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Miscellaneous - 106 ROCKY BROOK ROAD 4/30/2018 (2)
106 ROCKY BROOK ROAD oad = ' 210/090.A 0054'0000.0 e ' L I C 4 J s i4,r, -tip W r s(/1-✓a•Yt. s Y I"S ` 1•: � ..'. ' E -f7MFiy'� ��.r"� , g ��� 4 �,z,...r. • �+ y '• •t:f 4 , t f rr ��� . v i ),rt.ir{e �>'j �' K � �; ��-�`�`�R, �yJt�., . s` ' t} d-'3.,�':F "yiJ ".��y". 1p# +Y.. }x,x•r .• y-'�' !Y , ;�i, .r r:.• MAP # � ,� + , ;• LOT. # � , PARCEL # STREET .QNSTRUC.TION_APPROV..._ HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE APP. BY DESIGNER: ��f� PLAN Dam. CONDITIONS W ER SUPPLY: TOWN WELL WELL PERM DRILLER WELL TESTS: CHEMICAL DAZE APPROVED B TERIA I DALE f1PNRUVEU BACTERI I DATE APPROVED COMMENTS.- FORM OMMENTS:FORM U APPROVAL: APPROVAL 1'0 ISSUE YES NU DATE ISSUED CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NU FINAL BOARD OF HEALTH APPROVAL: DATE:� � �- BY: t'x IS"THE INSTALLER LICENSED? YES NO zr TYPE OF CONSTRUCTION. REPAIR 1 ANEW CONSTRUCTION: ,`.,�. CERTIFIED PLOT .PLAN ~REVIEW_ � sCONDITIONS OF:.APPROVAL YES NO . (FROM .FORM U) '1.• .' � i� •.�:'';•_L:• �,`1 :' .- ....1' 1. '. ' ISSUANCE OF DWC PERMIT YES NO "DWC PERMIT N0. y � INSTALLER: �sTB� f :BEGIN INSPECTION YES -NO: �:z• ':EXCAVATION . INSPECTION: NEEDED: t •Y• •\rte it _, .. •-• _ ._ •:.- r SASSED BY 'cCONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTflRY� • YES: • - r APPROVAL TO BACKFILL: DATE: BY— .:FINAL . GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY North Andover Board of Assessors Public Access Page 1 of 1 „oRT„ rth Andover Board of Assessors roperty Record Card Parcel ID :210/090.A-0054-0000.0 FY:2012 Community: North Andover Click on Sketch to Enlarge Click on Photo to Enlarge ppp� 106 ROCKY BROOK ROAD Location: 106 ROCKY BROOK ROAD Owner Name: WAISNOR,ANNE M JON D WAISNOR Owner Address: '106 ROCKY BROOK ROAD . City NORTH ANDOVER State: MA Zip, 01845 8-8 Land Area: 1.22 acres � Use Code ° --_�.�, _.._. #' Nei boyhood:`101-SNCL-FAM-RES-'Total Finished Area: X2752 sgft PIIEVIOUS 1 All Total_Val-ue: 612,300_ _ j_ 623,300 Building Value: 380,600 391,600 Land Value: 231,700 231,700 Market Land Value: 231,700' Chapter Land Value x LATEST SALE Sale Price: 383,350 _ ,Sale Date '11/01/1996 Arms Length Sale Code: Y-YES-VALID Grantor: OGUNQUIT HOMES Cert Doc: _ .t .'Book 194625 `;Page: 0140 I http://csc-ma.us/PROPAPP/display.do?linkld=1893220&town. NandoverPubAcc 3/22/2012 _C\ Commonwealth of Massachusetts City T®wn of North Andover sly-stem Pumping Record Foam 4 1 wy DEP has provibed 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.The System Pumping Record mustbe 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. RECEIVED A. Facility information u q important.When JUN 15 �O ,fillingout forms 1. System Location: / VER ` ��,L N F NOF H ANDD on the computer, use only the tab LJ� HEALTH QEPA�TME key to move your Address 01886 cursor-do not Ma i North Andover State zip Code use the return C�/Town key. 2. System Owner: Name r rmcn Address(if different from location) State Zip Code Cityrown -- - -- - --+- Telephone Number i I B. Pumping Record 2. Quantity Pumped: Gallons 1. Date of Pumping Date L 3. Type of system: ❑ Cesspool(s) Tight Septic Tank ❑ Tank E] Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No .If.yes,was it cleaded? E] Yes ❑ No 5. Condition of System: 1 6y stem Pu ped By: Vehicle License Number e Stew ervice any 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date System Pumping Record-Page t5form4.doa 03/06 a Commonwealth of Massachusetts' FF,CEIVED _City/Town of No And®ver System Pumping Record �' � 4! Form 4 _ l e t l�l.itr' , d",ee7:t I H.ANDOalE aTtr,HEENRTT 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. The Systempumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 3.10 CMR 15.351. A. Facility Information Important:When filling out forms .1. System Location: on the computer, / use only the tab key to move your Address earsor-do not r N0 Andover 4 ' Y :use.the�eturri _ ._ _ w. Ma�..>:. t•., - key. City/Town State Zip Code 2. System Owner: Name J/ J iraon Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1.. Date of Pumping Date 2. Quantity Pumped: Gallons 1 3. Type of system: ❑ Cesspool(s) O'Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes El No 5. Condition of System: 6. -System Pumped By: W0 1. Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of H Date Signatur eceiving Facility Date t5form4.doc-03/06 System Pumping Record-Page 1 of 1 4 ,. LTMENT SD � Commonwealth of Massachusetts013City/Town of No Andover ANDOVER System Pumping Record Form 4 ' �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. 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. System Location: on the computer, use only the tab 106 Rocky Brook Rd key to move your Address cursor-do not No Andover Ma use the return key. City/Town State Zip Code 2. System Owner: Name ienen ' Address(if different from location) City[Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingD'te 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Vf -E] ElSeptic Tank - Tight Tank Grease Trap r ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes/No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Systerry 6. System P mped By: 7_ Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford; Ma 01835 Si nature of Ha Date .ure of R Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 ,y 4 -' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is. No.Andover Ma 01845 3/9/2012 required for _ every page. City/Town State 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. i Important: When filling out A. General Information forms on the computer,use 1. Inspector: RECEIVED only the tab key to move your John DiVincenzo MAR 191 cursor-do not Name of Inspector .012 use the return key. Stewart Septic Service TOWN OF NORTH ANDOVER a Company Name HEALTH DEPARTMENT r� 58 South Kimball Company Address Bradford Ma 01835 'e10° City/Town State Zip Code 978-372-7471 S113386 Telephone Number License Number B. Certification 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 time 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 approded system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/13/2012 I pector's SignatureDate The system inspector shall su mit 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 system 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. t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 t t l 4 r-..► Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments —,•'V 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover a Ma 01845 / 3 9/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Replaced d-box. 13) 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. please p ( ) the following statements. If"not Check the box for"yes", no" or not determined' Y, N, ND for determined," ex lain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass in 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): t5ins-11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i • 5� °� Commonwealth of Massachusetts Map-Block-Lot �• 090.A0054 ----------------------- BOARD OF HEALTH Permit No North BHP-2012-0538 Andover ------------------- ---- FEE $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John DiVincenzo__________ __________________ to(Repair-DISTRIBUTION BOX)an Individual Sewage Disposal System. at No 106 ROCKY BROOK ROAD as shown on the application for Disposal Works Construction Permit No. BB 12-053, r 0 ----------------------------------------------------------------- Issued On- Mar-09-2012 BOARD OF HEALTH •1 S�q�GED7�6' . • North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION S. ADDRESS: �,,/�!v/ 0 /'��j` • MAP INSTALLER. DESIGNER: • ;IIAMIlzo O PLAN DATE. BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed loading ❑ Monolithic tank construction ❑ Watertightness of tank has been achieved by testing ❑ Inlet tee installed, centered under access port t ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet &outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port . ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure Line ❑ cover at final grade installed over pump access port ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX V❑ Installed on stable stone base L H-20 D-Box [Q' Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Comments: L � � T a Map-Block-Lot . s D' Commonwealth of Massachusetts oso.AooSa BOARD OF HEALTH - • •• Permit No North Andover BHP-2012-0538 ------------ -- -- P.I. FEE F.I. $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John DiVincenZo to(Repair-DISTRIBUTION BOX)an Individual Sewage Disposal System. at No --106 ROCKY BROO- K ROAD ------=---------------------- ------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2012-053 Dated March 09,2012 ------ - � - oP__Y_ Issued On:Mar=09-2012 BOARD OF HEALTH ------------------------------------------------------------ • wK�r °� Commonwealth of Massachusetts Map-Block-Lot s= �. 090.A0054 BOARD OF HEALTH ----------------------- North -- -----------------North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-DISTRIBUTION BOX) by -John DiVincenzo Installer at No 106 ROCKY BROOK ROAD has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2012-053 Dated March 09,2012 — — ----------------------- ----- ------------------------------------------- ------------- Printed -----------On:--- -Mar-09-2012--- --------------- --- ----- ------ ----- --------�-- � BOARD OF HEALTH 6029�pORT�. _ � Ott, -� • ... j O — w Town of North Andover �'• .. HEALTH DEPARTMENT ,SSgcNO5tt CHECK#: l/J 5 DATE: LOCATION: AD, 14DD H/O NAME: / CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ IP/Septic Dis W� � � ' , posal orTcs Construcfton( W ) $ ❑ Septic Disposal Works Instdtlers( $ ❑� Tit e 5Inspector $ Lei' Title 5,Report ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer A N ' ,,. gORrip Application for Septic Disposal System . 3�°�,r •_`•:" °t '' T AY' ATE Construction Permit - TOWN OF ORTH ANDOVER, MA 01845 $250.00—Full Repair eaus $125.0 m0�7T Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system*� X/) forms on the computer,use ❑ R air or replace an existing on-site sewage disposal system* only the tab key to move your epair or replace an existing system component—What? nt�j _ cursor-do not use the return key. A. Facility Inform ion � � Al i6 c ®� VAI Address or Lot# TN City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑Gravity(choose one) ***If pump system,attach copy of electrical permit to application*** CEJ Conventional System (pipe and stone system) j ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name Address(if different from above) City/Town State Zip Code Telephone Number i 3. Installer Information 6 A v L_ fl I Name Name of Company I Z/6 / Addres City/Town State Zip Code Telephone Number(Cell Phone#if possible please) n - \A a. Designer Information Name Name of Company Address Cityrrown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 i Application for Septic Disposal System Construction Permit — TOWN OF TODAY'S DATE � a $250.00-Full Repair ai S*���e� ORTH ANDOVER, MA 01845 $12s.00-Component �CHugt PAGE 2 OF 2 A. Facility Information continued.... S. Type of Building: dResidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of No Jdo and t to p m in operation until a Certificate of Compliance has be ued this and f Health. 1 vZ 2, N e Date A I�ati App e B 'Boajbf Health Reprentative) zi4 U� U Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes " No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S41 sv tem? If so,Attach copy ofElectrical Permit Yes_ No , 4. Foundation As-Bur'lt?(hew construction ronly): Yes_ No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 i SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: Ze (Address of septic system For plans by `� ^ (Engineer) Relative to the application of c_�u M./ 16)10 A C e)\20 (Installer's name) And dated i rigina ate Dated 9 o ay s ate With revisions dated (Last revised date) 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 manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting a�Pection without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally,this is the first (1'� inspection unless there is a retaining wall,which ' should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK(or e-mail to: healthdept&townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by 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 allpersons 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. f Inspection o Insp the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box, p pes, 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 Q12roved plans. No instructions by the homeowner,general contractor,,or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 's Date ipl Z_ zi�li 40,I&A2e P—A 2ri ame—Print) ame—Signed) Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 _ every page. City/Town State 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. - Important: A. General Information w. .� When filling out forms on the computer, use 1. Inspector: { only the tab key to move your John DiVincenzo - cursor-do not Name of Inspector 1 `e use the return HEA TH DEPARTMENT key. Stewart Septic Service - Company Name 58 South Kimball Company Address Bradford Ma 1 01835 ewn City/Town State Zip Code 978-372-7471 / S113386 Telephone Number �� License Number B. Certification 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 time 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 ® Conditionally Passes ❑ Fails rrther Eval tion by the Local Approving Authority In pectors Signature Date he 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 system 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. t5ins•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 17 i. 41 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd — Property Address Anne & John Waisnor — owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always completelall of Section D I 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: I 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. I The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) 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): i I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I i i Commonwealth of Massachusetts Title 5 Official Inspection Form _ s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is No.Andover Ma 01845 3/9/2012 required for every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) 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): Dist Box needs replacing coroded around outlet lines ❑ 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is No.Andover Ma 01845 3/9/2012 required for -- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) i 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. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: I ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia 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 '/z day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne& John Waisnor Owner Owner's Name information is Ma 01845 3/9/2012 No.Andover required for — every page. City/Town State Zip Code Date of Inspection 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. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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 from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303 , therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. I 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 fo 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 tinder 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. t5ins•11110 Title 5 Official InspectioniForm:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form — o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is No.Andover Ma 01845 .I 3/9/2012 required for every page. City/Town State Zip Code Date of Inspection C. Checklist 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 ❑ ® 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. Determined in the field (if any of the failure criteria related to Part C is at issue ® El approximation of distance is unacceptable;) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd _ Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): 76 gpd 9 ( Y 9 Detail Water meter readings Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): -- - Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft.,etc.): — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 YCommonwealth of Massachusetts Title 5 Official Inspection Form a _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is No.Andover Ma 01845 3/9/2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I General Information Pumping Records: Source of information: Andover Septic Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 Gal gallons 1 How was quantity pumped determined? Site guage on truck _ Reason for pumping: inspect tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single.cesspool ❑ Overflow cesspool ❑ Privy ❑ 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(describe): 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c M 106 Rocky Brook Rd Property Address Anne &John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): ' Depth below grade: 36"feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: B.T.G 20" i feet ;Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" 1.. Scum thickness Distance from top of scum to top of outlet tee or baffle 6.5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure, sluge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc:): Inlet&Outlet good condition, no leakage, no structual damage: 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 scumto top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins:11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts _ W Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne& John Waisnor Owner Owner's Name information is No.Andover Ma 01845 3/9/2012 required for every page. City/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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Capacity: gallons Design Flow: gallons per day, Alarm present: ❑ Yes ❑ No I Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd _ Property Address Anne & John Waisnor _ Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 -- every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): D-Box concrete broken around 4" outlet lines box needs replacing I 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor ? Owner Owner's Name information is No.Andover Ma 01845 3/9/2012 required for _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-4' x 92' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No hydraulic failure, no damp soils, no ponding j Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration j 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 F1 Yes El No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title .5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. City/Town State Zip Code Date of Inspection 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.): t5ins•11/10 Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i r � w " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. City/Town State Zip Code Date of Inspection D. '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 Y I C t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts _ Title .5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne & John Waisnor Owner Owner's Name information is No.Andover Ma 01845 3/9/2012. required for — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: fe +. feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Sept 18, 1996 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Checked file ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plans drawn by Thomas Neve Assoc. Sept 18 1996 As built; i I Before filing this Inspection Report, please see Report Completeness Checklist on next page. I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I i Commonwealth of Massachusetts _ _ W Title 5 official Inspection Form -- — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Rocky Brook Rd Property Address Anne &John Waisnor Owner . Owner's Name information is required for No.Andover Ma 01845 3/9/2012 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ®System Information – Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i I i i I i i i (Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I j j ® 3AF, Schedule of Tie DA �! - 7..�;P E, gar������ s, ; �S F 11`5c nt :� ,, r+� ► AB 52,990 S.F.