Laconia Circle
Location
Map 106B, Parcel 119
Map/Parcel #
Lot #
Installers Name
Address
Telephone #
Type of Building: Residential
Dwelling — No. of Bedrooms
Other — Type of Building
Other fixtures
4
John & Edith Thompson, Trustees
140 Appleton :�'ffr6WV Realty Trust
1725 Great PondAdRaad, North Andoi
978 688-0183
Telephone #
The Neve–Morin Group, Tnc
Designer's Name
447 Boston Street, Topsfield, MA
Address
978 887-8586
Telephone #
o. of persons
Lot Size 43 , 840 Sq. feet
Garbage Grinder (YE)s
Showers ( ), Cafeteria ( )
er, MA
01845
01983
Design Flow (min. required) 440 gpd Calculated design flow 440 gpd Design flow provided 440 gpd
Plan: Date 8/12/05 Number of sheets 2 Revision Date Non e
Title Sanitary Disposal System Designed For 140 Appleton Street Realty rust
Description ofSoil(s) See Plan John & Edith Thompson, Trustees
Soil Evaluator Form No. Name of Soil Evaluator s a a c Rowe Date of Evaluation 6/21/05
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed
Date
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No.
Description of Work:
THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. dated . Approved Design Flow (gpd)
Installer
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at as described
in the application for Disposal System Construction Permit No. , dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Date
FORM 2 - DSCP
FORM 1255 (REV 5/96)
Board of Health
DEP APPROVED FORM 5/96
H&W HOBBsB WARREN TM PUBLISHERS - BOSTON
No.
THE}COMMONWEALTH OF MASSACHUS—.TS FEE
�- BOARD OF HEALTH
Torn of Horth Andover.
f'
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - [] Complete System ❑ Individual Components
Lot 14 Laconia Circle
Location
VIC)p 106B, Parcel 119
Map/Parcel #
Lot #
Installer's Name
Address
Telephone #
i
Type of Building: Residential
Dwelling — No. of Bedrooms
Other — Type of Building
Other fixtures
4
John & Edith Thom
140 Appleton 9'tTr64V Realty Trust
1725 Great PondAdR*ad, Horth Andoi
978 688-01 83
Telephone #
The Cleve—Morin Group, Inc.
Designer's Name
447 Boston Street,,Tpsfield, NA
Address
978 887-8586
Telephone #
of persons
Lot Size 43,840 Sq. feet
Garbage Grinder (YE)s
Showers ( ), Cafeteria ( )
er, MA
01845
L-03t�3
•
Design Flow (min. required) 440 gpd Calculated design flow 440 gpd Design flow provided 440 gpd
11
Plan: Date 8/12/05 Number of sheets 2 Revision Date done
Title Sanitary Disposal System Designed For 140 Appleton Street Realty TBust
Description of Soil(s) See Plan John & Edith Thompson, Trustees
Soil Evaluator Form No. Name of Soil Evaluator JL saaC Rowe Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed
Inspections
Date
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( • ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. dated Approved Design Flow (gpd)
Installer
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ,
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon'( ) an individual sewage
disposal system at as described
in the application for Disposal System Construction Permit No. , dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
11 Date
FORM 2 - DSCP
FORM 1255 (REV 5/96)
Board of Health
DEP APPROVED FORM 5/96
H&W HOBBS&WARREN"' PUBLISHERS -BOSTON
CERTIFIED PLO T PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE. 1 "=20' DATE: 11/18/2005
LA CONIA
R=705.43'
L=150.00'
51'+/-
N) EXIST. HSE.
co FND-
00
LOT #14
431840 S.F.
PLAN #7865 N. E. R. D.
11
Scott L. Cites R. P. L. S.
Frank. S. Giles 4 P. L. Si
50 Dee f Meadod Ro d
North Andover, lass.
