Loading...
HomeMy WebLinkAboutMiscellaneous - 99 RALEIGH TAVERN LANE 4/30/2018 (2)� ._ < 2 � /.^\\�. . . � «� x � � � � � � �� \ � ± . - » � � � . .� zr aaa m� :��`^° � � � ; - -- - _ _ : �.� _� �.�- - - � � �� � �� � �| .� / � � �� � < »§ \ �� :L§ ?\\.�\\�. ] � ��,{�\�{. �.�\ � � � }� �� iƒ� ! � < « ! � ='� /\\\ f �� » r °f\ ,: : %�. > r§, > � » }:d < ?:w .- \ . .}w . > � � � �� � \. \\,9 } �\ �§,� \ �\ \ � �\ �\. \ ¢ \}?/ E' b � g \ � � {} ` ?y. «//� : _: �� , \ \ y � \�� \ C «» w.. � d � ! �.�� ! �\-��� \: \\.©.��<\ ��.§.: \. / < -. w 2t< . . �\yam ° \\§ � \\\;�, � /« � ��\ »_ -2 �! : \� / « 1. © / \<1©� . � ' 1 \ .�« \ .\»z :\ \� � � �-° \ © « /. \ �<2\{ 22 � <\ \/�:\\�/� . �\.� � , � Town of North Andover NORTsj Office of the Health Department 4 p Community Development and Services Division , 400 OSGOOD STREET North Andover, Massachusetts 01845 ��ssA 1 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 - Phone 978.688.9542 - Fax CE127IF'I�A�IE OF CO�I�LIANM As of: December 9, 2004 9his is to cert that the individuafsubsurface disposalsystem repaired (X,/ — �FuCCSystem by James �eCCett at 99 Raleigh tavern Lane North Andover, 31A 01845 has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board ofYffealth regulations. 'The Issuance of this certg7cate shall not be construed as a guarantee that the system will function satisfactorily. 1�usan 7 Sawyer Bu6fic Yfealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; (>j repaired, by located at- 9 g A A f e+ G 1-1 'F'4u e (-All L -ti was- installed in conformance with the North Andover Board of Health approved plan, System Design Permit.#_ _ plan dated with a design flow of gallons per day. The materials used were in conformance with those specified on the approved pian; the system wa& instal}ed in aaeordmce v�ith. the provisions of 310 CARR -15.000, Tido 5 and local regulations,. and the final . grading agrec,s 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: I D- 5- L y - Engineer Representative Final inspection date: !o -t - d *e Engineer Representative Installer. lie.#: Date: fol - 7 o y Engineer. * ''" Date: 1 d y CIVIL in NO. 4589 GIST ��� SPIAL RECEIVED D OCT 2 0 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT NEW ENGLAND ENGINEERING INC October 15, 2004 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 99 Raleigh Tavern Lane, North Andover Septic System As -Built Dear Susan, SERVICES 'E'VED OCT 202004 TOWN O= NORTH ANDOVER HEALTH DEPARTMENT The following Septic As -Built plans for the above referenced property are being submitted for approval and issuance of Certificate of Compliance. Enclosed are the following: 1. (3) Copies of the Septic System As -Built Plan. 2. (1) Form 3A — Certificate of Compliance Form. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE -.NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 N TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES F a 9 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 'sSwcNus� Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 99 Raleigh Tavern Lane MAP: 107.A LOT: 115 INSTALLER: James Kellett DESIGNER: NEES PLAN DATE: August 20, 2004 BOH APPROVAL DATE ON PLAN: September 28, 2004 DATE OF BED BOTTOM INSPECTION: September 29, 2004 DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = _ LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS Comments: ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Page 1 of 1 TOWN OF NORTH ANDOVER t NCRTFJ , Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX SEPTIC TANK Comments: PUMP CHAMBER Comments: ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Page 2 of 2 TOWN OF NORTH ANDOVER Ot NOR7ir Office of COMMUNITY DEVELOPMENT AND SERVICES or �'�to HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 0 18454 � � �cNus t Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM p Comments: PRESSURE DISTRIBUTION Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan inch manifold laterals installed with end sweeps size: material: Squirt test ft in height Equal distribution to all laterals orifice size inch as per plan Page 3 of 3 CQ Q TOWN OF NORTH ANDOVER t NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES �r •' a _ '° °°p HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 4►'Ss"CHU �cNus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped . ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV CED TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D -Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 C-11 A7 -L yC> 4 LLLI V-, . 0, TOWN OF NORTH ANDOVER a NORTh Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT p • 27 CHARLES STREET � °°, ,,•"; NORTH ANDOVER MASSACHUSETTS 01845 �s<� ' S�cHus Susan Y. Sawyer, RENS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM. R Comments: PRESSURE DISTRIBUTION El b Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down tocsoil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 %" double washed stone installed 1/8-1/2" (peastone) double washed stone installed laterals installed and ends connected to header (and vented if impervious material above) Orifices @ 5 & 7 o'clock positions Gravelless disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan inch manifold laterals installed with end sweeps size: material: Squirt test ft in height Equal distribution to all laterals orifice size inch as per plan, Page 3 of 4 11 e ra* Commonwealth of Massachusetts Map -Block -Lot I off,*sae }1ya 107.A-0115- I 4{.. -----------------..--__-_ Board of Health permit No North Andover BHP 2004-0667 P.I. FEE r\�►t F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted JAMES KELLETT K --------------------- — to (Repair) an Individual Sewage Disposal System. at No 99 RALEIGH TAVERN LANE -- as shown on the application for Disposal Works Construction Permit No. BHP -2004-066 Dated September 29, 2004 ---- - ----------- -------------- Issued On: Sep -29-2004 _ :u:..r.......� ..�................ ... ......... ... ........................... TOWN OF NORTH ANDOVER a� NORTN q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET : o NORTH ANDOVER, MASSACHUSETTS 01845 ''4S "^•°E<�� S4CHU5 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX healthdeptCy townofnorthandover.com www. townofnorthandover: com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 1 �4 LOCATION:��1���1/i�/ �i�✓��r� LICENSED INSTALLER NAME: PLEASE PRINT SIGNA TELEPHONE# %S-/— %5:iZ1Y7/ CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR (indicate what parts): * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As -Built Plan. X2500'00 or $125 Fee Attached? Yes No Project Manager Obligation From Attached? Foundation As -Built? Floor Plans? Approval of Health Agent ($125) Yes No Yes No Yes No Date: v r INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at // �l �� L��� relative to the application o /Ni PI/�_� dated for plans by and 9 y o dated �o2!/.WXwith revisions dated 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: �r2-9 Dis al Works Construction Permit # TOWN OF NORTH ANDOVER r Office of COMMUNITY DEVELOPMENT AND SERVICES F: •';� ' °°p HEALTH DEPARTMENT w 27 CHARLES STREET'°+• NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX September 28, 2004 R. Dennis Dionne 99 Raleigh Tavern Lane North Andover, MA 01845 Re: 99 Raleigh Tavern Lane, Map 107A, Lot 115 Dear Homeowners, 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 Engineering & Surveying Services dated August 20, 2004 (Last Rev. September 27,2004). The 4 -bedroom design has been approved for use in the construction of a replacement 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. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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 (3 10 CMR 15.020(1)). 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 and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Susa Sawyer, REHS/RS Pu is Health Director cc: New England Engineering C� O NEW ENGLAND ENGINEERING SERVICES INC September 24, 2004 Susan Sawyer North Andover Board of Health C ® 1 27 Charles Street 1 North Andover, MA 01845 SEP 2 7 7004 4: el- I'S Re: 99 Raleigh Tavern Lane, North Andover HLALT ovENT Septic System Design - Revisions C ��'� n J. Dear Susan, y/-; ' n -r� The following plans for the above referenced property are being resubmitted for approval. Responses to your comments from the letter dated September 15, 2004 are listed below. 