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Home My WebLink About- Soil Testing Results - 1 PENNI LANE 11/20/2019 3/8/2019 H Date: March 08,2019 Soil Testing Permit #46195 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/46906 COMMONWEALTH OF MASSACHUSETTS •, TOWN OF NORTH ANDOVER BOARD OF HEALTH 1 - James Kavanaugh 1 PENNI LANE is hereby granted a Soil Testing Permit This permit is granted in conformity with the statutes and ordinances relating thereto. Soil Evaluator Contact Number:978-375-9781 9781 E//f'�"�,�?C Owner Contact Number#:Number: 7 Engineer Contact Number:978-375-9781 FRANCIS P.MACMILLAN,JR.,M.D. Conditions: BOARD OF HEALTH CHAIRMAN 112 3/8/2019 Soil Testing Permit 46195 Applicant SZs James Kavanaugh �. 978-375-9781 @ kavanaughj@msn.com Location 1 PENNI LANE NORTH ANDOVER, MA 01845 General Information Owner(if different from applicant) Owner Contact Number Francis Boyle 978-375-9781 Engineer Engineer Contact Number: James Kavanaugh 978-375-9781 Certified Soil Evaluator Soil Evaluator Contact Number: James Kavanaugh 978-375-9781 Project Details Intended Use of Land Type of Testing: Single Family Home Repair Testing In the Lake Cochichewick watershed? Location of Soil Tests: No front yard Internal Conditions �bn Sc�V 1/1 Summary Page 1 of 1 /vri� Printable Record Card Previous Assessment I Condo Info Sales Webb `o Zoninq I Comments I Card 1 of 1 Location 1 PENNI LANE Property Account Number Parcel ID 107.D-0057-0000. M_233414_931773 IF Old Parcel ID -- Current Property Mailing Address Owner BOYLE, FRANCIS T City NORTH ANDOVER SUSAN M BOYLE State MA Address 1 PENNI LANE Zip 01845 Zoning R2 Current Property Sales Information Sale Date 5/10/1994 Legal Reference 04040-0210 Sale Price 270,000 Grantor(Seller) HEINZE, NORMAN Current Property Assessment Card 1 Value Year 2019 Building Value 307,700 Xtra Features Value 0 Land Area 1.000 acres Land Value 254,800 Total Value 562,500 Narrative Description his property contains 1.000 acres of land mainly classified as ONE FAM with a(n) N/A style building, built about 1976 , having N/A exterior and N/A roof cover,with 1 unit(s), 7 total room(s),4 total bedroom s , 2 total baths , 1 total half baths , 0 total 3/4 baths . Legal Descri tion Property Images 7 12JAn � 22 14 25 ( '. F 7. SFL 23 k �. FFL (1318) -.. r� 4' 14 \ 2 36 ! t 1 PENNI LANE ' http://northandover.patriotproperties.com/Summary.asp?AccountNumber=9620 3/8/2019 Town of North Andover, MA March 8, 2019 1¢J..D-0071 0000_0 107,D-0OSS 0 �.7 0 e107€�-0 1a tLh0061 6000 0 I :07 ,D-0072-0000.0 107,6-0054-000 107,1]1-0030-00 iOT,D-aa6R 0 0 =. 107.D-0073-0400.0 Ott S{ 107.$-0056- 107,D-0029-00 `- 05 / .J5 1tl7-D-006 0.0 107 D-0074-0000 0 1 } 7,D•0121.0000.0 s7.D-0137.0000.0 ', % 1071)0026-00 00 ^ 107^D-00540000.0 d 107 D-0056 0000 0 0120.0000.0 J '.107.C7.005 000.0 ', 107_D-0058.000.0 1 ` f ta1� 107.pD 0149.0000.0 s� 107.D-00'ds•0000 n 107.D-00 000.0 t 107.8 a030 107.D-0101 0000,0 10 13-0000.0 y 107.D-0136-0o00.0 1QT.D-00 000.0 �xf 107,D-0132-0000.0 f t - /e- 07,13-01 000,0 � t 107,D-0012-0000.0 p " 107,D-0110 00.0 �' .. � 107.13-0134-0000,o .. 107 G-r 11 DUO C / 1„=202 ft MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover,MA makes no claims and no warranties,expressed or implied,concerning the validity or accuracy of the GIS data presented on this map. Geometry updated 10/31/2018 Data updated 10/31/2018 3/8/2019 Payment Receipt SLED, S�' S1r Town of North Andover, MA $440 .00 Paid via Check Note: ck# 1319 soil test 1 Penni Lane Thanks for using the Online Service Center James Kavanaugh Soil Testing Permit#46195 March 8, 2019 Repairs or Maintenance Fee $440.00 Total Paid $440.00 ILE Powered by the ViewPoint Cloud platform 1/1 3/11/2019 Unofficial Property Record Card Unofficial Property Record Card - North Andover, MA General Property Data Parcel ID 107.13-0057-0000.0 Account Number M_233414_931773 Prior Parcel ID -- Property Owner BOYLE,FRANCIS T Property Location 1 PENNI LANE SUSAN M BOYLE Property Use ONE FAM Mailing Address 1 PENNI LANE Most Recent Sale Date 5/1 011 9 94 Legal Reference 04040-0210 City