+I- 1.22 A cres31 D = .3' A G — Leo t4A A - �� R CD = 44.4 CG = Vent _ ..,._ 1 i Leach Trench System CE = 52.9' CH = Two trenches, 92' Long, 4' Wide, 12" Deep AF = 39.7' Al = TP47 CF = 63.2Cl = . \ 9s HYD \\ TP48 Sta 14+52 \\ H Septic i E Tank C C)o mss, B - —Box �d\ c �a0 s�� Top Of Foundation Elevn- \ �\ 5TUBH2Q .. Lot 2A `N ore P�`J µ z A Plan 0 f L on d ,'ule of Tie Distances r = 16.2' In Nor th A�do ver, Moss. sho wing 44.44 CG132.2' 31. AG = 128.6' y Disposal As—Built Sanitar Dis System ' = ' = Lot 3A — Rocky Brook Road = 37.0' AH = 37.2' Prepared For = 52.9' CH = 48.8' 09unqult Homes, Inc. = 39.7' Al = 126.8 Scale: 1 " = 40' Date: September 18, 1996 ' = 63.2 Cl = 125.0 P Schedule of Inverts i Invert @ Foundation 133.96' Septic Tank In = 133.38' HYD Septic Tank Out = 133.30' sto 14+52 D—Box In = 133.00' D—Box Out = 132.83' C Invert @ System In = 132.78' Invert @ System End = 132.27' This plan has been prepared for the purpose of showing the "As—Built" conditions of the sanitary disposal system installed on the premises. All work was done within the construction limitations expected for a Job F� ® of this type. 9T I OF G P1EV ^ •JO 1 J pie Design P.E. Thomas E. Neve Associates, Inc. 447 Old Boston Road — U.S Route 1 Engineers — Surveyors — Land Use Planners Topsfield, Massachusetts 01983 (887-8586 Job No. 550-3A i APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# j LOCATION: Cl),( o c � Zook LICENSED INSTALLER: Ee zr-C e,-L" SIGNATURE: 1" ��1�v�--�� TELEPHONE# � `d '7 - CHECK 7 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation_ As-Built? Yes No Approval Date: ps Town of North Andover, Massachusetts F°'"'No.s BOARD OF HEALTH HORTM 19 O 9 4ys DISPOSAL WORKS CONSTRUCTION PERMIT E e. S CHUS .. - APp licant - NAME ADDRESS TELEPHONE PFiON E S°ite Location l�J rr1 ( 9-c�1P 1 Permission is hereby granted to Construct (t(or Repair ( ) an.lndividual Soil Absorption Sewage Disposal System as shown on the Design.Approval S.S. No. CHAIRMAN, BOARD OF HEALTH . .j - Fee �> D.W.C. No. 3 4 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH - Nov. 7 , 19 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X) or repaired ( ) by Peter Breen INSTALLER at 106 Rocky Brook Road, North Andover, MA SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 848 dated June 20 , 19 96 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH Town of North Andover, Massachusetts Form No.2 NoRTq BOARD OF HEALTH _ a?• ' 19 o A ♦i "'•b�� DESIGN APPROVAL FOR ss"C""SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Ctl nr�- -�__, 1✓Yut-rte Test No. Site Location ( ,OT P-4!-)Ce Reference Plans and Specs. ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. L6J/ L CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 60 , Lot �?� Schedule of Tie Distances Plan O f L am d cJ F NO RT HF; j_ovErr ��:�RD OF H���TH AB = 16.2' 52,9 90 S.F.+/- North Andover, Mass. 1.22 Acres f/— SEP , 8 1996 Lot 4A AD = 31.3' AG showing CD = 44.4' CG 132.2'= 128.6' " s "'As—Built Sanitary y-tar Disposal S stem " = L o t 3A — Rocky Brook Ro ad vent y AE = 37.0' AH — 37.2' Prepared For l Leach Trench S stem CE .= 52.9' CH = 48.8' C Two trenches, 92' Long, 4' Wide, 12" Deep Ogun q u t Homes, Inc. AF = 39.7' Al = 126.8' ,-P47 CF = 63.2' Cl 125.0' Scale: I " = 40' Date: September 18, 1996 � = Schedule of In ver is Invert @ Foundation = 133.96' Sep tic Tank In = 133.38' Hyo Septic Tank Out = 133.30' TP48 Eta 14+52 D—Box In = 133.00' H septic D—Box Ou t = 132.83' E D Tank C In ver t @ System In = 132.78' F OK\ ,'' Invert @ System End = 132.27' G � 0 This plan has been prepared for the purpose D—Box B ���d��\ 9A of showing the "As—Built" conditions of the A y�5 �(� S�@Qo i sanitary disposal system installed on the premises. All work was done within the To Of Foundation 35 `�r construction limitations expected for a job Fop o F of this type. Elev = 135.69' 4,�yrc� �\ STUBH2O 8 9f Lot 2A J Q�e Design P.E. Thomas E. Neve Associates, Inc. 447 0/d Boston Road — U.S. Route 1 Engineers — Surveyors — Land Use Planners Topsfield, Massachusetts 01983 (887-8586) Job No. 550-3A PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Cern icate o Com � fiance' As of Warch 19, 2012 This is to cert that a SATIS FACTO IST IMT ECTION Was completed for the: emplacement of a l istrihution Box For an On Site Wastewater pisposaf stem By ,john DiVinceno at: 106 &cb Brook Parcel ID :210/090.A-0054-0000.0 North Andover, gKx 01845 The Issuance of this certificate shall not be construed as a guarantee that the On Site Sewage DisposalSystem will function satisfactorily. S an . Sau ye Pu6C .Meath Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Certificate o f CompCiance As of Warch 19, 2012 This is to cert that a SATIS FAC ORT INSTECIT O5V Was completed for the: emplacement of a Distd6ution Box Tor an On Site Wastmater DisposarS B : fin Diyinceno at: 106 &cb Brook,ftad Parcel ID :210/090.A-0054-0000.0 5 orth,Andover, WA 0184.E The Issuance of this certificate shafnot be construed as a guarantee that the On Site Sewage DisposafSystem wifffunction satisfactorify. S: an . Sawye RkEX . Pu6r' Ifeafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Certz zcate of Co' mphdnce As of Warch 19, 2012 This is to cert that a SATISFACTORTIXSPECTION Was completed for the. ftP&cement o f a Distri6ution Box For an On Site Wastewater OisposafSystem �y� Johan DiVinceno at: 106,&cb Broo , Parcel ID :210/090.A-0054-0000.0 5 orthAndover, 91(9 01845 The Issuance of this certificate shaff not be construed as a guarantee that the On Site Sewage DisposafSystem wifffunction satisfactorily. S- an . Sawye WWS1 Tu6 U Ifeafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division Certificate of Com�Ciance As of Warch 19, 2012 This is to cert that a SA`IIS AC ORT INS PECT109V Was compfi*d for the: ft&cement of a Distd6ution Box For an On Site Wastewater gYyosaf stem By., Sohn DiVinceno at: 106 RQcb Brook Parcel ID :210/090.A-0054-0000.0 North Andover, WA 01845 The Issuance of this certificate shaCnot be construed•as a guarantee that the On Site Sewage (Disposa(System wifffunction satisfactorily. j S- an . Sawye (Pu61' VeaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i Driving Directions from 1600 Osgood St, North Andover, Mass... Page 1 of 2 ria nest' m : Blu . Trip to: Snaw- IK R 106 Rocky Brook Rd North Andover, MA 01845-1463 r 7.06 miles/ 16 minutes Notes a E4` _. - -� of equ or lesser value c Prescriolleglasses , I Starting a4 Ims-N,P -.95. ,, , 1600 Osgood St, North Andover, MA 01845-1048 1. Start out going south on Osgood St/RT-125 toward Orchard Hill Rd.Map 1.1 Mi 1.1 Mi Total 2.Turn left onto Great Pond Rd I RT-133. Continue to follow RT-133. Map 2.8 Mi 3 RT-133 is 0.1 miles past Commerce Way 4.0 Mi Total Casa Blanca Mexican is on the right If you are on Osgood St and reach Sutton St you've gone about 0.2 miles'too far ro 3.Turn right onto Main St. Map 2.4 Mi Main St is 0.3 miles past Essex St 6.4 Mi Total If you reach Tyler Rd you've gone about 0.2 miles too far 4.Turn right onto Foster St. Map 0.2 Mi If you reach Bennett Rd you've gone about 0.3 miles too far 6.7 Mi Total 5.Take the 1 st left onto Tanglewood Ln. Map 0.2 Mi If you reach Wintergreen Dr you've gone about 0.1 miles too far 6.8 Mi Total 6.Take the 1st left onto Rocky Brook Rd.Map 0.2 Mi If you reach Wintergreen Dr you've gone a little too far 7.1 Mi Total ® 7. 106 ROCKY BROOK RD is on the left. Mia If you reach Ogunquit Rd you've gone a little too far 106 Rocky Brook Rd, North Andover, MA 01845-1463 http://` www.mapquest.com/print?a--app.core.c9f3f42102d45c6d2... 3/14/2012 Driving Directions from 1600 Osgood St, North Andover, Mass... Page 2 of 2 Total Travel Estimate: 7.06 miles -about 16 minutes 4 4 �9 �rqi�bF,r+-.�^',� 17-V e� �` *�'"• �G I J 1�' o y ' #1 1P 1 t r ig a'P N9Q, 1 ,' Fr r ' '^ �,#e...'�---� �,! r�'<`y F„ `-s'•,`, • #t !'-, $.c t "yt��4 a l7 Q e town r. %�r Y, J, + ja 1.33 y,y -^r—. cV re n ,f ��{�diVO St�oxiorct el� •f'1 • _ est. , t k n ^,�'�•�� kid''- �c�,� +�� �i "S q v '���. -�.