CIRCLE
I
334A
w
N
,�%ti 1.,Wd
0
s
VE+R� . N VS 05
TO N OF NORTH ANHEALTH DEPARTM
4
LETTER OF TRANSMITTAL
North Andover Health Department NORTH
400 Osgood Street 3� o
0
North Andover, MA 01845
L
978.688.9540 - Phone:
978.688.8476 - Fax �o LwK•
healthdept(&townofnorthandover.com - E-mail �''7 '"4 *•o
www.townofnorthandover.com - Website Page / of SSA�Hugt�
TO:
Daniel Ottenheimer
DATE: 1-a
COMPANY:
FROM: Pamela DelleChiaie, Health Dept. Assistant
Mill River Consulting
Phone: 1.800.377.3044 or 978.282.0014
RE:
i�
Fax: 978.282.0012
COPY TO:
We are sending you:
eToil 1 est
OPlans for Review
/7 Other ill in below)
COPY TO:
SIGNED:
These are transmitted as checked below:
OFor Review and comment OAs Requested [FIs Required OFor Your Use
REMARKS:
COPY TO:
COPY TO:
SIGNED:
COPY TO:
ItA - A'11�&
a
TOWN OF NORTH ANDOVE]k NORTH
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT '
•:
400 OSGOOD STREET + °,,...s... �_ •
NORTH ANDOVER, MASSACHUSETTS 01845 �'ssACNUbt�
Susan Y. Sawyer, REHS, RS 978.688.9540 — Phone
Public Health Director
78.688.8416 —FAX
R
ECEIVED IVE
ealthdep�a�townofnorthandover.cpm
ww.townofnorthandover.com
18 2005
APPLICATION FOR SOIS
r,.;.,+JVER
DATE: May 17, 2005 , :i_��A;,'�"r,
L: Map 106B, Parcel 119
LOCATION OF SOIL TESTS: Lot 14 Laconia Circle
OWNER: John Thompson Contact#: 978-688-0183
APPLICANT: Same as owner Contact #:
ADDRESS: 1725 Great Pond Road, North Andover
John M. Morin, PE
ENGINEER: The Neve -Morin Group, Inc. Contact#: 978-887-8586
CERTIFIED SOIL EVALUATOR: Greg H o c h m u t h
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: Undeveloped Lot Testing: X Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes
No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.5"x 11" Plot plan & Location of Testing (please indicate test nit sites on the plan)
➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing, a scaled plan (no smaller than I"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date.
Signature of Conservation Agent.
Date back to Health Department: (stamp in):
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rte, John and.41ith: 4... tholOpson, husband and
Wife, both f 2i0 Appleton 8treat, Worth Andover, Essex county,
Massachusetts, for consideration paid of $X.00,. groat.to jobn j#,
Thompson and Edith g. Thompson, W
street Realty Trust dated' Trust the 140 Appleton
ed' Q.&& A to be regarded
herewith, of. 140 4PI
otan street, North AWavor, Essex -Coun
HasiaohusSttG1 wit- q4Itclmim'.c * ty
Andover,-— OvsnAntds the land in North.
14 Essex County; find being. shown &a Lot Not
an a plah, entItIa., *Dit�hitj*o rum of. Land of Ingalls .
Crooning, lodited'. In Rqrth Andovery . NameackWaotts, scale in
•
Of I dated.rApr4l ll,,'1977, ft4nk'd. oelin&s & As*oa,atom,
a
Engineers MArchijimijea and said VISA..Is regarded with the
Essex North DistrictRayintry of Deeds .88 Plan Hot* 7865 and
ce is m&4g to no 4
referen
Plan for A. liars Particular description. -
subject -to ", "Santa and restrictions
of regard insofar . . as the
same are stili in. force arA applicable.
Together with the right* to "'Oventle.", . their heirs, successors
and assigns to pass and repass and *the i,
Ways in the subdivision known ass 1:. " Use the mtregtm.and..
with all others lawfully entitled tb*XO . CtOmi4q" s. In common
. A, -far, 4,14 PUrPOSOM. for
which such streets and we" are'domi6jili used I 'the Tom or
North Andover, Massachusetts. However, - no fee =t in hereby
.
d0eded.to the Grantees.
Meaning and intending. to COWsythe son promises conveyed
to John J. wd Edith g- Thompson by dead'of .91yaoic Corso
Inc.., dated -may 7], 1979 and recorded. in the Essetructift'.