NORTH ANDOVER Grantor HEINZE,NORMAN Mailing State MA Zip 01845 Sale Price 270,000 ParcelZoning R2 Land Area 1.000 acres Current Property Assessment Card 1 Value Building Value 307,700 Xtra Features 0 Land Value 254,800 Total Value 562,500 Value Building Description Building Style COLONIAL Foundation Type CONCRETE Flooring Type HARDWOOD #of Living Units 1 Frame Type 1 Basement Floor N/A Year Built 1976 Roof Structure GABLE Heating Type FORCED H/W Building Grade AVERAGE+ Roof Cover ASPHALT Heating Fuel OIL Building Condition Good Siding VINYL Air Conditioning 100% Finished Area(SF)2752 Interior Walls TYPICAL #of Bsmt Garages 2 Number Rooms 7 #of Bedrooms 4 #of Full Baths 2 #of 3/4 Baths 0 #of 1/2 Baths 1 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 1.000 acres of land mainly classified as ONE FAM with a(n)COLONIAL style building,built about 1976,having VINYL exterior and ASPHALT roof cover,with 1 unit(s),7 room(s),4 bedroom(s),2 bath(s), 1 half bath(s). Property Images k 1 PENNI LANE `• Disclaimer:This information is believed to be correct but is subject to change and is not warranteed. http://northandover.patriotproperties.com/RecordCard.asp 1/1 Commonwealth of Massachusetts RECEIVED u City/Town of P` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DOFNDRTH 1� vTR HDpLTH DEPAR GSM DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information _Francis Boyle Owner Name 1 Penni Lane Map/Lot_107D/57 Street Address North Andover _MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. Published Soil Survey available? Yes ❑ No ❑ If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ❑ No ❑ Within the 100 year flood boundary? Yes ❑ No ❑ Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 1 of 7 Commonwealth of Massachusetts Cityffown of - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal rG,M 6. Current Water Resource Conditions (USGS) Range. Above Normal ❑ Normal ❑ Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 3/25/19_ _12 pm _breezy 50 Date Time Weather 1. Location Ground Elevation at Surface of Hole 97.03' Location (Identify on Plan ) TP-1 2. Land Use: lawn area (e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) mowed grass drumlin middle Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way Possible Wet Area _>100 feet feet feet Property Line_>20 Drinking Water Well _>100 Other feet feet 4. Parent Material: sandy loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 48 93.03' inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M Deep Observation Hole Number: TP-1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 Ab 10YR2/2 FSL granular, friable 8-14 Bw 10YR6/8 FSL granular, friable 14-24 BC 2.5Y6/8 FSL granular, friable 24-120 C1 5Y7/4 SL massive, loose Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G'M_ C. On-Site Review (Cont.) Deep Observation Hole Number: _2_ 3/25/19 _12 pm _breezy 50 Date Time Weather 1. Location Ground Elevation at Surface of Hole 96.82' Location (Identify on Plan ) TP-2 2. Land Use: lawn area (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) mowed grass middle Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way Possible Wet Area _>100 feet feet feet Property Line_>20 Drinking Water Well _>100_ Other feet feet 4. Parent Material: Loamy Sand Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: _42 93.32' inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal H`J Deep Observation Hole Number: TP-2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Depth Layer (Munsell y ) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 Ap 10YR2/2 FSL granular, friable 8-14 Bw 10YR6/8 FSL granular, friable 14-42 C1 2.5Y5/6 GLS massive, friable 42-82 C2 5Y7/4 LS massive, friable Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 5 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal iG^M D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ❑ Depth to soil redoximorphic features (mottles) A. _42_ B. _48 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ® No ❑ b. If yes, at what depth was it observed? Upper boundary: 24" Lower boundary: 82" inches inches