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Home My WebLink AboutMiscellaneous - 101 SHERWOOD DRIVE 4/30/2018 (2)!' • � I+yI I � � � + ^� I A \ `� I MAP # PARCEL # -`"` STREET ONSTRUCTIO.N_APPROVAL, HAS PLAN REVIEW FEE .BEEN PAID? J YES NO PLAN APPROVAL: DATE APP. BY-✓� _� DESIGNER: PLAN DATE.ot�<Q� CONDITIONS WATER WELL PERMIT WELL TESTS: Y: WN WELL COMMENTS: DRILLER CHEMICAL BAC- A I BACTERIAII DA 1 E AF'PRUVED DA f E flPIJf2UVED DATE APPRUVED FORM U APPROVAL: APPROVAL 1*0 ISSUECii�? NO DATE ISSUED 3 �� BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NO YES NO YES NU NO DATE:. -..._._...._..._ ....By:-. . ImPo wh" filktf GOA t on the Wroft, use Q* ft Ob key to move your Cursor. do floe use rho roper key. m 151om►d.doa OWN . we • o. w DEP has provided this forme for use by local Spa 6 of s H ee intarmstbn must be suostarru" ow same as UM prwj"e h:•Other may be used. but the local Board of Heab to determine tie form they use. TIN is ku thm. cltm with your rho ®card of Nsaftlr or Other approving auarorihr wigririo R must be submitted to V'' weh 310 CMR 15.351. date in A. Facility Information 1. System Loc OW: 2. System Owner NM TON i „n�ER cttylf0�q . Ct 7e - T40ho m Motor 13e Pumping Record 1. gate of Pump" 2. Oete Quantity PumpW: e�uore 3. Type of system; ❑ CMWK$CV SepticT; ❑ rW Tank ® ® Other (dest�ibe): Grease Trap 4. Effluent Tee Fdter present? ❑ Yes (9 No 5. Condition of System: 6. Sy Pumped By: N ___5OCAC 7-9 k Sea`C 7. Location where contents were deposed: e"r'-LSD IOWM of R®O"q Fafq h If yOs, was it leaned? ❑ Yes 0 No Yb ► "t+Oytnpor Y Systom PWOV Record 'Page 9 of i Of NORiM 7023 4��? ` f��o 00 • • Town of North Andover �� HEALTH DEPARTMENT q'L SACNUSf CHECK #: DATE:. ;O LOCATION: ' H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) t ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $- 1.1 ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ -)i Title 5 Report $ E ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Commonwealth of Massachusetts Title 5 Official inspection Forn Subsurface Sewage Disposal System Form -Not for Voluntary As se Or Ow ner Owner's Name — - - information Is n. required for every �A,- page, Qty/Town State OCIC a � i", )F N0R1*H AWj3YHM TM,DEPARTMEWT a/�ys /,/ Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Mportartt: When filling out forms A. General Information on the computer, use only the tab key to mrwe your 1. Inspector: cursor - do not use the return `le1141-t-) 4�FjCZeX- key. Name of inspector /}9r�tCZ tJ St/) - 1 i rr., /VC, cornpanytie &I �'f �j 2 e-1 n/ Cornpany Address ay/ own Telephone Nu rnber B. Certification St(�atej [ Zip Code License Number — I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the tirne of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant'to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditional) Passes Y ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority iyf1_6!,1 pe'to r's Sgnalue / Da l6 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system Is a shared systern or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *—*This report only describes conditions at the time of inspection and under the conditions of use at that time. This Inspection does not address how the system will perform in the future under the same or different conditions of use. T1UU5ohaal ills pu Uai Fvni SuWurracu SC-va�U Ulsposa� SA(Um• Pagel 1 of 17 Cw ner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /G I E til �tx�l l) �ropert Address aN ner s Name aty/ Tow n B. Certification (cont.) AA 4iniState Zip Code Date tion Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: .�(I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: � 1 ('1j�/�[1J f C41a 1`L 1�'Lr G�ud c(�TlclN %/� /`',l 11 B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or riot) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 1.51N 3113 1It e 5 official if ps Wcuon Form Suusurfucu Sewage Dlaposai SALOm•Pug �?o11.' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N 50� >erty Address Ow ner Owner's Name information is required for every page. City/Town C�NL`L State Zip Code DatedsTn pection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning In a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t9rn- 3113 Ne50ffidal uspecuor, Fornc Suusurtece SoveQeDlsposal S)61gm• Page 3of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /01 S�-er (4,VC( h )oerty Address f\ C_,w ner O✓a ner s Blame ru// ZU/ '.n-olion is , required for every / �n��M �V((as e. Gty/TowSlate Zip Code Date of Inspe tion 9 . +r._ , 3.1 3 B. Certification (cont.) ra 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. and the SAS is less than 100 feet but 50 feet or The system has a septic tank and SAS more from a private water supply well'". Method used to determine distance: --- 4R This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of arnmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ -- Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ �" Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow 'fide 5 o I:aa In )tnuui Fa nt suwuri ace Su wage Dispusrf Syutum- Page <u'1i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments fr Ow ner Cw ner's Narne C��/� inf orm��VQ� ation Is A � required for every / ' Stale Zip Code Date of Inspec on page Ut Rwn B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or ❑ obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. portion of cesspool or privy is within 100 feet of a surface water supply or El tributary to a surface water supply. tributary ❑ �j. Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet wwater quality aat from a private water supply well with no accepttabl if the well water analysis, performed a DEP certifiednalysis system passes laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, that no other failure criteria are triggered. A copy of the analysis provided and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ �_ 10, 000g pd. The system falls. I have determined that one or more of the above failure fails. The ❑ criteria exist as described In 310 CMR 15.303, therefore the system system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 C fid al Ins pec11a1 Form Subswfuce Sevege Disposal System- Page Sof 17 t5ins - Y13 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G S/I Pf �a1c�' i Owner r J -- I r7 r information is OvnersNafns -- required for every _.-.LL A—y jtl iycr page. aty/Town ' - C. Checklist taro • y13 St C�CId �2G / State Zip Code Date of Inspe tion Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ X, Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? [� Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) �� ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ( Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ {�f r� Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms (design): <� Number of bedrooms (actual): --L-- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Title 5 0f 1ici:1 ins pu Uw F a rit Subsurface Sewage L)ISp Md SA,eni . Page & 01 1 ; Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 10 S/Ifr •cod Dr /Sec�I [�Ir Ow ner Owner's Name '/ Information Is / required for every IV -6A.1 C�/8Ys 7 page. City/Town State Zip Code Date of Insp ction D. System Information Description: D_ 6&x Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection Information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Gallons per day (gpd) R` A ❑ Yes No ❑ Yes No ❑ Yes., No ❑ Yes,," No NT`s Yes ❑ No t /c Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Water meter readings, if available: t5lns - 313 Tile 5 0Mclal lrn pec Oon F orm Su bsurf ace SewV a Dlsp osel S Wte m - Page 7017 ov ner information is required for every page, Commonwealth of Massachusetts Title 5 Official Inspection Form; Subsurface, Sewage, Disposal System Farm - Not for Vol untary Assessments Property Address owner's Name Q/S16 Otv/Town State Zip Code Date of Ins action D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Date yes Source of information: Was system pumped as part of the inspection? Yes ❑ No /sem If yes, volume pumped: gallons � e 13.o-�t,�x � nl�ti �� l� -- How was quantity pumped determined? o �1�0'V�' Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Pin - ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (descri be): Tifo60ffidd Ins pecticnFarm Subsurface Sevsga Msposd SAte m -page Sof 1 t5ins • 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /o/ S / CrtUXJ D, .. -' BcC,V, Ow ner Owner's Name information is required for every ' *v Li of page. Qty/Town D. System Information (cont.) o/Ws State Zip Code 2L /j Date of hs ection Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes b< No Building Sewer (locate on site plan): Depth below grade: feet Material of construction ❑ cast iron J" 140 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): to 10 fiN T P I'vr "' "v G"� Cc' d' 11"" Septic Tank (locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No A Dimensions: Sludge depth: t5ins 3113 Title 5 Official Impecson Form Subsui ace Sevaga Disposal SAte m• Pepe go117 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments owner information is Owner's Name required for every .f' V �/4y l o V er page. clty/Iown State Zip Code Bate of Ins pection D. System Information (cont) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Z �� Distance from top of scum to top of outlet tee or baffle AV7 v Distance from bottom of scum to bottom of outlet tee or baffle 0 4 _ How were dimensions determined? A«5clte l _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): are i N (,,j- I Grease Trap (locate on site plan) Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain: Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date UwLs - 3m 3 Title 6 Official Ins poc tial F orm Subsurface sevugo Disposed System- Page 10a 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 4�sertuoaJ _ 0r Prs Cw ner information is Owner'ssName required for every _ AI—Ay DOUCr q ?4 A/ Page. Qty/Town State Zip Code Date of inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5im • V13 Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below g ra de: Material of construction: ❑ concrete ❑ metal Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Title 5Offlclal 11u pectien Fern Suns;ulece Sevege Dlspmal System, Page 11 d 1? Commonwealth of Massachusetts - - Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /01 �Acc wol 1) - cs een/g Ow ner Owner's Name information Is d required for every �iJ^f�Nj�jUC( page. City/Town D. System Information (cont.) Z!k 0/W37 State Zip Code Date of In p tion Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert -�5— Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soll Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 19r1s- 3113 ri as 5Otlkia( I ns poctip) Form: Subsurface Sewaga Disposd Systam• Page 12 d V Commonwealth of Massachusetts Title 5 Official t Ins�pecti®nFOrm Subsurface Sewage Disposal System Form _Not fbrVolunta, rYsments lcvo�� pr FToPe;4Y Address (Avner ..._.......