� e s sir X `* `,� � �''; fir"' •'� �a.'"i� � ..1` t �.r�a.,,r v ��. r , K I n e ai "",a '` ,°`' v '< :V qF M rble Ridge r'r � nonS �-fi ae . rryf3te'tlon '� "... tr�1,�tYt3 r A- •"r, 4 ' �A�.. C.. 1 ,..e��. ,. I��yS `' � �`y� '•f�C�,x .. # .p r`t 01 � 5Y•LI iwv +" t '`� � '� .�'f �"'�Y P� .�i' ,i � '�I`� *moi i j 1� �_ e+M� • , .� }�ret t,`L..,i( ,(S ,_ e1 y` J`� a."i:.: • w* ,1 k i'� iE,-• �'t, e 4[il` r•". t �` `:"� r ., .ry�,,,,�a,''x h" 1fs. ".+ �,�., "6 ' "T�"''`^"'-. °r J'S Xford rr 'k, I •` 5/" : -5 \xpr41' - ,f '�1 + { �' E.v i Av .• r xU #4e�`gt RAn:_ '® !� �,, ,,,_`- �.�_ J 1�.rw '�•A ��+�x:."� ,# ` r' k,°g '�!t,g•.Snr�r45;s �R� �7�, � '+... 5000ft '��. �fliflimuLLJ2000m overF+ .. 02012 Ma Qu = Portions©2012 .Ml f#;.Inmrma ©2011 MapQuest, Inc.Use of directions and maps is subject to the MapQuest Terms of Use.We make no guarantee of the accuracy of their content,road conditions or route usability.You assume all risk of use.View Terms of Use tC w Create Your Own 4 Pack of Custom Word Get the Deal! Cloud Labeled Wine... on North Andover Patch i http://www.mapquest.com/print?a=app.core.c9f3f42.102d45c6d2... 3/14/2012 4 .ti.��J'•r:���1•'\.rt4��ro 11� � �f+..li•Y+..r r�,��.• 5 , �� t p•�f� ,» H Ia4 y'+..ipr ....--rm....,n--r�rn.•a,,.-�.�-. ... _ 5 DEC 0 6 2005 40VVI9 OF NORTH ANDOVER 'Ys }"{ PVMPINCaALTH DEPARTMENT r TQM 1,�'.�T_,C•,.ti Vis.. .,QoAN71TY .._.. .. ,_...R,... ._ rrQ , YU) M 11c• � HA r �V{7UC i tlr,t h, 1v// v i 000D GQuorflUN�MAYY VL tU �'Ci v r.X ov ., OAMU IN Nl n�.t OLC. CA�UCY9Y� .... i M(evr"wW.r. Y„/ r+��rJ; lj,')%; .. .•i7 •. P. e 1 • .•abQ4.e...a♦ d utr 1' N 1'y rM tOt mb U 1't •a ' i t ) 7 , ` q rm F" 1 f 1 . ..TOWN*OFNO$TH ANDOVER SYSTEM PUWIN(3 RECORD DATE SYSTEM OWNER&ADDRESS SYSTEM LOCATION -------- .NO,ONIJ©Uel, f rnQ F DATE OF PUMPINQ—a./ L QUANTITY PUMPED 15-0 D CESSPOOL NO Ins, 1 SEPTIC TANK NO YES NATURE OF SERVICE�));;RQ�ITlao.. EMERGENCY OBSERVATIONS:- GOOD BSERVATIONS;'GOOD CONDITION° ' . FULL TO COVER 4BAFFLES GREASE _„�,, IN LACE OTSLEACHFIELD RUNBACK EXCESSNE SOLIDS;,•FLOODED SOLID CARRYOVER OTHER EXPLAIN - SYSTEM PUMPED BY COMMENTS: CONTENTS TRANSFERRED TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) .C,14��IZ2(5J DATE OF PUMPING: oZ QUANTITY PUMPEDALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: I i CONTENTS TRANSFERRED TO: i North Andover Board of Health Andover Septic 120 Main St. 47 Railroad St. North Andover Ma.01845 Bradford Ma. 01835 Haul Lic. #151-OOH Install Lic. # 128-0 Date Address Gallons Comments 11/1/2000 303 Chester St 1000 11/1/2000 50 Willow Rd 1000 11/1/2000, 160 Carelton Ln 1500 11/1/2000 165 Bridal Path 1500 11/4/2000'. 174 ingals St 1000 11/4/2000 1062 Salem St 1250 11/6/2000;373 Raligh Tavern Ln 1000 11/6/2000 252 Boxford St 1000 Leachfield Run Back/ Ex. Solids 11/6/2000 ,150 Liberty St 1500 11/6/2000 149 Osgood St 1000 11/7/2000 255 Haymeadow 1500 11/7/2000 850 Winter St 1250 11/8/2000 25 Windsor Ln 1500 11/9/2000 249 Carlton Ln 1500 11/9/2000 767 Johnson St 1500 11/10/2000 56 Academy Rd 1500 11/14/2000 Sugar Cane Ln 1500 11/14/2000 250 Abbott St 1000 Extra Solids 11/15/2000 195 Winter St 1500 11/15/2000 187 Winter St 1500 11/16/2000 85 Laconia Cir 1500 11/1612000 86 Willow Ridge 1000 11/17/2000 2135 Turnpike St 1500 11/20/2000 203 Grandville Ln 1000 Flooded 11/20/2000 391 Pleasant St 1500 11/20/2000 124 Tucker Farm Rd 1500 11/22/2000 394 Boston Rd 1500 11/22/2000 728 Forest St 1500 11/22/2000 18 Johnney Cake St 1500 11/24/2000"-l-06 Rockey Brook Rd-' 1500 11/24/2000 258 Rea St 1000 11/28/2000 1815 Great Pond Rd 1000 11/28/2000 1420 Great Pond Rd 1500 11/29/2000 266 Lacy St 1000 11-129/2000 155 Laconia Cir 1500 e FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with- any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT Phone LOCATION: Assessor' s Map. Numbe Parcel J 3 � n 3 �Subdivision � ''% /� o /,5' Lots) Street /r to P ,�°b o _ St. Number ***** *** **************0 ficial Use Only************************ RECO DATIO O O AGENTS Date 1 Approved Conservation Adm nistrator Date Rejected Comments Date Approved i Town Planner Date Rejected Comments i Date Approved Food Inspector ---Health Date Rejected , Date Approved Z AMA� Septic Inspector-Health Date Rejected Comments Public Works sewer/water connections driveway permit Fire Department Received by Building Inspector Date PLAN REVIEW CHECKLIST ADDRESS (3/9 �y-R3,-,0X//f ENGINEER / 6 � GENERAL 3 COPIES 1� STAMPy� LOCUS �� NORTH ARROW SCALE CONTOURS PROFILE SECTION BENCHMARKe-� SOIL & PERCS `� ELEVATIONS L� WETS . DISCLAIMER WELLS & WETS WATERSHED? DRIVEWAY �Elev) WATER LINE [ FDN DRAIN SCH40 t,-'. TESTS CURRENT? tom" SOIL EVAL c`j , i GD6L5 SEPTIC TANK MIN 1500G ✓/ . 17 INVERT DROP i`"� GARB. GRINDER(+200% EDF) 25 ' TO CELLARI-----. MANHOLE 0/( -- ELEV GW # COMPS. D-BOX SIZE ## LINES FIRST 2 ' LEVEL STATEMENT INLET 1,:53.0(o _ OUTLET z6 (2" OR .17 FT) TEE REQ'D?A LEACHING M 9 �f / IN 660 GPD. RESERVE AREA L, 4 ' FROM PRIMARY? �2% SLOPE ' 100 ' TO WETLANDS `-��100 ' TO WELLS 4 ' TO S.H.GW E,---' (51 >2M/IN) 35 TO F I ND & INTRCPTR DRAINS �325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY O�(—^ MIN 12" COVER FILL? (151 if above natural elev; 10 ' if below) BREAKOUT MET? C----- TRENCHES / MIN 660 gpd SLOPE (min .005 or 611/100 ' ) SIDEW ALL DIST. 3X EFF W OR D (MIN 61 RESERVE BETWEEN TRENCHES? FILL? MUST BE 10 ' MIN. PEA STONE? F/ VENT? (>3 ' COVER; LINES >50 ' BOT ! + SIDE c�C9� / -:,"640 ) X LDNG `� = TOT k'2 (L x W x #) (DxLx2x##) (G/ft2) Copyright 9 1995 by S.L. Starr ----� �� �� ,��j � C5�' - J,•l4. '��'�`''r� cry ���! f THOMAS E. NEVE ASSOCIATES, INC. [A44En OT 4 o e H@WDVUQ1L Enginee'rve Land Surveyors * Land Use Planners 447 Boston Street US #1 TOP SFIELD, MASSACHUSETTS 01983 1 DATE (508) 887-8586 �� FAX (508) 887-3480 ATTENTION Prt—tl�t'LA�J�S'�tA��L TO �jprN IJ'�, �-�r.r7 r� RE: WE ARE SENDING YOU ',Attached ❑ Under separate cover via the follow' item ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US Pry-s'D�A' P REMARKS 11:e� Lx5t ?�N — QUI.—`-� i COPY TO i RECYCLED PAPER: .r g? Contents:40/Pre-Consumer-10/Post-Consumer SIGNED if enclosures are not as noted,kindly notify us at once. FORM 11 - SOIL EVALUATOR FORM PAGE 1 of 3 No. 550-3A Date: 6/27/96 Commonwealth of Massachusetts North Andover,Massachusetts Soil Suitability Assessment for On-site Sewagesnosal Performed By. Steven J.D'Urso Date: 5/15/95 Witnesses By: Sandra Starr Location Address or Lot# Owners Name,Address,and Telephone# Lot 3A-Rocky Brook Road Ogunquit Homes, Inc 770 Boxford Street North Andover,MA 01845 New Construction, X Repair, (508) 687-7774 Office Review Published Soil Survey Available: No Yes X Year Published: 1981 Publication Scale: 1" = 1320' Soil Map Unit:CrC(Charlton) Drainage Class: Well Drained Soil Limitations: Moderate (slope,large stones) Surficial Geologic Report Available: No X - Yes Year Published:. Publication Scale: Geologic' Material (Map Unit) Landform: Ground Moraine Flood Insurance Rate Map: Above 500 year flood boundary: No Yes X Within 500 year flood boundary: No X Yes Within 100 year flood boundary: No X Yes Wetland Area: National Wetland Inventory Map(Map Unit): Wetlands Conservancy Program Map(Map Unit): Current