F. Certification I certify that I have passed the soil evaluator examination* approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 01- V Signatu rwzrSoil Evaluator Date Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 6 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 3/25/19_ _12 pm _breezy 50 Date Time Weather 1. Location Ground Elevation at Surface of Hole 96.25' Location (Identify on Plan ) TP-3 2. Land Use: lawn area (e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones Slope(%) mowed grass middle Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way Possible Wet Area _>100 feet feet feet Property Line_>20 Drinking Water Well _>100 Other feet feet 4. Parent Material: sandy loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal iG^M Deep Observation Hole Number: TP-3 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-48 Large Boulder Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 3 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: _4_ 3/25/19 _12 pm _breezy 50 Date Time Weather 1. Location Ground Elevation at Surface of Hole 96.12' Location (Identify on Plan ) TP-4 2. Land Use: lawn area (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) mowed grass middle Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way Possible Wet Area _>100 feet feet feet Property Line_>20 Drinking Water Well _>100_ Other feet feet 4. Parent Material: Loamy Sand Unsuitable Materials Present: Yes ® No❑ If Yes: Disturbed Soil❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole 74 Estimated Depth to High Groundwater: _32 93.45' inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal iG^M Deep Observation Hole Number: TP-4 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-18 Ap FILL 8-14 Bw 5Y7/4 SL massive, friable Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M C. On-Site Review (Cont.) Deep Observation Hole Number: _5_ _3/25/19 _12 pm _breezy 50 Date Time Weather 1. Location Ground Elevation at Surface of Hole 98.17' Location (Identify on Plan ) TP-5 2. Land Use: lawn area (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) mowed grass middle Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way Possible Wet Area _>100 feet feet feet Property Line_>20 Drinking Water Well _>100_ Other feet feet 4. Parent Material: Loamy Sand Unsuitable Materials Present: Yes ® No❑ If Yes: Disturbed Soil❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole_100 Estimated Depth to High Groundwater: _56 93.50' inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal GSM Deep Observation Hole Number: TP-5 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-48 FILL 48-51 Ap 10YR3/2 FSL granular, friable 51-56 Bw 10YR5/8 SL granular, friable 56-110 C1 2.5Y6/4 LS massive, friable Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M Use this sheet for field diagrams: 0 Tp-S � (se-� b ti • j��N �A-IV4 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7 Commonwealth of Massachusetts City/Town of a Form 9A — Application for Local Upgrade Approval ^M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important:When filling out forms 1. Facility Name and Address: on the computer, use only the tab Francis Boyle key to move your Name cursor-do not 1 Penni LAne use the return — --- ---- key. Street Address North Andover Ma 01845 _IG� City/Town State ------ Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: Single Family Home 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): leach field t5form9a.doc•rev.7/06 Application for Local Upgrade Approval, Page 1 of 4 Commonwealth of Massachusetts City/Town of m Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440gpd -- Design flow of proposed upgraded system 440 - gpd Design flow of facility: 440gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: construct new setpic/pump_tank and soil absorption system 3. Local Upgrade Approval is requested for(check all that apply): ❑ Reduction in setback(s)-describe reductions: ❑ Reduction in SAS area of up to 25%: - - - - — - SAS size,sq.ft. %reduction ® Reduction in separation between the SAS and high groundwater: Separation reduction 4ft-3ft. ft. Percolation rate 15min./inch Depth to groundwater 3.5 ft. t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4 Commonwealth of Massachusetts City/Town of a W Form 9A - Application for Local Upgrade Approval ^M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluator's Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: cost prohibitive 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: cost prohibitive t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 3 of 4 Commonwealth of Massachusetts City/Town of Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: n/a 4. Connection to a public sewer is not feasible: n/a 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ® Application for Disposal System Construction Permit ® Complete plans and specifications ® Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." /P-O Facil Owner's Signature Date h'Ce�✓tu S � Z0 Print Name J/ James Kavanaugh 7;f I Name of Preparer Date 14 Shady Hill Drive North Reading Preparer's address City/Town MA 01864 978-664-2925 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval• Page 4 of 4 Commonwealth of Massachusetts REG�,V�D -- City/Town of ZJ Percolation Test n oR111PN ' Form 12 �D •O`FNp�p�t�M kIM N�� Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important:When filling out forms A. Site Information on the computer, use only the tab Francis Boyle _ key to move your Owner Name cursor-do not 1 Penni l-Ane use the return —---- - -- — - key. Street Address or Lot# North Andover MA _ 0 45 - . r� City/Town State Zipp Code Contact Person(if different from Owner) Telephone Number ' B. Test Results 3/25_/_1.9 _ 12:30 am Date Time Date Time Observation Hole# P-1 Depth of Perc 30+15=45" Start Pre-Soak 12:2�m End Pre-Soak 12:38 pm Time at 12" 12:38 Time at 9" 1:1�_prn - Time at 6" 1:56 pm_ Time (9"-6") 45 - -- -- - Rate (Min./Inch) 15 MIN./IN. Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ James Kavanaugh Test Performed By: Erin Kirchner- N. Andover_B_.O.H. _ Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 Bk 15806 Pg140 #7265 04-08-2019 @ 11 : 15a QUITCLAIM DEED We, Francis T. Boyle and Susan M. Boyle,husband and wife of North Andover, Essex County, Massachusetts for the frill consideration of SIX HUNDRED FIFTEEN THOUSAND AND 00/100 DOLLARS ($615,000.00)paid grant to Daniel Tucci and Emily Tucci,husband and wife as tenants by the entirety, now of I Perini Lane,North Andover, Essex County, Massachusetts 01845 A certain parcel of land with the buildings thereon, situated in North Andover, Massachusetts, and n o o shown as Lot B on a plan of land entitled"Revised Plan of Land Located in North Andover, Mass., o Owned by Scott Properties, Inc." dated August 28, 1975, Frank C. Gelinas, Civil Engineer, North <� Andover, Mass., and recorded with the Essex North District Registry of Deeds as Plan No 7280 and t. being more particularly bounded and described as follows: v SOUTHEASTERLY by the northerly line of Gray Street,as shown on said plan, 150.00 feet; c NORTHEASTERLY by land now or formerly of Scott Properties, Inc., as shown on said plan, z 283.85 feet; a� NORTHERLY by land now or formerly of Scott Properties,Inc.,as shown on said plan, 102.64 feet a NORTHWESTERLY, WESTERLY, and SOUTHWESTERLY by Penni Lane, as shown on said plan, by five courses measuring 70.03 feet, 75.46 feet, 65.10 feet, and 42.16 feet. C Grantors hereby waive any and all homestead rights they have or may have had in the property described above and conveyed herein. Grantors also swear and acknowledge under the pains and penalties of perjury that no other persons are entitled to any benefits of an existing estate of homestead. For title see deed recorded in the Essex North Registry of Deeds at Book 4040 Page 210 on May 10, 1994. MASSACHUSETTS STATE EXCISE TAX Essex North Registry Date: 04-08-2019 e 11:15am Ctl#: 69 Doc#: 3265 Bee: $2,804.40 Cons: $615,000.00 Y 1 / 51, �- 65 R h P ja rw.e-) 100u`,N OEpPR� iz 12 S ! Al of ore 4 - I a g 1�1-!N $w' �. /o rjt . ,ln C -2,y 2_s7 bj� S s v � , rj R ci Ls E::3-Tf 2 OtN � z c/ h11 i 32 _ e