�......... SCA/ ��Gl information Is owners Name required for every.. �xy z r page ............. ab(7•own D. System Information (cont.) Type: ❑ leaching pits t9rn • 3X13 � ' State Zp Coda pate of1hape tbn number: ❑ leaching chambers number: leaching galleries number: leaching trenches ��2 / number, length: ❑ leaching fields number, dimensions: E3 overflow cesspool number. :. I;: ❑ innovative/altemati% system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding; damp soil, condition of vegetation, etc.): /VO St �t I p �' A Rfv �C iii �u'/L A Cesspools (cesspool must be pumped as part of Inspection) (locate on site plan): Number and configuration Depth — top of liquid to Inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Tide 5oflidel hu Pec Von Form Substeiace SewVedlspoeel System. Pape 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rol r I Sem Ow ner ow ner's Name / information isw oyrz s �u! required for every N G/.Vlj/L— page. City/n State Zip Code Date of Inspec Ion D: System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t!iiz - 3/13 Title 501ficid Iris pec Uon For rn: SUb5Ur1aCe Se,.ega Disposal Ststurn-Page 14 ot 17 ---------.-_,.__..�..___..�.,__..m„w,;an�.,»-• ... ._ ._ .wanas+nasaxasics9�^�= Commonwealth of Massachusetts -_-( Title 5 Official Inspection Form JO Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1116 01sY5- 9A6 Ay State Zip Code tate of Inspection Li. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ❑ drawing attached separately f�f► D-r)qK- 26 / — l�fe 15eo6-�,l {gNf� TweIofficial InspoctlaiForm: Subsurface So Vag a 01sp Mai SAla rn• Page 15 d 17 Property Address /) Cn/ A j phi; Owner information is ner s Name required for every /V^9Qn/�0✓f� page. Qty/ l ow n 1116 01sY5- 9A6 Ay State Zip Code tate of Inspection Li. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand -sketch in the area below ❑ drawing attached separately f�f► D-r)qK- 26 / — l�fe 15eo6-�,l {gNf� TweIofficial InspoctlaiForm: Subsurface So Vag a 01sp Mai SAla rn• Page 15 d 17 0 Commonwealth of Massachusetts Title 5 Official Inspection., Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. „ . �a Ar(woorA n,- �j' Proper Address f� Ce�lfj 1"�jl Ow ner Cw War's Nems information is //11 required for every _ 1[�tf yrr/"i OV v CM15— &/� page. City/Town State Zip Code Date of Inspectlon D. System Information (cont.) Site Exam: Check Slope Surface water /0- Check cellar Xf"Shallow wells f Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record c� \ If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5irs • 3113 TItle50fficial InspecUmForm Subsurface SevageDlspoed SAte m• Peg 16 of 17 Commonwealth of Massachusetts Title 5 official InspeCtion dorm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Its) Shc�w 1,5eeyv 4 ON ner ON ner's tJameMp. information Is 'Doug(' required for every State page CQty/Town E. Report Completeness Checklist .F71inspection Summary: A, B. C, D, or E checked tyres- 3113 Zip— Co"—'de " Date of Inspection ,,Q"'Inspection Summary D (System Failure Criteria Applicable to All Systems) compieieu ' System Information — Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file TIDO 5 Official ins paeOW Form: Subsurface Su Y49 Dispmal System• Paye 17 a' 11 To Timberland Builders, Inc. (Name of Applicant) 40 Sunset lock Road -Andover MA 01810 Address _ This Order is issued arid delivered as follows: Same as applicant if,imine of prooerty owner) Address Same as applicant ❑ by hand delivery to applicant or representaiive on _ Idats} o XFX by CeftlflCt. ri,ail, return receipt rer;ues:ed on //. -i� � % / � -. (his Y, eiecl. is located at Lot 12 . Sherwood Drive The property is recorded at the Registry ),o r cc ----- Cook . 3289 Page 096 Certiticate (it registered) April 5;.,,19-96 (�ade1 ,.. The Notice of Intent (or this. proie�et was -filed on The public.hearing was closed on June 5, 1996 (date) Findings The North Andover Conservation Commission has revie,.ved the above-(eler�-nced rloDce of Intent and plans and has held a public hearing on the project. Based on the rnlormot!on avallaole Ic the NACC at this time. the LLLC _ has determined llint the area on which the proposed work is to be done is significanl to the loiloviing interests in accoroance vith the Presumptions of Significa ce forth in the^re ulat!ons !or each Area Subject to Proted'!41i �!r'der 1i1e -178 Recreation Act (check as appropriate): Ch.178: � Prevention of Erosion & Sedimentation Ch. 1782 Wildlife Flood control ❑ Land containing shelllish. 