1. Minimum 15' from edge of chambers to breakout per 15.255(2) — Per your conversation earlier today with Steve Pouliot from my office the current design with the 40 mil impervious barrier and 2:1 slope has been determined to be acceptable. Therefore, no change has been made. 2. Amend profile to show 9" min. cover over septic tank 15.228(l) — Plan has been revised to identify 9" min. cover over septic tank. 3. Explanation of use of leach bed rather that leach trench 15.240(6) — Explanation provide below. No change has been made. 4. A 3:1 slope between 100, 98, & 96 contours. — Per your conversation earlier today with Steve Pouliot from my office the current design slope has been determined to be acceptable. Therefore, no change has been made. As for item number three, a leach bed was designed rather than leach trenches due to the limited area suitable for construction of a septic system and cost considerations. If you have any comments or questions please do not hesitate to contact this office. Sincerely, " C 0�' Benjamin C. Osgood, Jr., P.E. President 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT w 27 CHARLES STREET '��►.•�VA �+ NORTH ANDOVER, MASSACHUSETTS 01845 �'88;C Susan Y. Sawyer, REHS/RS Public Health Director September 15, 2004 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 99 Raleigh Tavern Lane, Map 107A, Lot 115 Dear Mr. Osgood: 978.688.9540 — Phone 978.688.9542 — FAX The proposed septic system design plans for the above site dated August 20, 2004 and received on August 24, 2004 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 is not met by this design. 1. Please provide a minimum of 15' from the edge of each of the chambers to the breakout elevation of 100.45, or extend the impermeable barrier. - 255(2) 2. Please amend the profile to show 9" of cover over the septic tank. -228(1) 3. Trenches are to be used as the soil absorption system mechanism whenever possible. Please use trenches in this instance or explain why they cannot be utilized. (3 10 CMR 15.240(6)) 4. A 3:1 slope is needed between the contours 100 to 98 to 96. 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. Sincerely 1-91 S Y. Sawyer; REHS/R Public Health Director cc: Owner File Town- 6f°North-_ Andover HEALTH -DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 healthdeyWownofnorthandover. com AUG 2 4 2004 TOwN OF rvUk r NEgLTH DEP H ANDOVE ARTMER NT SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: 6c Z1 ell SITE LOCATION: qq /Zl�! ENGINEER: /Vecv �ei(!�✓� ll`z/CT�f�' _�,�/kT NEW PLANS: YES $225.00/Plan ✓ Check #: 69q / (Includes 1 w and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan SITE EVALUATION FORMS INCLUDED: YES LOCAL UPGRADE FORM INCLUDED: YES Telephone #: Fax #: E-mail: HOMEOWNER NAME: OFFICE USE ONLY When the submission is complete including check): I. !/D a sta lans and letter �P 2. C71ete and attach Receipt 3. ���py File; Forward to Consultant 4. Enter on Log Sheet and Database Check #: NO NO ow NEW ENGLAND ENGINEERING SERVICES INC. August 24, 2004 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 99 Raleigh Tavern Lane, North Andover Septic System Design Dear Susan: I�rn AUG 2A 2004 TOWN v, r+UKTH ANDOVER HEALTH DEPARTMENT The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (1) Copy of the soil evaluator sheets. 3. (1) Check for payment of the Town approval fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager RECEIVED AUG 2 4 7004 TOWN OF iv'vK ti AivUUVER HEALTH DEPAR T IvIENT 60 BEECHWOOD DRIVE -.NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 No. FORM 11 - SOIL EVALUATOR FORMM Page 1 of 3 Date: Commonwealth of Massachusetts .Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: Date: 2015V"14- Witnessed By: ........'.����-......��C��>�...................._ Location Address or 9 � GAJ/�' �c��/' � %y Ow xr's Narm, � • L/r N� La I Zi(l�� N . �j�{ �j Address, card �Z' Tdcphone /� v+' jew Construction ❑ Repair ® 197ce Office Review i r Published Soil Survey Available: No ❑ Yes R1 Year Published /9ifY ................ Publication Scale �'t�/' /8 Soil Map Unit wh Drainage Class–AlC-��I��....... Soil Limitations .K .... C -- Surficial Geologic Report Available: No ® Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit)..................................................................................................... . Landform............................................................................................................................................. ...... _... _. . Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ... ......... - ..... Wetlands Conservancy Program Map (map unit) .......... ....... .... _..................... ........._. ... . Current Water Resource Conditions (USGS): Month UUGY Range :Above Normal ONormal ❑Belc,.v Normal ❑ Other References Reviewed: — DEP APPROVED FOPUM - 12/07/95 /D4 FORM 11 - SOIL EVALUATOR FORINI Page 2of3 Location Address or Lot iso. On-site Review Deep Hole Number / Date:.. l:.. T Time: �'Weather � Location (identify on site plan)�.- Land Use s%T>cCtTl�l� Slope M Surface Stones Vegetation Landform Position on landscape Distances from: Open Water Body feet Drainage way 2 feet Possible Wet Area 2feet Property Line.. feet Drinking Water Well 0 feet Other ..:. DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) � Y� L, Sy A13 P/srAlCr Parent Material (geologic) C `f'�/ ' L �"' DepthtoBedrock: _ Depth to Groundwater: Standing Water in the Hole: _ Weeping from Pit Face: a Estimated Seasonal High Ground Water:_ DEP APPROVED FORM • 12/07/95 . o FORM 11 - SOIL EVALUATOR FORM Page L of 3 Location Address or Lot iso.G�(�{f On-site Review e Deep Hole Number ..2 Date:.:..�1Time:.�•.� WeatherIr2 Location (identif site plan) . . Land Use ?. /z�.UT�4 Slope M Surface Stones Vegetation ....w251 Landform Position on landscape -5,1 Distances from: Open Water Body feet Drainage way 2�G feet Possible Wet Area feet Property Line ...4T feet Drinking Water Well /. feet Other .......... .:... DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, Gravel) r� / Z�y � L 1571-acr — Parent Material (geologic) `� G DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water:_ DEP APPROVED FORM • 11/07/95 0 FORM 11 - SOIL EVALUATOR FOWN1 Page Z of 3 Location Address or Lot No. On-site Review Deep Hole Number Date: (: 1 Time: 9. Y -S Weather%/' Location (identify on site plan) �� �i�%-_,:.•5'/lJ, -.�kT Land Use 'kc ---v"?) vrtve Slope (%) Surface Stones Vegetation�2.1�� Landform���v Position on landscape Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line . 2� feet Drinking Water Well 1,5-0 feet Other DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure, Stones, Boulders, Consistency, % Gravel) Y/O tt o �irr R20 L �Yw Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water:___ DEP APPROVED FORA) - 12/07195 DepthtoBedrock: Weeping from Pit Face: Location Address or Lot No. // 0 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ............... inches ❑ Depth weeping from side of observation hole.- ... ..... inches Depth to soil mottles .:::.:::: inches d z- ❑ Ground water adjustment ................... feet _ 30 Index Well Number .................. Reading Date .................. Index well level ...... Adjustment factor ................... Adjusted ground water level ................................. __...... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in-11areas observed throughout the area proposed for the soil absorption system? ;ZtL If not, what 'is the depth of naturally occurring pervious material? — Certification I certify that on 441'�/��(date) I 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. Signatur GAY 4g� Date 2'�/allc W ' DEP APPROVED FORM . 12/07/95 o :5:59 0 0CD O 7� a CDO w "1 b •ri b 3 A A A A % O O O O O 00 J Cl J C 0 A cn 0000 1 m y o N O N o N o w A t A A A A Y z m z z c z M m m m y O O O A o A O C J O` F n O o 0 N � A O A 7 D .• N C: w c o � o � � o w 0 z CD CD z CD a 0 o - (/� CD O O O O ee O ON ON O `� N N O x CD o m x C CD o 0 r w I*N< b z BOARD OF HEALTH H NORTH ANDOVER, MASS. 01845 978-688-9540 r, APPLICATION FOR SOIL TESTS DATE: -7 Lf L'`t MAP & PARCEL: _ I 01 A— (1 S LOCATION OF SOIL TESTS: _ 121 41-' t p E 0 t t-4 ,,j ( .4S S li7e M fcj�u( SO E ,�7ET OWNER: 7 F Kkiii S 1�> ) U N h e TEL. NO.: Ci -7 G( `75 - Z Z ADDRESS: 99 I4qLCc 6� ! f T14v�:12 ( L4AIE /qDo� � ENGINEER:_C, OS( -Mob x- P'c TEL. NO.: `7 L (� / 7 CERTIFIED SOIL EVALUATOR: N--� A -VU ( KS 0 SC -760 b 1i? 17 � Intended use of land: Residential Subdivision Single Family Home \` Commercial Is This: Repair testing x__ Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No 7� THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for'new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be.submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Bel w This Line N.A. Conservation Commission Approval: Zf %,s Date Received: Check Amount: Check Date: L/ v t r' we, Robert F. Miller and Mary Kay Miller, husband and wife, both 203 of North Andover, Essex County,Manachusetts, being ainarriad, for eotuidention paid, and.iu full consideration of $57,500.00 . grantsto R. Dennis Dionne and Mary . Dionne, husband and wife, as joint tenants of 99 .Raleigh Tavern Lone, said North Andover withqultrlalm.rmmnattts S�S1il1l'fial9t l[k+cdpti.o.ed.sntumbraxe, I/..nrl A certain parcel.of land with the buildings thereon situated in.North Andover,Essex County, Massachusetts, being shown as Lot No. 28 on a plan of land entitled "Definitive Plan 'Raleigh Tavern Estates' i North Andover, Massachusetts, Owner, Old North Andover Realty Trust, Engineer, Hayes Engineering, Inc." dated May 15., 1968 and recorded in North Essex Registry of Deeds as Plan No. 5913, said lot being more particularly bounded and described as follows: NORTHEASTERLY by Raleigh Tavern Lane.(North).in two courses, One hundred twenty-two and 59/100. (122.59) feet and twenty-seven and 41/100 (27.41) feet; NORTHWESTERLY by Lot No. 29, two hundred seventy -ane and 58/100 (271.58) feet; SOUTHERLY in three courses by land of Old North Andover Realty Trust Lot No. 33 and Lot No. 34, .one hundred fourteen . and 05/100.(114.05) feet, ninety-eight and 66/100 (98..66) feet and one hundred eighteen and 61/100 (118.51). feet; and EASTERLY by Lot No. 27; two hundred twenty-five and 04/100 (225.04.) feet. All as appearing on said Plan and containing 57,294 square feet more or less. Thin conveyance is subject to any and all restrictions of record insofar as the same are now in force.and..applicable. saing.the same premisea.conveyed to us by.deed of the said Robert F. Miller dated October 27, 1970 and recorded in North Essex Registry of Deeds in book 1161 Page 581.. c' Said premises are conveyed_eubject.to. taxes for the current year i which the grantees assume and agree to pay. i iAltneso..our..hands and seals this.......16th.......day of.........May, ......................19Z2. ..... f r s........................................................................ ............................................................... jlII4e �otnmanmralth of 8140"rhusetts Essex SL May 16, 1972 7 o personally appeared the above named Robert F. Miller . } Bed the foregoing. and acknowledged .uutnuneoc to be his. free act and deed,1 Sfore we i I • ! i Fernand A. Nernaalh, I �.t��-- EU'.',r.ancu�a. FS ur s,l«� avu• March 13 to 75 i w . ICY' Ci,iuoe Recorded May 18,1972 at.10:53AI4 13786 1 y '� 0 t � q ♦ Q46 7 c � � 4 { 3 3 , r i I �i I 4 i r u} 0 0 i' , n,r lrwwwwOA s+wa+q+rr • l,T.. _.� w.w _— _ _ +— �M'_�"' .f.+•.w.+-. e, r — }` ve Ot13 ca < ,rco r APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I her`eb make a plication for a permit for a se'aage disposal installation at . I will install this system in ac-. cordance with all the lawd of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/811 to 1/4" (dia.). will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signa a of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signature of Health Agent I hate inspected the uncovered system indicated above and find everything done as described. DATE 4/L 0 7 a Signature of Iris cting Officer Percolation Test Garbage Grinder ++ �+ BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS., t I to R A LB ( &4 AJr-r-0%.-) � 1. NAME ac -'t"- , eo_�� DATE 2. ADDRESS �(�� �, /U,rte 0 LOT NO. Ar TEL. 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES %. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. ,04% .« BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL NAME OF APPLICANT Curtis Devgl o ent CQrj2. LOCATION Lot #28 Ralelgla Tavern Address of lot no. BUILDING: Dwelling X Other. SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high _ .. SUBSOIL: Clays GravelSand PERCOLATION TEST _7 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK;000 gallon capacity. LEACH FIELD 2'QO lineal feet of drain pipe. William J*- Dri C 11, Engineer Board of Health