Registry Of 00048 at Soak 1372, Page' 17.4. x County
Executed this _I&L_ day Of ACNE
"t 1994.
John Tholspson
Edith S. Tho
9
fOrOPIP4 Instrument to' their
lot of ,_,Jure 94,
No ry7#a
W Vim.
4
M
�I
LETTER OF TRANSMITTAL
North Andover Health Department
400 Osgood Street
North Andover, MA 01845
p0RTF q
�OO
978.688.9540 - Phone 4` -
978.688.8476 - Fax �� a ""
�pq coc.«c«�w.c« ` 7
healthdent(atownofnorthandover.com - E-mail
www.townofnorthandover.com - Website Page of SSwtHus��
TO:
Daniel Ottenheimer
DATE:
3 l�
COMPANY:
Mill River Consulting
FROM: Pamela DelleChiaie, Health Dept. Assistant
Phone: 1.800.377.3044 or 978.282.0014
RE:
Fax: 978.282.0012
SIGNED:
We are sending you:
PSWI Test
OPlans or Review
0Other ill in below)
COPY TO:
SIGNED:
These are transmitted as checked below:
L7 For Review and comment OAs Requested Ms --Required OFor Your Use
REMARKS:
COPY TOC
COPY TO:
SIGNED:
k
C� "
COPY TO:
HP Fax K1220xi
Last Transaction
Date Time
May 23 1:49pm
Type Identification
Fax Sent 819782820012
Log for
NORTH ANDOVER
978688954
May 23 2005 1:51pm
Duration Pages R suit
2:19 4 OK
814000
N��xit DSD •
We, John T Thompson dnd.8d#th:8.,44w�rpson, husband and
wfte, both of 160 Appleton 5trsot, North Andover, Essex county,
Massachusetts, for consideration paid of $X-00,. grant. to john s�
Thompson and Edith 8. Tho*pson,'Trustess o .-the 140 .Appleton
street Realty Trust dated`
herewith, 'Of -210 A plpton Street, Noir h lCndovirtotaesex County,
flaesachusstts, wit gyiitclaiti covenants; the land in North
Andover,•'Essex County, $assa.Chusetts and beinq.�how» as Lot No.
26 on a pla<ti entltiad.'"Definitive Pian of.Lan4 of Ingalls
Crossing,. located-.1n•Worth Andover, MaRsachusetts, Sca1M le a
600, dated `Apr## 1!,..1977, 1'rankC. Gelinas i Associates,.
Engineers and Architectse and said plan..is recorded with the
Eaaex.Morth District Registry of Deeds•as Plan No. 7865 and
reference is sada to said plan for a *ore particular description.
Subject -to aasaMents and restrictions of record insofar as the
same are !mill in, force and`applicabl6. ;
Together with the right to hair hairs, successors
and assigns to pass and repass and othas�iisa use the streets and
ways al the ers ivisiolawfully
known as "In*"la- Cimasiog", in canon .
with. all others lawfully ertitlod theX;@to, for, Ai#.N
which such streets and Ways ar''comatonly used in 'the Town or or
North Andover, Massachusetts. However, - fee interest is hereby
deeded.to the Grantees.
Moaning and intending to,copvey.the sat* premises capveysd
to John J. and Edith a. Thompson by dyed of ,p1 #c Coegi
Inc. dated•May =a, 1979 and recorded in the Essex Count�tilm,
Registry of Deeds at book 1773, page 17.6.
Executed this _ ise day o!�.1� UNE _ , 1996. sa
mess John: Thompson an.