0. Pubii.: water supply ® � [9 Private water supply Storm damage prevention Fisheries Prevention of ollution Protection of wildlile habitat Ground water supply � p Total Filing Fee Submitted $250.00 Stateosharr"' $112'.500 CityrTown Share 137.50 1 (1.1= lee in rxccss of 5331 Total Refund Due S City[Town Portion S State Portion S ,• P/7 total) x.99 Lot 12 Sherwood Drive DEP Frye No. I ` 242-805 l (to w, vw�s.h ey UEP1 Commonwealth C,ry•tow� North Andover of Massachusetts Timberland Builders, Inc. 'app°o"'t Order of Conditions Massachusetts Wetlands Protection Act G.L. c.131, §40 and under ttie Town of North Andover's Bylaw Chapter 3.5 From NORTH ANDOVER CONSERVATION M-IrIISSION To Timberland Builders, Inc. (Name of Applicant) 40 Sunset lock Road -Andover MA 01810 Address _ This Order is issued arid delivered as follows: Same as applicant if,imine of prooerty owner) Address Same as applicant ❑ by hand delivery to applicant or representaiive on _ Idats} o XFX by CeftlflCt. ri,ail, return receipt rer;ues:ed on //. -i� � % / � -. (his Y, eiecl. is located at Lot 12 . Sherwood Drive The property is recorded at the Registry ),o r cc ----- Cook . 3289 Page 096 Certiticate (it registered) April 5;.,,19-96 (�ade1 ,.. The Notice of Intent (or this. proie�et was -filed on The public.hearing was closed on June 5, 1996 (date) Findings The North Andover Conservation Commission has revie,.ved the above-(eler�-nced rloDce of Intent and plans and has held a public hearing on the project. Based on the rnlormot!on avallaole Ic the NACC at this time. the LLLC _ has determined llint the area on which the proposed work is to be done is significanl to the loiloviing interests in accoroance vith the Presumptions of Significa ce forth in the^re ulat!ons !or each Area Subject to Proted'!41i �!r'der 1i1e -178 Recreation Act (check as appropriate): Ch.178: � Prevention of Erosion & Sedimentation Ch. 1782 Wildlife Flood control ❑ Land containing shelllish. 0. Pubii.: water supply ® � [9 Private water supply Storm damage prevention Fisheries Prevention of ollution Protection of wildlile habitat Ground water supply � p Total Filing Fee Submitted $250.00 Stateosharr"' $112'.500 CityrTown Share 137.50 1 (1.1= lee in rxccss of 5331 Total Refund Due S City[Town Portion S State Portion S ,• P/7 total) Commonwealth of Massachusetts City/Town of Merrimac �System Pumping Record Form 4 OuL 20 2012 TOWN OF NORTH ANDOVER DEP'has provided this form for use by local Boards of Healt . P , 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. The -System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping.date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms 1 on the computer, use only the tab key to move your cursor -.do no. use the return key. . System Location: 1Ut S�'cc wood Address /� dJO • �% ✓tliC(J V� _ MA 01860 Cityrrown State Zip Code System Owner: Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: Date State Zip Code Telephone Number 2. Quantity Pumped: ❑ Cesspool(s) ( Septic Tank ❑ Tight Tank ❑ Other (describe): 4.. Effluent Tee Filter present? ❑ Yes K No 5. Condition of System: 6. System Pumped By: Name BORACZEK'S SEPTIC & DRAIN Company 7. Location where contents were disposed: 6�-vjie Signature of Hauler Signature of Receiving Facility IS -06 Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑. No Vehicle License Number Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of t L 4 1 L. .. - � I Type.: Emerpney 0 Routine Cesspc .�I: No � Yes Septic Tank; NO Yes L�-��"�U C�uantiry Pumped: /S?�d _gallons Date c : Pumping; ,00RAC �'�`5' Permit .. systei:. Pumped by (Company). Cont:,)ts disposed*at; Dace �r � Pumper SionoNre G��ryP Condition of ,syswm/mhcr cor menu; r f ` , .k. POW q • SYSTE i pt.iivi D' G RECORD commonwealth t -of, t1S 'a Se s /j/-%��e , MOSSOChtusetis JUW rd TO1PlIm"blo, /VN OF NORTH ANDOV Ft Faca ion L 4 1 L. .. - � I Type.: Emerpney 0 Routine Cesspc .�I: No � Yes Septic Tank; NO Yes L�-��"�U C�uantiry Pumped: /S?�d _gallons Date c : Pumping; ,00RAC �'�`5' Permit .. systei:. Pumped by (Company). Cont:,)ts disposed*at; Dace �r � Pumper SionoNre G��ryP Condition of ,syswm/mhcr cor menu; r f ` RM 4 - SYSTEi1 PUMPLNG RECORD Commonwealth of Massachusetts �/ %�-jt�(��U�'1'� Massachusetts yin Record .�'v.ctpnt TIZD. �' _ �yste :i weer (� D t S e�W c e� 6) DLJ � ry r�'�v J 1-/ oZ L1 m� System LOCauon l^44 5,: p --e c� ,' (vi')d 15-eOv� g'' ��QCP L � P 00 Rpe -1 ;4 P° Type: Emergency ❑ Routine ��'`"3 Cessp( )k No Yes Si ❑ tic Tam1 : Noy ❑ Yes ❑ p �%0 '� Quantity Pumped: Date c . Pumptne: �— B O R.ACZ EK'`S Permit -: Sestet:: Pumped by (Company): Conic Is transferred to: Cont:.tts disposed at: Date Pumper Signarure Condition of systern other comments: DE? A.PPAOVID FOR01 • I:I0719S FORM 4 - SYSTEM LNG,H RECA�V- -R— OF NOR i _, eo,,�Po OF HMTH Commonwealth of Massachusetts )DOU I? Massachusetts S stem in Record ystern �)ysje wne I I -U "I ocation �5 L) Tv p e Emergency 0 Routine 9---- — CesspcoL No ❑ Yes ❑ Septic Tard,: No ❑ Y e s (2-10 —0 Cq- Quantity Pumped:% 6-00 gallons Date c:' Pumping: Permit S%.slel:: Pumped by (ComPafly) Conte is transferred to: Cont,.it,s disposed at: Pumper Signature—I� , I Coric ;t'on of systerrijoLher comments: DE? APPROVED FOR -M • 1-/07195 Ev = rN W W cz i� C) A o a U 1n � U U GG z Pw PO A x z z, u \ '`� z w A m owl 2 Q o v w cn o o E G w 04 . U w m o G w W id o c� rL o G r� u. E c4 cn cn v U a H43 O �p O O ♦`a'c c AS•� 'moo ~� m 1:�: c CM E m H L CJ y 3 •. C '^ 7 O z � :93 CC c O 0 r m o U/) cm v/ C y Q �_ p,C= �� /� � al � 1®1 V Z O Cf ts CL C a � � m C •O CO3 ® Z C t ® r+ LL H O A C O` O . C.0 O O V� UL .n mLU CD L3 CD 0 -0 O R a cm � H Co � = $ 9%4— Zra tovi O l CO CD ® v co ® vi cm C c C °E w CD co CD co ca ® i CL cc ca °a. cm CD ca tj CD ems® CO) AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS �-/ LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC / TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM ✓ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX J' ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 10/31/00 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Dave Maynard at 101 (Lot 12) Sherwood Drive has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (>� constructed; ( ) repaired; by located at/.d / "�/a �' j O,& 4"'a 6 0i z`7f-, was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow ofqq-d gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: _ 7711!i4a Final inspection date: 71-2,V1,, 42 Installer Design 1 Engineer Representative Ehgineer Representative Date: le — K -Z70 Date: 4106 Z" INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Initi A. Bottom of Bed 1. Excavation to proper depth 2. With trenches, sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation, etc. Comments: B. Retaining Wall 1. Wall height and width as specifie 2. Waterproofed 3. Wall minimum 10' to leaching facility 4. Wall meets specifications of plan Comments: C. Building Sewer 1. Pipe diameter minimum 4" 1. Level 2. Schedule 40 pipe ✓`� �. 3. Watertighta joints 4. Manhole to grade 4. Inlet to tank cemented .� 5. Slope minimum 0.01 or 1/8" per foot minimum ✓ 6. Pipe properly set on compact firm base ✓ 7. Pipe laid on continuous grade in straight line 10. Air space 3" above tees 8. Cleanouts precede all change in alignment and grade 9. Manholes at any 90° change 13. Compact base with 6" of 3/4" crushed stone under tank 10. 10' minimum offset to water line Comments: 14. Tank is watertight Comments: D. Septic Tank 1. Level _ 2. 1,500 gal minimum 3. Gas baffle present on outlet 4. Manhole to grade 5. Manholes over center and each tee 6. 3-20" manholes ✓ 7. Inlet tee minimum 12" under invert 8. Outlet tee minimum 14" under invert (/ 9. Outlet line cemented 10. Air space 3" above tees 11. 2" - 3" drop from inlet to outlet 12. Pipe set 13. Compact base with 6" of 3/4" crushed stone under tank 14. Tank is watertight Comments: s E. Pump Chamber 1. If separate from tank, compabase with 6" of/e" stone 2. Minimum 2" pipe to d -box if vity system 3. 20" access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit 10. Alarm functions 11. Manual operating switch 12. Pump delivers liquid to d -box Comments: F. Distribution Box 1. D -box level 2. Minimum 0.1 T' (2") drop from inlet to outlet 3. Minimum 6" sump 4. Outlet pipes show equal distribution 5. Compact base with 6" of stone beneath box 6. Box is watertight 7. All lines cemented with hydraulic cement 8. Schedule 40 pipe Comments: G. Soil Absorption system 1. All stone double -washed -3/4 1 %i" 2. 3. 4. 5. 6. 7. - pea stone Yes NO Bucket test done? Minimum 27of pea stone above distribution lines Minimum 6" stone beneath pipe Distribution lines capped or connected together /v.,y,,,/ Grading meets 3:1 slope Minimum of 9" of fill graded over system Toe of slope stops minimum 5' from edge of property; if not, then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches f 2. Length of trenches agree with plan. (Max. length 100') f 3. Width of trenches agree with plan - Minimum 2'; maximum - 4'. 4. Vent present it)" feet or specified 5. Distance between trenches minimum 4' and maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6" per 100' 8. Depth of trenches below outlet invert minimum of 6". J as Yes NO 9. Pipes set on stable base. Comments: I. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6" per 100' 3. Separation between pipe 6' maximum 4. Pipes connected at end 5. Separation between adjacent fields 10' minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: I Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12" and 48" wide 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: K. Final Grade 1. Slope over soil absorption system minimum 0.02 2. All system components covered by at least 9" soil 3. Cover soil free of stones larger than 6" r/ r 4. Grading slopes away from dwelling 5. No areas over system that may pond -n V)� cn y +* rowti 0 m ;; CD B ter' o'"' o v S — cv N CDD 6 i m CD 3Lnoa o a v, S a o N o D � O O -+ O W p o ora o N = � D° X m m D a N Z c D Z Z a m LA CD r* o � 3 m N � O = D rn rn O m "V O o 3 r O z ° � m w APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PER1lMIIT DATE: 40 CL-RRENT LYSTALLER.'S LICENSE; %/�2 LOCATION: LICENSED D, a ST LLER: SIGNATURE: CHECK ONE: �e TELEPHONE; (4:�-// 5P2,�, -2�5-- NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. 