Water Resource Conditions(USGS):Month Range: Above Normal: Normal: Below Normal: Other References Reviewed: DEP APPROVED FORM-12107/95 FORINT 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 3A- Rocky Brook Road On-site Review Deep Hole Number: 95-1 Date: 5/15/95 Time: AM Weather: Fair Location(identify on site plan) See sanitary disposal system design Land Use:Residential Slope(%)8-15 Surface Stones', Vegetation: Wooded Landform: Ground Moraine Position on landscape(sketch on the back) See sanitary disposal system design (locus map) Distances from: Open Water Body ft Drainage way ft Possible Wet Area ft Property Line 40+/-ft(from left lot line) Drinking Water Well ft Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency,%Gravel) 0" -4" A None 411 - 3011 Bw None 30" - 144" C1 S/G/L 2.5Y 5/6 Redox @ Low Chroma Mottles> 5% 112" *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic): Glacial Till(loose, sandy) Depth to Bedrock:None Depth to Groundwater: Standing Water in the Hole: 144" Weeping from Pit Face: None I Estimated Seasonal Nigh Water: None i I DEP APPROVED FORM-12/07/95 I FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Lot 3A- Rocky gook Road Determination for Seasonal fth Water Table Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles 114 inches Ground water adjustment feet 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 all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on date I have passed the soil evaluator(date) p o 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 19 27 /Q6 I i I DEP APPROVED FORM-12/07/95 FORINT 12 -PERCOLATION TEST Location Address or Lot No. Lot 3A- pocky Brook Road Commonwealth of Massachusetts North Andover,Massachusetts Percolation Test Date:9/9/86 Time: PM Observation Hole# P48 Depth of Perc 4211 Start Pre-soak 4:03pm End Pre-soak 4:18 Time at 12" 4:18 Time at 9" 4:30 Time at 6" 4:48 Time(9"-6") 18 min Rate Min./Inch 6 *Minimum of 1 percolation test must be performed in loth the primary area AND reserve area. Site Passed: X Site Failed: Performed By. Steven J.D'Urso Witnessed By: Mike Graff Comments: DEP APPROVED FORM-12/07/95 I FORM 11 - SOIL EVALUATOR FORM PAGE 1 of 3 No. 550-3A Date: 6/27/96 Commonwealth of Massachusetts North Andover,Massachusetts Soil Suitability Assessment for On-site Sewage his oral Performed By. Steven J. D'Urso Date: 5/15/95 Witnesses By: Sandra Starr Location Address or Lot# Owners Name,Address and Telephone# Lot 3A-Rocky Brook Road Ogunquit homes,Inc 770 Boxford Street North Andover,MA 01845 New Construction, X Repair, (508) 687-7774 Office Review Published Soil Survey Available: No Yes X Year Published: 1981 Publication Scale: 1" = 1320' Soil Map Unit:CrC(Charlton) Drainage Class: Well Drained Soil Limitations: Moderate (slope, large stones). Surficial Geologic Report Available: No X Yes Year Published: Publication Scale: Geologic Material(Map Unit): Landform: Ground Moraine Flood Insurance Rate Map: Above 500 year flood boundary: No Yes X Within 500 year flood boundary: No X Yes Within 100 year flood boundary: No X Yes Wetland Area: National Wetland Inventory Map(Map Unit): Wetlands Conservancy Program Map(Map Unit): Current Water Resource Conditions(USGS):Month Range: Above Normal: Normal: Below Normal: Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 3A-Rocky Brook Road On-site Review Deep Hole Number: 95-2 Date: 5/15/95 Time: AM Weather: Fair Location(identify on site plan) See sanitary disposal system design Land Use:Residential Slope(%)8-15 Surface Stones Vegetation: Wooded Landform: Ground Moraine Position on landscape(sketch on the back) See sanitary disposal system design (locus map) Distances from: Open Water Body ft Drainage way ft Possible Wet Area ft Property Line 25+/-ft (from left lot line) Drinking Water Well ft Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency,%Gravel) 0" - 4" A None , 4" -28" Bw None 2811 - 5411 C1 S/G/L 2.5Y 5/4 None 54" - 128" C2 S/G/L 10YR None Refusal at 128" 4/6 *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic): Glacial Till(loose, sandy) Depth to Bedrock: 128" (El= 127.3) Depth to Groundwater: Standing Water in the Hole: None Weeping from Pit Face: None Estimated Seasonal High Water: None I I I DEP APPROVED FORM-12/07/95 i FORM i 1 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Lot 3A- Rocky.Brook Road 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 Ground water adjustment feet. 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 all areas observed throughout the area proposed for the soil absorption system? Yes i If not,what is the depth of naturally occurring pervious material? I Certification I certify that on (date)I have passed the soil evaluator examination approved by the D artment 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. `� 27 ala Signature Date DEP APPROVED FORM-12/07/95 I i FORM 12 -PERCOLATION TEST Location Address or Lot No. Lot 3A-Rocky Brook Road Commonwealth of Massachusetts North Andover,Massachusetts Percolation Test Date: 9/9/86 Time: PM Observation Hole# P47 Depth of Perc 3 6" Start Pre-soak 3:47pm End Pre-soak 4:07 Time at 12" 4:07 Time at 9" 4:18 Time at 6" 4:39 Time(9"-6") 21 MM Rate Min./Inch 7 *Minimum of l percolation test must be performed in both the primary area AND reserve area. Site Passed: X Site Failed: ! Performed By. Steven J.D°Urso Witnessed By. Mike Graff , Comments: DEP APPROVED FORM-12/07/95 i JUN-27-1-996 11:28 TROMAS E. t E,'E ASSOC. P. ; From: Steven Sarsceno Thomas E. ,'leve Associates, Inc Oues,tions? Gall (508) 887-8588 447 Old Easton Road Fax(508) 887-3480 Topsfield, iv% 01983 Sandra Starr Company: north Andover, Board of Health 688-9542, ,curie 21, 19-'8 .i" 11:28 AM Paws: 9 (including this one) _.� milt `� �, _ 'r r, t, ' r. + irase find to fot�o.+r the soil e.ai�at�on forms for Lot 3A F'ta,.,.,y Broo., ko:ad. .Ve .�..I& ,-w ma,tkng you the originals for ;Mur records. s,,-io llri have any questions please do not hesitate to ca;W z; nze .,cat�ori, see you Wi),n you return' w i �l'•�-_ -'l�r;t l:1% TH01-1 o E. HE' IE q',=iSi-Jl_. P,Cl fOW 1 i - SOIL EVALUATOR FORM PAGE : of Col"InonweiJ th of Massachusetts North Andover.NiaswchuseM. , Suit Suitobilit><,Assessmentfv�• r- � SewageDisposal _ _ Performed By. Steven J. DT rso 6te- -5/15/95 with ; av: Saudra Stair Lot 3A 'Rocky Brook Road � ()guxlqult Homes, tae i 770 3o2-ard Stt-:wy � Noet;a Andover,MA i New Construction, X Repaiz. (509) "7-7774 Published Soil Survey Available: No Yes li Year Published! 