• o+
r as
Edith s. Thomps n
i OF
yF!
sators.aer Pe • appoarei!'�1oh»'�. and ldlth .8,. t
fres a3 ,de rw� s fo�1n4 instruftnt to: g their '
�.....:, , .i•�.- "r.of June s t `
a �� NOa_#y pubin ,,..�..,.. N
R 4
TOWN OF NORTH ANDOVER f NORTa
Office of COMMUNITY DEVELOPMENT AND SERVICES F °�`.,Se �° p
HEALTH DEPARTMENT
400 OSGOOD STREET
� Oe .K�iiw. 4r x
NORTH ANDOVER, MASSACHUSETTS 01845 ITS C s�
Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone
Public Health Director RECEIVED
78.688.8476 —FAX
ealthde t townofnorthandover.com
.townofnorthandover.com
Y 1 8 2005
APPLICATION FOR SOI TS
F ,'V RTH �ifvuOVER
DATE: May 17, 2005 N .: A1?Trn�
�gq L: Map 106B, Parcel 119
LOCATION OF SOIL TESTS: Lot 14 Laconia Circle
OWNER, John Thompson Contact#: 978-688-0183
APPLICANT: Same as owner Contact #:
ADDRESS: 1725 Great Pond Road, North Andover
John M. Morin, PE
ENGINEER: The Neve—Morin Group, Inc. Contact#: 978-887-8586
CERTIFIED SOIL EVALUATOR: Greg H o c h m u t h
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: Undeveloped Lot Testing: X Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes
No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.5"x 11 "Plot plan & Location of Testing (please indicate test pit sites on the plan)
➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Dater
Signature of Conservation Agent:.
Date back to Health Department: (stamp in):
I
yam, 460
�•4 19'51 . S.F.
1
241p. per.
10 +Po -s E D
Qa0' �t�• �
Q TEST pt -r ZEAz
' e;'o
LocAT1oN5 -r0
(APPRoX . y
V• I
�
N,
(11
1
r �
N •y.
1 M
N8�
Rsac.'oo A
Fri. 2'r
`V.I
J�lw 11 We
- "' to (50� W toi
l5
�i 31 6l3 S. F.
o L o -f- I
N �i 317 t33 S.F.
OP
00
0
gg
R't40.fS0 LP l.Oel�r
1�,, w I s Imp pp C
—.—N 24'-24 - _ _ L R� 1Z`5.
10� •1 ,Z `.r.
Ir
W N.ee
K+ee
Town of North Andover
Health Department Date:
Location: (/�r
(Indicate Address, if Residential, or N 4/s,
Check #: 5 ��13
Type of Permit or License: (Circle)
➢
Animal
$
➢
Dumpster
$
➢
Food Service - Type:
$
➢
Funeral Directors
$
➢
Massage Establishment
$
➢
Massage Practice
$
➢
Offal (Septic) Hauler
$
➢
Recreational Camp
$
➢
SEPTIC PERMITS:
?�
&,tic
- Soil Testing
$
❑
Septic - Design Approval
$
❑
Septic Disposal Works Construction (DWC) $
❑
Septic Disposal Works Installers (DWI)
$
➢
Sun tanning
$
➢
Swimming Pool
$
➢
Tobacco
$
➢
TrashlSolid Waste Hauler
$
➢
Well Construction
$
➢ OTHER: (Indicate)
Health Agent Initials
�IJf.
White - Applicant Yellow - Health Pink - Treasurer
LETTER OF TRANSMITTAL
North Andover Health Department
400 Osgood Street
North Andover, MA 01845
v10RTft '1
�: a �' ' .».. a A►
978.688.9540 -Phone
978.688.8476 - Fax ��
healthdegt(a townofnorthandover.com- E-mail �-y 0Aw*�o
www.townofnorthandover.com - Website Page / of SS�CNVS��
TO:
Daniel Ottenheimer
DATE:
la
COMPANY:
FROM: Pamela DelleChiaie, Health Dept. Assistant
Mill River Consulting
Phone: 1.800.377.3044 or 978.282.0014
SIGNED:
Fax: 978.282.0012
COPY TO:
We are sending you:
9oil Test OPlans or Review
L7 Other ill in below)
COPY TO:
COPY TO:
These are transmitted as checked below:
OFor Review and comment DAs Requested "s Required OFor Your Use
REMARKS:
COPY TO:
COPY TO:
SIGNED:
C�
COPY TO:
TOWN OF NORTH ANDOVER NORT11
' Office of COMMUNITY DEVELOPMENT AND SERVICES of``�•� '1tio�
HEALTH DEPARTMENT p
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845�cH„
CHMU �
st
Susan Y. Sawyer, REHS, RS 978.688.9540 — Phone
Public Health Director 78.688.8476 — FAX
RECEIVED ealthde t townofnorthandover.com
ww.townofnorthandover.com
MAY 18 2005
APPLICATION FOR SO11111 TESTS
TOWN OF ATH �P DOVER
DATE: May 17, 2005 HEALTra .:CPAF17ryr
L: Map 106B, Parcel 119
LOCATION OF SOIL TESTS: Lot 14 Laconia Circle
OWNER: John Thompson Contact#: 978-688-0183
APPLICANT: Same as owner Contact #:
ADDRESS: 1725 Great Pond Road, North Andover
John M. Morin, PE
ENGINEER: The Neve—Morin Group, Inc. Contact#: 978-887-8586
CERTIFIED SOIL EVALUATOR: Greg H o c h m u t h
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: Undeveloped. Lot Testing: X Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes
No X
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.5"x 11 " Plot plan & Location of Testing (please indicate test nit sites on the plan)
➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date;
Signature of Conservation Agent:
Date back to Health Department: (stamp in):
Lo ` �
40
'a,yam a
ted.
