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Home My WebLink AboutMiscellaneous - 125 SHERWOOD DRIVE 4/30/2018 (2) 125 SHERWOOD DRIVE _ 210/105.0-0067-0000.0 Drive 1 r I I f c +l • �? MAP # LOT # PARCEL # STREETS CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? DYES NO PLAN APPROVAL: DATE S 6 h4 APP. BY DESIGNER: /1/��/G PLAN DATE CONDITIONS WATER SUPPLY-:-- -0WN WELL WELL PERMIT DRILLER WELL TESTS: MICAL DATE APPROVED BACTERIA DATE APPROVED BACTERIA II E APPROVED PLUMBING SIGNOFF WIRING SIGNOFF COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE C NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: � r v+ i SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? NO TYPE OF CONSTRUCTION: REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL E9 NO (FROM FORM U) ��''''��,, ISSUANCE OF DWC PERMIT ALX. '' NO DWC PERMIT PAID? C E- NO DWC PERMIT NO. ( INSTALLER: / ( BEGIN INSPECTION ' Y NO: EXCAVATION INSPECTION: NEEDED: PASSED V 3�z BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: BY /Y FINAL GRADING APPROVAL: DATE BI i FINAL CONSTRUCTION APPROVAL: DATE: (/ BY O* OORTy q �t�eo 6� ti0 OL O �yi eye : T O�4[Otw[MlY.1Cw v - �9SSACHUS PUBLIC HEALTH DEPARTMENT (ammunity Development Division Date: February 23, 2011 Linda Pegalis Andy Spitzer 125 Sherwood Drive North Andover, MA 01845 Re: Building application for sunroom and 2 decks 125 Sherwood Dr. Dear Homeowners,: Your application for the sunroom has been reviewed by the Health Department. The application was denied on, February 23, 2011, for the following reason as shown in red: 1. X Missing information 2. X Passing Title 5 inspection of septic system required per Title V 310 CMR 15.301(5) "system shall be inspected prior to any expansion ... for which a building permit from the local building inspector is required" 3. Location of structure not acceptable 4. Undersized septic system To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house, septic system and proposed project in scale (you may pick up an as-built septic plan at the Health Office) If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: (inspector list attached) OR b. Tie-in to municipal sewer 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com If#3 is checked: a. Relocate the project If#4 is checked: Options a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a deed restriction agreeing to always be a_-bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved, record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Susan Sawyer, Public Health Director Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 . Fax 918.688.8416 Web www.townofnorthandover.com Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: -ELECTRICAL: Movement of Meter location, mast or service drop requires a rov Electrical Inspector Yes Pp al of No DANGER ZONE LITERATURE: Yes MGL Chapter 166 section 21A—F and G min.s100-s1000 fine NO NOTES and DATA— For department use D Notified for pickup - Date Doe-Building permit Revised 2008 - i 7 - – —125 BO, No uild ne OL Nlf Canellakis Existing, Sew. �' V�oa -+ Stone Retaining \�% WO// CV � v' ` v Existin g � .� l.Op' Wet/and fJ .Paved ��.u� Buffer Zone Driveway o v"< 1 ... Approximate Location Of Existing Leaching Facility szc?�O 57.06_ ' — L=32.001 R=433.71' VF v e Wo o o d l l JOHN MORI. , CIVIL (Public — 50' Wide) No.398 1 AL. i onus : � \ - X25 50' No Build Zone ,. ._._ 129 _,130 N/F Canellak ' Existing 1e Stone Retaining v wall Existing 1.00' Wetland o_ Paved Buffer Zone Driveway Approximate Location Of Existing Leaching Facility \ 57.06'_ L=32.00' R=433.71' o o d V "' JOHN MORI. CIVIL (Public — 50' Wide) No.398 Al. - 1 i — — �-Qas.,-. -- _�; _ / X25 50' No :•��.—�! Build Zone �l129 }�� ` z..777� •�— _ .•—� d n 130 N/F Canellakis Existing U0 Stone .•'` Retaining : WO// S) 0 Existing `1 moo_ Exti 1OfI' Met✓and ved Driveway Buffer Zone � I Approximate Location Of Existing Leaching Facility 57.06' L=32 O(7' R=433.71' S h of d D V JOHN MORI, f CIVIL (Public — 50' Wide) N0.398 O AL OE NORTH 1 520 1 IO .. p Town of North Andover ��'• i HEALTH DEPARTMENT ,SS�CMUSEt CHECK#: DATE: LOCATION: IAA H/O NAME: ,a CONTRACTOR�ME: Tyye 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 $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 n'spector $ itle 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer d Commonwealth of Massachusetts a a Title 5 Official Inspection Foic � � Subsurface Sewage Disposal System Form-Not for Voluntary, g p y A essments MAR � 41011 125 Sherwood Drive Property Address TOWN OF NORTH AN Linda Pe alis HEALTH DEPARTMENT Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 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 When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-dgwnot Name of Inspector use the return key. Bateson Enterprises Inc. Company Name r" 111 Argilla Road Company Address Andover Ma _ 01810 'eh0/ Citylrown State Zip Code 978-475-4786 S115 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 ❑ Ne sF rther Evaluation by the Local Approving Authority 3/8/2011 InspectqVs signature U Date 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 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 m in the future under the same or different conditions of use. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 125 Sherwood Drive Property Address Linda Pegalis Owner Owners Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown 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: ® 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: 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 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): t5ins•09/08 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System-Page 2 of 17 t f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown 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): ❑ 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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. t ❑ 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: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 %day flow t5ins•09/08 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 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown 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. ❑ ® 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. 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 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 approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts • w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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 d Yes 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Current Date 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form w a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 8/15/2007, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank. Reason for pumping: Inspect tank&tees 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): t5ins•09/08 Title 5 Official Inspection Farm: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 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 13 Years old, 4/17/1998, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 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.): 4" PVC thru wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 4 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 Dimensions: 10'x 5'x 4' Sludge depth: 4 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts G W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. City/Town 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 23" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 5"deep. 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 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityrrown 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 Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 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 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 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.): i i D-cover level &distribution equal. No evidence of leakage. Evidence of light carryover. 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•09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 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 trenches 62' long ❑ 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.): Lawn covered in snow. No sign of ponding to surface. No sign of hydraulic failure. 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 t5ins-09108 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 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. City1rown 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.): a 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•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. City1rown 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 u � � Ct �. vvse, o Sept t5ins-09/08 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 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is required for North Andover MA 01845 3/8/2011 every page. Cityfrown 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: 5'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: 4/19/1995 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 125 Sherwood Drive Property Address Linda Pegalis Owner Owner's Name information is North Andover MA 01845 required for 3/8/2011 every page. Cityrrown 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 03/08,/2011 14:29 19786889573 PAGE 01/01 . PeOp 1 Summary RgcoM Card Qan8M&d on At=1 2:31:30 PM by Kww Healon Town of North Andover Tax Map # 210-106.0-0067-0000.0 Parcel Id 16963 125 SHERWOOD DRIVE SPITZER, ANDY PEGALIS, LINDA 125 SHERWOOD DRIVE NORTH ANDOVER, MA 01848 Class 101 Single Family Property Type 1 Residential Size Total 1.14 Acres FY 2011 UB Mailing IndexActivellnactFrom Until Name/Address Type Loan Number . SPITZER,ANDY Payor PEGALIS,LINDA 125 SHERWOOD DRIVE NORTH ANDOVER.MA 01845 UB Account Maint. Actwnective Account No cycle Occupant Name Bldg Id. 17698.0-125 SHERWOOD DRIVE LaS1 Billing Date 1/412011 Active 3170369 03 Cycle 03 US Services Maint. Account No.3170369 Service Code Rate Charge MuRiplier/users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 98.20 /1 UB Meter Maintenance Account No.3170369 Brand Type SI2e YTD Cons Serial No Statues Location 225 36399721 a Active ERT HH b Badger w Water 1 1 Variance Varia Data Reading Code Consumption Posted Date nce 12/8/2010 164 a Actual 24 1/1212011 -100% 9/9/2010 140 a Actual 140 10/1512010 -100% 6/17/2010 0 n New Meter 1 7/15/2010 178% 6J17/20`10 2404 r Replacement 61 711512010 25% 319/2010 2343 m Manual estimate 20 4/1412010 MSG 16 1/12/2010 -69% 12/8/2009 2323 a Actual 150 10/16/2009 246% 9182009 2307 m Manual estimate MSG 41 720/2009 93% 6/8/2009 2157 a Actual 23 4/292009 38% 3/13/2009 2116 a Actual 16 1/2012009 -91% 12/9/2008 2093 a Actual 200 10/10/2008 201% 9/102008 2077 a Actual 63 7/16/20D8 302°x6 61612008 1877 a Actual 15 4111/2008 -64% 3/7/2006 1814 a Actual -55°/* 12/1112007 1799 a Actual 47 1/221/008 9/5/2007 1752 a Actual 84 10/12/2007 115% 6/1912007 1568 a Actual 48 7202007 132% 3/15/2007 1620 m Manual estimate 20 41162007 -52% 12M 2/2006 1600 a Actual 36 1119/2607 .58% 9/1812006 1562 a Actual 96 1020/2006 60% Trouble Code:03 234% 81192006 1466 a Actual 68 7/1012006 3/8/2006 1398 a Actual 16 4/1712006 -9% s J ' t Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. A. Facility Information 1. System Location: Left front of house, ht front 4 hh e-,Aeft side of house, right side of house, Left rear of house, right rear of house, left side o w Ing, right rear of building, under deck. City/Town State Zip Code 2. System Owner: ` C Name Address(if different from location) City/Town Statei Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Location where contents were disposed: G.L. D. L e aste Woter Signature of au r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING &-DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS r , HEALTH Reviewed on v I Si nature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street -S 4- PublicHealth Prevent.Promote.Protect. o NORT11 69 6 0 c 'b~ �SsgCHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division Date: February 23,2011 Linda Pegalis Andy Spitzer 125 Sherwood Drive North Andover,MA 01845 Re: Building application for sunroom and 2 decks 125 Sherwood Dr. Dear Homeowners, Your application for the sunroom has been reviewed by the Health Department. The application was denied on, February 23, 2011, for the following reason as shown in red: 1. X Missing information 2. X Passing Title 5 inspection of septic system required per Title V 310 CMR 15.301(5) "system shall be inspected prior to any expansion ... for which a building permit from the local building inspector is required" 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition—all rooms b. Certified plot plan showing house,septic system and proposed project in scale(you may pick up an as-built septic plan at the Health Office) If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating properly: (inspector list attached) OR b. Tie-in to municipal sewer 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com • If 93 is checked: a. Relocate the project If#4 is checked: Options a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult a professional engineer or registered sanitarian to determine the flow capacity of the septic system. b. Hire a professional engineer to design a new septic system that meets State Regulations c. Request approval of a deed restriction agreeing to always be a_-bedroom home. i. Submit a request in writing to the Board of Health identifying why the need to upgrade the septic system is a severe hardship. ii. Attend a BOH meeting to address the board iii. If approved,record the deed restriction at the registry of deeds Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincere Su+n Sawyer,Pub ' ealth D' ctor Cc: Building Department File 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com D c ,- o �F � 6,,, s,'qw. � (� !