1981 Publication Scala: V = 1320' $Jil Map Ct31t:t.;.3QG10Y'it9H) DrainaPe Class: Weil Drained Soil um itations, Moderlite(Slope,verge stones) Surficul otologic Report Available No X Yes Year Publisbed. Dubh'aWlja scalp: Geolosmc NL=ml(map t`nri): Landform: Ground Moraide Flood lnssuance Rate.Map. Ahuve S00 year t1wd boundary: do Yes X Witil_m 100 vzar tlood boundary. Nu X Yos 4 Witfun L(;0 rar flood bouiidar�- No i Yes WWz,ad Air.:: National Wetland Inventory Map(P+ dp Unu) W etlamis Caalsf rvancv Program Map(Map UD,1j4: / II Cumin Water Resource Condimms t Ii5GS):Mkmth Range: .Above Normal: Normal: Below Nom.: othrtKefc rcn,x-•Reviewcd: r1Fi'aPPRvv s)hU M- T Uta-2"-13% 11 29 -HCP JHE E. JF-IE t4SSG�-. SUI I.EVA UJA1-Uft. fOKM C.ication Address or Lot No. Loi 3A-Rocky RrooL +Roa6 Deep Hale N=txtir- 95-1 Bate: 5/1-5/95 Tune: AiiM Weather: i{air Wc,ation(identify on site plan) See sanitary disposal system design Land Uw: Residential siope(%)8-15 Surface Stuncs vcgetatian Wooded i mwona: Ground ibioraine Position cin landscape(Retch on tlu:bads) See sanitary disposal system Design (lacus map) L)L%unec s fintrl OMt Nater Body ft Dr tuage way il Possible.Wet Arta ft Prupua v Linc 40 ti- ft (tittm left tot line) t rtL-AinF Watu Well ft Uthei N D EL,P OBSERVATION MOLE LOG" #j Depth from 'Soil Hwizon I Soil Texture 'Soil color� foil r v Other ! Surface(inches) i i kt7SDA) (fvitrnseil) ( Mottling (sTruclpire.St.Rl� E;nuTdss C-cnns[mcry,`aC.Ta moi, - - t -- - -, - - - - 41 00f _ q„ A N,one i( q,+ _ ;0" BNv ; ?torte 30" - 144" C1 S/Q/L 12 5Y 5161 Redox (i� : Low Chroma:Mottles t * MUNIMt.,'M OF Z HOLES REQUIRED AT EVERY PROPOSE DISPOSAL AREA Parent Matertai(geol(r�ie).Glacial I'M(loose, sandy) Depth to Brock-(None Depth-to rciwdWer; 5t•andm.g Water m the Hole: 14 Weeping from rte lace, lvune F_,-tinned 5ca-,m9 I'igh water: Notre Tt.P + F JJI-27-1996 11: '� T�'Jt1�}.r ry H,�✓r,` F. ,1 EL?RM 1 i - SOIL FVALUATOR FORM Location Address or Lot No. Lot 3A- Roctiv isrook Komi ,fete►tit buil oro ror Seasop a£K "?"'a-ter I able l thud L's—ed, Depth observed standmg m obscYvation hoie m hes L"ffi weeping from side of obsuvation hole inches X Depth tc]soil uroulcs 114 uiclIt S Ground water adjustment feet litdex Well N'amber Rmdlng trate index weld tcvei Adjustment fzctir Adjusted gsoimd water level D t•thh of Nall a}IHy/QS 411IT11_ll�i'�I�tm ' t t- 1)6cs at least taur tW(ifnaturally occurm g pemous mat4"rW exm m all arms observed throughout the area LtrMosed for the soi atwrpu0A sv;;[emY Y eS i If not,what is Lite death of nanim,fly cwcurru-t pervious mat nai i ��l.icauon I cer.iiv that on 1 7 Wate)1 have pa i�d the soil eval"or cxawmlauon approved by the Rrpartment of.EuvtrunmenW P.o*ec`uon and#hat t$e above amilw5 - was perfurmed by me const.Aeet with the regmre(l tma umg,expertise,and exf enunce &z,txikea m 310 CMR 1,).(it ?. rte-+ `i39narure _ _ Date LyF:P�tE�tfVl'.�lill��' 1Z:+i rr� I i fOfLM t> - P 4'C OLATION "I'•E ST Location Address or 4)t.\4o. Lot 3A - Rocky.3raok Roar,, Commonwealth of i:1assachusetU NotII:b Andu%,tr,:1vi.4 ssa6 iuseti.s Date 9/9/R6 -run, JUMCA-ation Holt 4 P4� 'Depth of PCrc q tart Pro-soak 4 0'1 Pi u rd Pre-soak 4.t S ne at 12" ... 1 't ui:4 at 9" 4.30 'Time(90-61') 18 min [Rtatc Miru L h _ IVIMIMUM of 1 P1U1r la11nu test mast be pt:rturm M in both L4e prgmzuy arlua AN 1) fess-IM ar«. Site Passeki: X Site Fad xj: K-riortiud B" Steven J. D''tj rso Witnessed By N'lke Graff C'emalent5: 1)1EP.%PPROVLD 1!OK.V1 ll,TIN5 I I JUhJ–?7-1 agF, i 1 v F.G FOWvI 1 i - SUIT. VVAU,ATOR ('t.SitVi N0. 5.5 0,--3 A Commonwealth of Massachwe'l, North Andover,N-tassschusetts Soil itabi tv A essmen tri- sin-!site Y, va as 5ai Perfouaw Eyr Steffi nJ. D Uno ozvc. w 15195 Witnesses By: Sandra Starr P"S's N=C, l q[t--, ,iil(i Lot 3A Rocky Brook Road Ogen quit Homes, Lic 10 fla-'l-o"Oed +:oilh Andover, MA 01 k New Constructiom X Repair, -- - — (503) 681--r 174 -- t Ofdiv a R.evim Published Soil Survey Availabl4: No -Y vs Year Published: 1981 PublieWim Scale: V = 1320' Soil map that fL;t'('4cs arftan) Drama ue Claw Well Drained Soil LiMILations: Moderate tslope, It 14rge stones) 5urficial Cn;ologic R Rwt Available: No X Yes Year ftblistwd t�2bhcamw .kale•. Geoto9ic NtRawri' (lvlap Una.`- tandfomi._ Ground. Moraine Flmxl inswanri:Rate flap. Above 500 year t1wS boundary, No 4`rs widen 51jo year tlood txwuA3rr. No X Nes Within 100!year flt)od boun.daiy: No h Yes WaJund Ai ea: National Wetland Inventory Map(Map knit)- , Wetlands Ccm,'eevancv Progam Map(NIap area),. Cuiw-nt Watez Ri;source Cunditions(uSVS): .Anal Raiiyr-e: Ahwe Nomi4— 1 omml: Below ,VUILidi. Other Kpff.Tmxes&`Y1Cwcd �(kEP.�!'PROr r_o F1►tL'K Yz u y.., JUI-27-1996 11;3! T�-:Di'tAS P. i.ILE FOR-M I I S01 i. ENI A.1.IJ ATOR FOR.. I LA)cation Addrews.or Lot No. Lot 3A- Aocliw fsrooti R- toad Deep Hole Nuniber. 95-2 D&te: 5115/95 Tune: AM We,-tthcr: Fair Loa,ucn(identify on sits:plan) See sanitary disposal system design i-ami Use: Residential slope(,%)8-1.5 vqetanon: 'Wooded landform: Gtround Momine Position on landscape(sMch on the back-) See sanitary disposal system design (locus map) Distanev,from Open W,.)ier Body tt Dramage vn, Po,--sihle We Area it Property Lme 2.5 -ty it ICII lot ime) Dnnking Water Well it OLhzr DEE,F CUSERVA110N ROLE LOG"2'1 Depth from Soil Horizon Soii Texture Soil Color Sorb II Surface(inches) t (USDA) (Mims0l) Mottling I (b'T'1d11t:,lvkuncs,boutdi;r, t7l�V-ILII,y okinNcl, ot' - 4" A None 4" - 28" B w None I 28" - 54" CI S/G/L 2 5Y 5/41 None 54" - 128" C2 S/G/1, 10YR .done Reltsal at 12s" MINPvWM OF2 FJOLES REQI MED AT F-VERY PP,0F0SBr)DISPOSAL AREA I Parmtm_umai(geotopc): Glacial 1111(loose, sandy) Depth to u,:&ock: )28" (uCi= 127.3 ) r�th to QLtj)pj,&wate.r. Standing Wawr in the Hole: None tYexPlng Crum fit lacc. iiujje FAimate,d Sasoual Roth Vater: Mile DIEP I-PIPROVED FORM U. 'Y'! JUN-27-1996 4L I:3 THC llt��7 P FORM11 SOUAVAll'AlORI-ORM P Loca6wi Address or U4 No, Lot 3A- Rodw Brook Road Detertriiiatiorg kpr Seasonal 6whj,iTetl—ubie DWh observod stan&ng in ahstrvauun boic w Gllm� Depth ivelepiug from-,.i&otubtervauou hole Inches MTth to SW EaOtlkN GTound water adimmieut fee. Index Well Nwmlx;r Rearbmq. Date intl4x\,.,eit levri Adju=ent factor A4mqod gwiotd w&wr leve! DW-h oiL NgtrzallySX-pupgqFory-loos Mwt�al Does at It.-wq four feet of naLura.Uy wurunp peiNrious malei*km,,t m&U aeds observed throughout the area pioprised toy We.suit absaqXiuu systein'. vs It'not, wb.3t is the depth of naturally occuiTmg pervious niatcoal I cerufv that cm (date) I have passed the%oll evgwitur vxanullal-IM a,PPRIV ent of Envirourx-mal Protec6m� and that th�aboveanmysis ed bv the bwarL ,%hw performed by me cmsiqentwith tfic requued trammg.expertise anij oxpcnva" descritW m 3 10 CIR 15.0 I I UFF kPPRONTP FORM ,ZK07;95 rUH-2 r-19'9t 11 - P.09 I (:R.;O LI 131-.R (I ATIO TES] Location Addres-,or Cali No —Oi 3A_ Aul.cv -hook t oad C:ortsu�oncealth cr# �riass�chu::�its ' Date 91,4190, ?au, ? Ubs rvaiion rloe 1 __-- - �Std,t Pre-soak ` { 'Pan i Tuuc at 1 "1•tcttC dib - -- i 7 i} -- � . line 9*4'") i ;;atr Min ARLh P * Anammn of I g=r:olation tri t must tx pt.rtormt.d in both Ghc,pnmar-� area A'ND t.-r.el vi.,rca Pt'�ttirtUtY� t�v' ."f?C'Vf'1" a�, 1%��.sliU UN- �CRsil21.K�= .. Dc!'Y lt"PF!?vtllFc7l1SS �.;�� TOWN OF NORTH ANDOVER" Q(••• v SYSTEM PUMPING RECORD '0 STEM OWNER & ADDRESS SYSTEM LOCATION. .. ��� (exam'ple: Iefl front of house) 1394<�, r U \'I E OF PUMPING: QUANTITY PUMPCD� � NO YES SEPTIC TANK: NO YES w ATUflE OF SERVICE; ROUTINE �Ml~RGEf�CY T10NS COOD CONDITION. fj'ULL TO COVE HrAVY CREASE BAFFLES IN 1'L,ACE ROOTS LEACHFIELD RUNBACK CXCESSI-VE SOLIDS FLOODED SOLIDS CARRYOVER O;HFR (EXPLAIN) u I.ly1rNTS: UNI I:'NTS TRA NSFCRRED TO: .V�,��.�i�5'fC't�}�1�Y�1'�'�'iiti'ii.'' •r..� .. :.. ,. '�` '•'9:.