-6 .r
S�
AVOW
y
Z „3
N Ay
IL a
t� f3q
3
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00 + IN
�- PRoPols
t TEST P t 1- ZEA �, c� I
�0
LOCATio�vs 0.2
p (APPRoX y
a
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� �t O P
IS1
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i+
t'
f
t
i.t�.O4�r
00r p Fi �N 24�-goo - �• w _ �s ISO-
6z �� LZ VS.
2a•il:
W �s.e•
rPee
1"0� A {�1i �:.
"''..e (5d W toc
rill
814060
tip
both
f and. 11: P*. IbOWson, husbandaW
wife, OUR street North Andover, Us** County,
Massachusetts, , for Consideration 1414 of -$I - 00, - grant. to john a
ThORPOOn and Edith S. ftosp-m,.Tiust
street Realty Trust 4&tmd." I 44!jafjthQ.!40.Appl*ton
herewith f, I an St it, no be recorded
o Ra"N -County
massadhUattso 114-1041tolaim enintm� the I&FA in North,
AMOVOi.-Ilm Cqunty; 11*s0*j*Us4tts 6M being. dam
14 ons PIWv 4ntltjad'*DjfpiitjiFs p as Lot No.
Crossing,.located,.1a #qrth I" of x4rod at Ingalls
401 Scala V 46
- datQdrA#rIill,'1977,- frenk'g. "lines a Asepociateg,
Engineers atA'Archijaitem and said
Essex .North District Plan. -is rwrftd with 'the
R try Of DssdG as Plan No. 7865 and
reference is made to "14'evTlan for a more parti
cul&r description.
subject -to -""sent& and restrictions
Dam are still, in fares Of r*COrd insofar as the
s*:tIcablo.
Together with the right to t'" - 4,va their'beirs, a
and a RtGAN, .1
8 to page and repass and *the ft Wmassove
ways Wgthme subdivision known as a 1: . use the stg-aeft.am...
with. all - Others lawfully sntjtlad� 1441 .- Vk0mi0g-, in qasam
which such streets . . . . . tat. 444. PCs" for
anew am'dombonly 00A in Oki
North Andover, Massachusetts. Noweve at
deeded to the Grantees. r, -no fais L In herft*
Meaning and -intw4ing .. t1b."Way the Waft Promises conveyedto John J. sold Keith S. "Wopmen by 4W of.'
Ino.., dated -May 23, 1979 SrA rMrded. in91YE010
.Registry Of 00*48 at look 1371, Page 1760 the . finex county
Executed this "Y at ilia-
W16kiss John 4"
ftoh"on .
-47
ss agacA
at n 5E
--wzmm OF XU"amfirm
or fi
'"W"acid 02U&U.
their'
00
Q94
EDITH S. THOMPSON
JOSEPH THOMPSON
140 APPLETON STREET
iTH;ANDOVER, MA 01845-3138
PAY TO THE
53-7054/2113 2 9 5 3
121715407
DATE
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3 a Banknorth 370 Main Street 'r'
Worcester, MA 01608
Massachusetts p-�
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