/ � �� .�---- ,� �� - � / I✓v- 5 �" �y` J �9� ��' MEMORAI DATE: April 1, 1998 TO: Community Development Staff FROM: Sandy Starr,Health Administrator RE: Permit Tracking Software Demonstratic DesLauriers Associates,Inc. will be presenting; for our division on April 21", 1998 at 1:00 P.M. at the 30 there. u Town of North Andover, Massachusetts Form No.2 : Of MORTN BOARD OF HEALTH o, w DESIGN APPROVAL FOR • �,b•�ro•1�",Cj ss^C""SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant eJ�'l3-^ � - Test No. Site Location I'�� Ib b Reference Plans and Specs. uJv�'�- • 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. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 3t� "107 FOREST STREET FILE# 81000A MIDDLETON,MA 01949 (978)774-7122 ENVIRONMENTAL SOLUTIONS, CORP. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: MURPHY PROPERTY ADDRESS: 125 SHERWOOD DR. N.ANDOVER MA ADDRESS OF OWNER: SAME (IF DIFFERENT) ty DATE OF INSPECTION: 10 APRIL 2000 e1r' NAME OF INSPECTOR: THOMAS CHIGAS * THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY -J ' +107 FOREST STREET FILE# 81000A MIDDLETON,MA 01949 (978)774-7122 SEPTIC&DRAIN SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PROPERTY ADDRESS:125 SHERWOOD DRIVE NAME OF OWNER: MURPHY NORTH ANDOVER,MA ADDRESS OF OWNER: SAME DATE OF INSPECTION: 10 APRIL 2000 NAME OF INSPECTOR: (PLEASE PRINT)THOMAS CHIGAS I AM A DEP APPROVED INSPECTOR PURSUANT TO SECTION 15.340 OF TITLE 5 (3 10 CMR 15.000) COMPANY NAME: CURRIER ENVIRONMENTAL SOLUTIONS, CORP MAILING ADDRESS: 107 FOREST STREET: MIDDLETON MA 01949 TELEPHONE NUMBER: f 78, 774-7122 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PREFORMED BASED ON MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEM. THE SYSTEM: YES PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTOR'S SIGNATURE: Q,S DATE: 10 APRIL 2000 THE SYSTEM INSPECTOR SHALL SUBMIT A COPY OF TH INSPECTI REPORT TO THE APPROVING AUTHORITY(BOARD OF HEALTH OR DEP) WITHIN THIRTY(30)DAYS OF COMPLETING THIS INSPECTION. IF THE SYSTEM IS A SHARED SYSTEM OR HAS A DESIGN FLOW OF 10,000 GALLON GPD OR GREATER,THE INSPECTOR AND THE SYSTEM OWNER SHALL SUBMIT THE REPORT TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION. THE ORIGINAL SHOULD BE SENT TO THE SYSTEM OWNER AND COPIES SENT TO THE BUYER,IF APPLICABLE,AND THE APPROVING. NOTES AND COMMENTS: N/A REVISED 9/2/98 PAGE 1 OF I 1 _S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 INSPECTION SUMMARY: CHECKS B, C, OR D: A. SYSTEM PASSES: YES I HAVE NOT FOUND ANY INFORMATION,WHICH INDICATES THAT ANY OF THE FAILURE CONDITIONS DESCRIBED IN 310 CMR 15.303 EXIST. ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: N 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. INDICATE YES,NO,OR NOT DETERMINED(Y,N,OR ND). DESCRIBE BASIS OF DETERMINATION IN ALL INSTANCES. IF"NOT DETERMINED",EXPLAIN WHY NOT. N THE SEPTIC TANK IS METAL,UNLESS THE OWNER OR OPERATOR HAS PROVIDED THE SYSTEM INSPECTOR WITH A COPY OF A CERTIFICATE OF COMPLIANCE(ATTACHED)INDICATING THAT THE TANK WAS INSTALLED WITHIN TWENTY(20)YEARS PRIOR TO THE DATE OF THE INSPECTION;OR THE SEPTIC TANK,WHETHER OR NOT METAL,IS CRACKED, STRUCTURALLY UNSOUND, SHOWS SUBSTANTIAL INFILTRATION OR EXFILTRATION,OR TANK FAILURE IS IMMINENT. THE SYSTEM WILL PASS INSPECTION IF THE EXISTING SEPTIC TANK IS REPLACED WITH A COMPLYING SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH. N SEWAGE BACKUP OR BREAKOUT OR HIGH STATIC WATER LEVEL OBSERVED IN THE DISTRIBUTION BOX IS DUE TO BROKEN OR OBSTRUCTED PIPE(S)OR DUE TO A BROKEN,SETTLED OR UNEVEN DISTRIBUTION BOX. THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH). N BROKEN PIPE(S)ARE REPLACED N OBSTRUCTION IS REMOVED N DISTRIBUTION BOX IS LEVELED OR REPLACED N THE SYSTEM REQUIRED PUMPING MORE THAN FOUR TIMES A YEAR DUE TO BROKEN OR OBSTRUCTED PIPE(S). THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH): N BROKEN PIPE(S)ARE REPLACED N OBSTRUCTION IS REMOVED REVISED 9/2/98 PAGE 2 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N CONDITIONS EXIST WHICH REQUIRE FURTHER EVALUATION BY THE BOARD OF HEALTH IN ORDER TO DETERMINE IF THE SYSTEM IS FAILING TO PROTECT THE PUBLIC HEALTH, SAFETY AND 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: N/A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF SURFACE WATER N/A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A BORDERING VEGETATED WETLAND OR A SALT MARSH. 