-,� RT O t S• a� y .0 Rµ MASSACHUSETTS �� r mpin "Record ,'w;y?cl � (�+� arm ���'�',,a, 1 {�, Fbihr �y, y,)y�,rf 1'•::''.:,• ' •<�:`. .:l',^. .,f.i"fO:f;-,'•1.!'`/rjiA�!•1�'•1^h�,l y�V*.u,,v'At.tK :Q�\Ltli:l.!r."• `• .:I•' ;'!{t.ni.1 V4'ii':' •�t���r �il�''i r!$.;n:•4••, tl`'•.iJ'•tY'ar;,: .. .t�,(,,JYgtji..l'.�'„ brl„!r Ir'• 1,i4'' �Ii.1A,�':4•'' 1'„ ;'' '..''''•.. l:P,.has proJlded thh form for us® b WWII be :ubmnl4ed to the.local'Soard of He ith o he System Pumping Record ,m:;s ; s ::;;, ;;,:�” ;' •'r<:'rl': .,c:....., 9 authority, A; Facility Inforratlon DSD 0 7 2001 ?""tYAM Oiling out: 1, System l.ocadon:*", TOWN OF;NO TH ANDOV.ER EAL ART ENT only thew key Address to move your:; . wn ..do pot;.; uii the•rotum';:v;' State ':','.,'�}�` 1'r l'w.�t'jef'!r,•�•;+;•. ;i'.:;'.�}',p14.w,r.1:'•;,.''`�r•�";' :1:;�' .. ..� - P Coda i•;.; '1. ,1�, ;,'..�i• .;;:.,gystam Ow , � �;:r`'••• /: • `.�:. EM :iC•''vl;';fa ,�M%,:Yr;•';�1 .:t.' +i::q:y: �F.''' ,1 , Nam1;•roti^�!'',I:�d.: ''}�r�r.J.\� 1 Addrass(Il dlllarent from io ��71 oAtlon) , .,;�:• . '��'.Glq�rTowr►,,.,: •''11,' '•,,:,' ' ' Stale• �p. Cod AW A. 70" �D � Telephone Number ii ;r,'• �:'S>,vilt't'�btrr r/r�l�t;..�1�1�'�I'1�1,,1.'�'•I '' bats'ofPtm'p'In ' Date 2. Quandty Pumped; �; . ,3� �,TYP,e.Gf,systam;• '• Gallons 001 S . , ) e tic Tan P .. .. ..r. �' ��' ,. '�•::.,, ,, ❑ Tight Tank • Other 8 scribe Effluent Tee Fllte f',prosant?.❑ Yes No .. ';' ,. ,,;': '\:,,•� , r es was I ,-.l. y 1 t I a •r , :�•�,•.,„ •,;...,.r,�,c�•.crl••.,• .: Yes No 1, ❑ i C •,r';} :••:, •;. „ .or>ttlltlon,o(.,8y$t..m, •. .. _ .1.'v':y.nn �r .:''''�t!'a!,)�)'fi:•I/���,�i: nl„�i } '/ ..•: ,y..� r ' '� '''' ;f':!1lt"�{f��C'J,T lu.P4��":''t,it' ''�;`•ll.�,'t:'�•�". ��f:.. • '`Il'�•.�` '. ';,di:a!;, fi',k.•/.�Y,' 'ui%;•'1 '' l'�al� `.til.,',,., •.,:• �'� , ;'l•w'1.:..:. ��1'�aural\l}.,i,;1+1.;+,.. '}N ;Y:, ' , '. �� %•, `, , �� •,.,1i=,r,yy v� r •r;'': i�C:rZ �] t, "'1•T•:; f'r��'}�,j.t�r �yy � itt1L '�' �"'N Gan :.C:• ` ,.:�•>,�..r;�::,,:'I,'��q.l t. •. Y�i,fY,up}'±��i'1'}� 1'1•��il�y"►/',�,1{.>�.,•.�,'Y,'r:: J .. yy F'.7i,:.,, y,l I ,qr,y..�J�,; ��/y[a�r" 1","•��' '1►(1�5. , ,•Y't`;• .'•�;,i.'��'yri%,1tfi.,,.t .,}i', H'}i Al!�Ik�r1'.::.fr.�l:r��Cnl`1T X1.0: } 1 .. •�� '�,, :;:';'.��..F,,r,.;�:,;.,.7,. locabon.where, :,t,•:; ,, contents yvere.dipposed; t ;t 1X6. • N{: ., -1..,;11, ':':It., ,•, '' f. •' .;1.r'i4:: ,f�r��•�:�:,�1': 'r, ' it•i., �" �''{t�.iTt B••'.�:.r1ii,{r` �:r ':+r lnl 1r., a x'. nater ..� 1 .,�, •.r: IY H r ( Ula r' h� ' Date e aP itivww,mass;eov/deplwater/approvaJslt5forms,htm#Inspect System Pumping Record Page 1 ?r , 'r} �p(./I,1• >',1:;, i'7 �:r4 �� 1,.�Il..f;^'V' .'l., ..,.I,. i Ir ,11 A3P rZ /��� 1�'��:'�1 ,,//ti b•�; (,► ,�' Y wnv��,�9QO�Cd ' � MA r E h,l r.r�rr �r I,vII1r1,,1�V,1(''qII.I �,p, E� QEPrhil p t 9 11rvlihi�yl`I:/in; 2009 p� Ivblltlllod.lc utr Ic o8cf�u Iry v;' 1p''01 boar T QFN A Facllld ty Inl.orm�►lor� ENT �� . r•, ''`'r�.1;1�1�, ',y �I„ o .;'ll(r,t'I'' r',I'a ' , $IIII ' 'I.r +"/„r url •'Y/,I ll,.rl ,1',rY�;',{„ . .�,` 4' V ,;,1� ,r 1Ir'Ir1'II V'll 1!1��Y,1 nU,l/r♦l, � /\ IA � tV\ I, III IPM to V4 ' -.. �41o.rr , .......... vale of+PVm''II�; t r • Oflf :� ', „ ., , yalOm,„ �• Cas o01( :,,. s, ,'y,1111'1'' 1';nl'lrrf u k',/l1,1',•r• ,'•,,::, •4 ,,,�;fll��,m�+ (,r�t.�,l(I� , ,(,0,aenrl r, yo) it n'o , ' ,'? C'Odn ('1 oil n , T/ rr off IV MOO, �901 "Will� I� �! '�r'IYi11ry', iblv �4,+;1�ora 1091oo, ;��4,7 41u;1 Y , , ,�L'( ,�,I,�.';" VII',',' i,v i ' 1,111rY'�II��, W.'1r/f,v i' d,i��iY�f I'd Hl •-�7 ti ''.�; n /�;�;�dl�•''I'l >S�nl„�+'1.Q/N1 V4(��II��f'll•',v1,11 I s. �jG-,/ . p 9-Y. /,V(. orm�,n�r�nain�o'ocl a►,1f Commonwealth of Massachusetts City/Town of No.Andover .. - W System Pumping Record RECEIVED a a Form 4 pp❑q DEP has provided this form for use by local Boards of Health. Othe f$?� i� �Vl7ot e information must be substantially the same as that provided here. oil a with your local Board of Health to determine the form they use. The System bmitted 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 1. System Location" forms on the computer, use only the tab key A dress to move your o.Andover � Ma 01886 cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name I Address(if different from location) City/Town State Zip Code j I Telephone Number B. Pumping Record 1. Date of Pumping Dae j ' 7,9. Quantity Pumped: aeons 3. Type of system: ❑ Cesspool(s) Septic Tank [I !Tight Tank ElGrease Trap I ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sys m Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed:- Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 i nature of H ul Date i Signature of ec g Facility DaTt-' � t5form4.doc•03/06 System Pumping Record•Page 1 of 1 DelleChiaie, Pamela From: J and S Development Corp. J and S Development Corp. Bandsdevelopment@hotmail.com] Sent: Wednesday, April 04, 2012 2:49 PM To: DelleChiaie, Pamela Subject: RE: COC- 106 Rocky Brook Road , North Andover Thank you Pam! Stewart's Septic Service 58 South Kimball St Bradford, Ma 01835 Phone:978-372-7471 Fax:978-373-6611 Email: Tandsdevelopment@hotmall.corn The information contained in this e-mail message is intended for use by the recipients(s) named above. If the reader of this message is not the intended recipient,you are hereby notified thatY ou have received this document in error and that any review, dissemination distribution or copying of this message is PY 9 9 strictly prohibited. If you have received this communication in error please notify me immediately by email and delete the original message. From: pdellech(&townofnorthandover.com To: jandsdevelopment(Motmail.com -CC: ssawyer(atownofnorthandover.com Date: Wed, 4 Apr 2012 09:24:01 -0400 Subject: COC - 106 Rocky Brook Road , North Andover Hi John, Here is the COC. I mailed the original to the homeowner. Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg. 20 1 Suite 2-36 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie(c townofnorthandover com Web www.TownofNorthAndover.com 1 T�wN®F 9�!®RTF1��,©©v��� Plan O f L (9/7 d 130A`t)OF HEALTH //7 'AUG 16 996 North Ando ver, Mass. sho wing "As—Built " Foundation Location Lot 3A - Rock- Brook Road Prepared For Lot 3A Ogunquit Homes' Inc. Wintergreen Lot 4A Estates 52,990 S.F. Scale: 1" = 40' Date: August 15, 1996 1.22 A cres Zoning District: R- 1 (Residep,ce 1 nis tric t) (Previously Approved Subdivision Under R-2 ZQning� Note: Property line data taken from a Definitive w Subdivision Plan Of "Rocky Brook Estates" By `0 Thomos E Neve Associates, Inc., Dated November MQ Top Of Foundotion 24, 1986, revised to August 30, 1988. \Eley = 135.69' In my opinion, the proposed Dwelling is not in a Flood Hazard Zone as shown on the U.S.D.H.U.D. kk` Flood Hazard Boundary Maps, Community Lot 2A Pcnel - ��' G No. 250098 0007 C, Revised to June 2, 1993. O`0 hereby certify that the foundation on this property is located as shown on plans and complies with the 5zoning requiremen ` U Town of North Andover, 3 \�� 0 Ma huse t is v b ofessioncl Land Surveyor \`N �Y�• O \ F��O'D�[ LAND SVS 0 l i Thomas E. Neve Associates, Inc. O CP< Engineers — Surveyors — Land Use Planners { 0 447 Old Boston Road — U.S. Route 1 Topsfield, Massachusetts 0798J 887-8586 550-3A