575:00 Fee Attached? Administrative Use Only Yes i0 No II'I Foundation As -Built? Yes- No Floor Plans? Yes No Approval Date: - A3c 00 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at f i2/ /�2 _S&A,,111 relative to the application of D¢,, -e dated for plans by Y and dated 37,2 2� F& with revisions dated ,-a3-� I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to 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 two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against 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 BOF-); 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. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company 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 in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. 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. NAY,? 0 Undersigned Licensed Septic Installer Date: f CE �f�t i"��.*f}u��F`frni r��•�"7(�' rr. S A bk ei.-�A 152 14 •«,}� tan :,. R �'fAS.�� '1�1 '.�d`t 'p' ys�.� ...h � �w.r• � »�� ... �. f.. .YC gp- ZL tL .k�tT i � ( � .. PIM _ .L► �,ML ..,.}..... lb .k 1 ' ,j ir4':y : .,k � :s n. '. 4 „1�^t—�I•.. ! Y d.4,-� .. ., -. ., i �., •.� � �' sx. i �i: 4 �! - �. d -. ( {t -k c.+ 'r,J,,: a :n .• a a, a r, t ,3. �-. y _� '�x2� '.4 � 'rte '.. t , .. �, -{ -,� h * - ko, • {,� • F. .1' C _;� s. �� r w.`: y -. { �°�' >5 :µ ,ro, �€ til• F rte. '•.'r4 � � Y ?«e r�' -• ,,�'��": .a'st > '� Y"t�,�+' '.�0�` ' �' �' T {� 1 i,. w �Y: • •, n , ;.,, j° • :7B ':+Yi ` r •.:aY r.: r'..,,, . n i'., • :b '1-,., 4 :t ,:G'. �' 9x.,� ' Y �:,,' �C Z tiT. Yt cay,.l:, ('',cJ'•>ri is .. iA a. :t4�i' ,�. ..4i ,� }. _ .`y:, �. ,p a �� T- �"',i 1 •l�+ •C ..Q'.l} ff i> 1'{., � w:�•.y+• t. ..nE i.. . T c+5" :.ti,y{ !� �� ,a.„ �x y b s '1 '. '+. .;. ..�•1 c It �'. �. T: �.� r .,. ,� .. -pr �:�< r ! l"'r g:*� r.�+,r.{-,:c,+-•9•s.Y l� �'t �1 t� � '.. lizu UIx r s wv`- • il 00 5 -" 10 1—�► I F pot t ti -r- F 4-41 c_ __ 0 7 71 I IJ jo, Ah C:) U-4 14 X9% RACAL. W/ LALL-r P: L-4 T - m lei Town of North Andover, Massachusetts Form No. 2 f NORTI, BOARD OF HEALTH liY1,4}/ O'tt��o ,o1�O F w 9 ♦ o P' i 40 DESIGN APPROVAL FOR "OSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant- Test No, Site Location__ Reference Plans and Specs ENGI io All DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee U CHAIRMAN, BOARD OF HEALTH Site System Permit No. ?13 7 No . 1449 -- I2 FOR 111 - SOIL EVALUATOR FORA Page 1 of 3 Date: 4 ?J -p Commonwealth of Massachusetts WM;T4 AtVbv6z-; Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Date: Performed By: _................. _........._........ _ : "1J'p��` . � _............................. Witnessed By. 2 L 2t,on Addrus or Qwrcr's Ysrt+e. 1 �MgE,�..I,.J�� C31.-11�-'�-�S t►•1C,. I - Addrus. sM L0( , ' 5 u �.15�'f � 200 W b� Ip 'CXL \ J E Tdcphorc I LI � - -J1"_...,, �/ ,4t -'Dov u2, M A o � � ►o ewconstruction Repair ❑ 548 1 S"1�5 Office Review �--'/ Published Soil Survey Available: No ❑ Yes ll� ,`_ ``-��.. Publication Scale 1\ =. ?� Soil Map Unit . .\- J Year Published �.Ssi�tc.>`-t c�vC�t.E . ...................... D.alnage Class ta2� ��+.......... Soil Limitations Surficial Geologic Report Available: No VYes ❑ Year Published Publication Scale Geologic Material (Map Unit) ...... ........................... .............. -,............. ..................................................... .. - ......: ............................... ..^._. Landform ...................................................................................................... Flood Insurance Rate Map: �-,/ Above 500 year flood boundary -No LJ — Yes ❑ Within 500 year flood boundary No L�JYes ❑ - Within 100 year flood boundary No Yes ❑ i Wetland Area:. National Wetland Inventory Map (map unit) ................................................................................. Wetlands Conservancy Program Map (map unit) .................................................................... Current Water Resource Conditions (USGS): Month - Range :Above Normal []Normal ❑Belau Normal ❑ Other References Reviewed: DEP APPROVED FORM - 12/07195 FO RM I1 '- SOIL EVALUATOR DORM Page ' of 3 Location. Address or --Lot Ao. A On-site Review Deep Hole. Number 9.?J •'1 Date.: 5� n c, 3 Time:, .-. A,M i Weather �A 12- • • Location (identify on site plan) SSR.►-i�-tAe�-4 Land Use Slope (%} Surface Stones .. Vegetation Landform 'Say -i �-tP¢_^t d1SFbSa� S`YS't'� � S1 C�t.1 Position on landscape (sketch on the back)Pllr- Distances from: CL -C> . M , r.--' Open Water Body ICDCI{/-feet ' Drainage way OWC- feet Possible Wet Area feet' Property Line 40'� feet ('IgM 1--r-q L�O-T L1rsc Drinking Water Well 146t, feet ' Other DEEP OBSERVATION HOLE LOG' f ,Depth from Surface Ilnches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling ` Other (Structure;. Stones, Boulders, Consistency, % Gravel)' Wit'•„ -amu �•Cbf �g �1 Y�io 1��Sf�-�._• MINIMUM Ur' L nULCJ nCUUMCU Parent Material (geologic) ��wPr�-'lr} ` OepthtoBedrock: N�N� Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: �E Estimated Seasonal High Ground Water: N6 FORA 11 - SOIL LVALUATOR FORM Pabe 3 of 3 Location Address or Lot No. Determination for Seasonal High ' Water" Table i Method Used: ❑ Depth observed standing in observation hole. ........ .. .... inches. ❑ Depth weeping from side of observation hole ....... inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet Index Well Number ................. Reading Date Index well level ..... Adjustment factor .................. Adjusted ground water level ....... ........................... ......... Deoth of .Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in• jaII areas observed .throughout the area proposed for. -the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/94 (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. 96 Date 5 Signature Y 1 / / DEP APPROVED FORM - 12/07/95 03-21-1996 14:36 617 932 7615 DEP NORTHEAST REGIONAL P.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. 12.— 51-11F�2u�(5c��p1 COMMONWEALTH .OF MASSACHUSETTS i' N61g:T�k PcNV0\Jf L— , Massachusetts Percolation Test' Date: Time: Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. r = Site Passed `j Site Failed ❑ ....... . Performed By: Witnessed By:'\• Comments: DEP AYMOvm TORM • t2/07/11 FOR-N,I 11 - SOIL EVALUATOR FOR.%[ Page 1 of 3 YZ Date: 4 Z(o I'—'CP Commonwealth of dlassachusetts t�1dCC.'t� Au Massachusetts Soil Suitability Assessment for On-site Sewage Dis oral Dace: fit- Performed By: ........... ... ... �N aTA. ......................... . Witnessed By. ................. . L=uan Addtus or 12- "'2f' 4S&WMp GYL JE aw cnnstruc-ionC ReQair ow�r� �.�MaE��>sfl ��c�es i►�c.. Adam:. ,aa ii ,� sl U Q , Tekpfwne � I—IV S�'T iLC�- 2ora•� ,4�1Co�1E�L; t A4 i SaR� 4��— 815 Office�w Published Soil Survey ,available: No L! Yes << .. Publication scale , ` . 13 Soil tifap Unit Pucat Year Published E�S�rv�,�ve3r-E (ko�.. Drainage Class p2A tN.......... Soil Limitations ........................................ ............... Surficial Geologic Report Available: No 19 Yes Year Published Publication Scale ..................... Geologic Material (Map Unit)................................................................ . Landform........................................................................................ ......................................... Flood. Insurance Rate Map: Above 500 year flood boundary No `, Yes ❑ Within 500 year flood boundary No QYes ❑ : 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 (JSGS): Mont Range :Above Normal ❑Normal ❑ Bela• Normal ❑ Other References Reviewed: iipgp APPROVED FOPuM - 11/07195 FOR.Ni 11 -SOIL EVALUATOR FORN1 Pacyc 2 of 3 Location ,address or Lot ;Jo. On-site .Review Deep Hole Number Date:..4A1a�5)5 Time: Pt�A Weather r-P�-I2- Location (identify on site plan) S ��.:` !J�'t�2`f o)s. �L s.� ..tom t�ES.%C., Land Use Siope M) Surface Stones Vegetation lnS�o,r�tsp C "P"Z,r,U_'ar3V_-' a.,�S to St-y�2v8s� Landform SY�dL_ Position on landscape (sketch on the back)'a< SA._,�-ta,rL.� pi•sPdsp� s--�S-rt�wl Lis\srJ Distances from: Open Water Body \Z5 feet Drainage way NdtsC feet Possible Wet Area lZrs+/ feet Property Line 35 -y- feet (` zOM �-F'f Lir tilN40 Drinking Water Well tJbNy--- feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Tex ure Soil Calor Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) C.ntt ?Ati — LvA" G \a�t�c�t19- �o �tP•-c►F,c-� �r�..�,t�s t l_.00SE �,t—� � Z.t �.. S � �– z•5Y 5 i . MPFsStvE 'FVZIF:re&A mrrvimum u c nuccZ nC"'.)- cv Parent Material (geologic) CuTtr`-)F�i� Depthtol3edrock: NU G Deoth to Groundwater: Standing Water in the Hole: N��Weeping from Pit Face: god' Estimated Seasonal High Ground Water: DEF APPROVED FORM - 12/07/95 N FOR1.1 11 - SOIL LVALUATOR FORS I Page 3 of 3 Location .address or Lot No. 1 Z — �Jar�2W�oC� t>e—WE Determination for Seasonal High Water Table Method Used: tvD C,uw�--cam 1ovt-x�) ❑ Depth observed standing in observation hole ...... inches ❑ Depth weeping from side of observation hole ..... inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet Index Well Number ............... Readina Date Index well level _. . Adjustment factor ................ Adjusted ground water level _.._.. .... ........ Depth of Naturaliv Occurrina 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? If not, what is the dept} of naturally occurring pervious material? Certification I certify that on r 11/94 (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. i. Signature Date 5/1/96 hiDEP APPROVED FORM . 32/07195 �3 c -1996 i4:36 617 932 7615 CEP NORTHEAST REGICNLaL P.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH .OF MASSACHUSETTS i N6ve:.f>4 ANPoub2— , Massachusetts Percolation Test' Date: 8 , S t�j Time: Observation Kole Depth of Perc N T 6<, Start Pre-soak Vz End Pre-soak I Time at 12" ` Time at 9" ` Time at 6" Time Rate Min./Inch ' Minimum of 1 percolation test must be performed in beth the primary area AND reserve ar Site Passed Site Failed ❑ Performed By: Witnessed By Comments: DV AFMOvm FORM - ulvtn! FOR -NI 11 - SOIL EVALUATOR FOR.N,1 Page I of 3 No. 144 — 12 Date: 4-\v, V��Cp Commonwealth of Massachusetts m'ssachusetts Sewage Disposal Suitability or On-site Performed By: 1-2 < - f S � J. Date: Witnessed By: .. ..... ................................ .. . Lm2uan Address Of L -N I 12- - P\A/ rnnstrucrion Address. -A Tcicvrorc I 1 .4-t s - 81 � 9 office Review Published Soil Survey Available: No 0 Yes Soil Mao Unit ..... . ........ Year Published Pubiica ion Scale e�q. ....... - - - - . . ......... .... Drainage Class ......... Soil Limitations ............................. Surcial Geologic Report Available: No V fiyes ❑ Year Published Publication Scale ............ -Geologic Material (Mao Unit) .......................................................................................................... I ........................................................................................... ...................................... . ... .......... .... L�'ndforrri ............... Flood Insurance Rate Map: Above 500 yearkflood boundary No PYes Within 500 year flood boundary No g<es ❑ Within 100 year flood boundary No WetlandArea: unit) ............................... ........................................................... . ......... . . ..... National Wetland Inventory Map (map .......................... Wetlands Conservancy Program Map (map unit) .................. ............................................. Current Water Resource Conditions (USGS): Month Range :A - bove Normal []Normal F-1 Belc,-,/ Normal Other References Reviewed: DEF APPROVED FOFLM - 12107195 FOR.N1 11 -SOIL EVALUATOR FORM P f Pace ., v 3 Location Address or Lot ;vo. On-site Review Deep Hole Number Date:.. Time: Weather rrA�2-- Location (identify on site plan) ��F�_, SA+-��'T-e p1Si5L� 5�45'TE p�s1C�tJ Land Use Slope (%) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: CLoe-0S V..1 Open Water Body Drainage way t.4C*,SG feet Possible Wet Area jo50+/—feet Property Line lzjio+/—feet Drinking Water Well N6t S feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) I (Munsell) I Mottling (Structure, Stones, Boulders, Consistency, % Gravel) IVIIIVIIvIVIvI yr G nVLc.� 1L.11v„L,! �, ��,.,•' "..' ......v v.... ....^..^••.." ��, `` Parent Material (geologic) C=*JTt'..j DepthtoBedrock: ,y Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM - 1:107195 I FOR 111 - SOIL LVALUATOR FORINJ Page 3 of 3 Location address or Lot No. -1Z - '54f -s? -y -3o40 C>e-WE Determination for Seasonal High Water Table Method Used: (Wb ❑ Depth observed standing in observation hole........... inches U Depth weeping from'side of observation hcle .. inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet ` Index Well Number ...... ....... Reading Date _.. Index well level . Adjustment factor ........ 'Adjusted ground water level .... ... ... ... .... Deoth of Naturallv Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in II areas observed throughout the area proposed for the soil absorption system? �E� If not, what is the depth of naturally occurring pervious material? Certification I certify that on _ _11/94 (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. Signature Date 5/1/96 kiDEP APPROVED FOP -M . 12/07/95 03-c'-1996 14:35 517 932 7615 DEP NORTHEAST REGIC%aL P.D2 FORM 12 - PERCOLATION TEST Location Address or Lot No. 1�, 5 t,2 WC`1J�01 COMMONWEALTH .OF MASSACHUSETTS i wovg:-V}4 P<No0vE'wL , Massachusetts Percolation Test' Date: 1 g 1� �j Time: Observation Hole Depth of Perc I 1 Start Pre-soak 1\3 b'� � — End Pre-soak I Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./inch U 2 • Minimum of 1 percolation test must be performed in both the primary area AND reserve ar . Site Passed Site Failed ❑ .......... __............................ ........-................. .................... -.............. Performed By: Witnessed By:' Comments: _.. ntr X1710y= roam - U1 7M Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 April 17, 1996 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lots 3,4,5,7,14,15,16,12,&19 Sherwood Drive The above named lots at Sherwood Drive have been incompletely submitted. The submission of new designs after January 1, 1996 requires the inclusion of soil evaluation forms. Until these forms have been received, the above mentioned plans will not be considered submitted. Should you have any questions, please call me at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 + 'PLAN REVIEW CHECKLIST ADDRESS �/� �Js`E,eGc�Q(� ENGINEERED GENERAL 3 COPIES STAMP 1/ LOCUS V—'� NORTH ARROWy S'C'ALEy CONTOURS k-/ PROFILE l/ SECTION BENCHMARK 1/ SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?DRIVEWAY ✓ (Elev) WATER LINE / FDN DRAIN _AL.> SCH40 TESTS CURRENT? SOIL EVAL �U2Sd SEPTIC TANK MIN 150OG ✓/ .17 INVERT DROP 25' TO CELLAR MANHOLE ELE D -BOX SIZE # LINES INLET OUTLET 13 709 = 2� GARB. GRINDER /V 6 (+200% EDF) GW # COMPS. FIRST 2' LEVEL STATEMENT (2" OR .17 FT) TEE REQ' D? /yb LEACHING MIN 660 GPD? RESERVE AREA6-----4' FROM PRIMARY? L--' 2% SLOPE 100' TO WETLANDS L- 100' TO WELLS z-"" 4! TO S.H.GWt� '>2MfI 35' TO FND.& INTRCPTR DRAINS 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY (-� MIN 12" COVER FILL? (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd /X"/ SLOPE (min .005 or 6"/1001) L---SIDEWALL DIST. 3X EFF. W OR D (MIN 6') L -------RESERVE BETWEEN TRENCHES? &---- IN FILL? MUST BE 10' MIN.---' 4" PEA STONE? (,-- VENT? (>3' COVER; LINES >50') BOT 6 + S I D E �00 X LDNG = TOT -0 ,--/ G (L x W x #) (DxLx2x#) (G/ft,2) Copyright O 1995 by S.L. Starr