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 AND SAFETY AND THE ENVIRONMENT: N 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. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND THE SAS IS WITHIN A ZONE I OF PUBLIC WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND THE SAS IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND THE SAS IS LESS THAN 100 FEET BUT 50 FEET MORE FROM A PRIVATE WATER SUPPLY WELL, UNLESS A WELL WATER ANALYSIS FOR COLIFORM BACTERIA AND VOLATILE ORGANIC COMPOUNDS INDICATES THAT THE WELL IS FREE FROM POLLUTION FROM THAT FACILITY AND THE PRESENCE OF AMMONIA NITROGEN AND NITRATE NITROGEN IS EQUAL TO OR LESS THAN 5 PPM. METHOD USED TO DETERMINED DISTANCE (APPROXIMATION NOT VALID). 3) OTHER: N/A REVISED 9/2/98 PAGE 3 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 D. SYSTEM FAILS: YOU MUST INDICATE EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: N I HAVE DETERMINED THAT ONE OR MORE OF THE FOLLOWING FAILURE CONDITIONS EXIST AS DESCRIBED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS IDENTIFIED BELOW. THE BOARD OF HEALTH SHOULD BE CONTRACTED TO DETERMINE WHAT WILL BE NECESSARY TO CORRECT THE FAILURE. YES NO N BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N DISCHARGE OR PONDING OF EFFLUENT TO THE SURFACE OF THE GROUND OR SURFACE WATERS DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N STATIC LIQUID LEVEL IN THE DISTRIBUTION BOX ABOVE OUTLET INVERT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N/A LIQUID DEPTH IN CESSPOOL IS LESS THAN 6' BELOW INVERT OR AVAILABLE VOLUME IS LESS THAN 1/2 DAY FLOW. N REQUIRED PUMPING MORE THAN 4 TIMES IN THE LAST YEAR NOT DUE TO CLOGGED OR OBSTRUCTED PIPE(S). NUMBER OF TIMES PUMPED N ANY PORTION OF THE SOIL ABSORPTION SYSTEM,CESSPOOL OR PRIVY IS BELOW THE HIGH GROUNDWATER ELEVATION. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 100 FEET OF A SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER SUPPLY. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN A ZONE I OF A PUBLIC WELL. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N/A 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. IF THE WELL HAS BEEN ANALYZED TO BE ACCEPTABLE,ATTACH COPY OF WELL WATER ANALYSIS FOR COLIFORM BACTERIA,VOLATILE ORGANIC COMPOUNDS,AMMONIA NITROGEN AND NITRATE NITROGEN. LARGE SYSTEM FAILS: YOU MUST TES EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: THE FOLLO G CRITERIA APPLY TO LARGE SYSTEMS IN ADDITION TO THE CRITE BOVE: THE SYSTEM SERVES A ILITY WITH A DESIGN FLOW OF 10,000 GPD 0 ATER(LARGE SYSTEM) AND THE SYSTEM IS A SIGNIFICANT AT TO PUBLIC HEALTH AND SA AND THE ENVIRONMENT BECAUSE ONE OR MORE OF THE FOLLOW ONDITIONS EXIST: YES NO THE SYSTEM IS WITHIN 400 FEET O URFA G WATER SUPPLY THE SYSTEM IS WITHIN 200 OF A TRIBUTARY TO RFACE DRINKING WATER SUPPLY THE SYSTEM IS LOCA IN A NITROGEN SENSITIVE AREA RIM WELLHEAD PROTECTION AREA-IWPA)OR A MAP ZONE II OF A PUBLIC WATER SUPPLY WELL THE OWNER OR OP OR OF ANY SUCH SYSTEM SHALL UPGRADE THE SYSTEM IN ACCO CE WITH 310 CMR 15.304(2 ASE CONSULT THE LOCAL REGIONAL OFFICE OF THE DEPARTMENT FOR FURTH INFO ON. REVISED 9/2/98 PAGE 4 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 CHECK IF THE FOLLOWING HAVE BEEN DONE: YOU MUST INDICATE EITHER"YES"OR"NO"AS TO EACH OF THE FOLLOWING: YES NO Y PUMPING INFORMATION WAS PROVIDED BY THE OWNER, OCCUPANT, OR BOARD OF HEALTH. Y NONE ON THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE VOLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. Y AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED.NOTE IF THEY ARE NOT AVAILABLE WITH N/A. Y THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. Y THE SYSTEM DOES NOT RECEIVE NON-SANITARY OR INDUSTRIAL WASTE FLOW. Y THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. Y ALL SYSTEM COMPONENTS, EXCLUDING THE SOIL ABSORPTION SYSTEM HAVE BEEN LOCATED ON THE SITE. Y THE SEPTIC TANK MANHOLES WERE UNCOVERED, OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN DETERMINED BASED ON: Y EXISTING INFORMATION.FOR EXAMPLE,PLAN AT B.O.H. Y DETERMINED IN THE FIELD (IF ANY OF THE FAILURE CRITERIA RELATED TO PART C IS AT ISSUE,APPROXIMATION OF DISTANCE IS UNACCEPTABLE) [15.302(3)(b)] Y THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SUBSURFACE DISPOSAL SYSTEMS. REVISED 9/2/98 PAGE 5 OF 11 t ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 FLOW CONDITIONS RESIDENTIAL: DESIGN FLOW: 550 G.P.D./BEDROOM. NUMBER OF BEDROOMS(DESIGN): 5 NUMBER OF BEDROOMS(ACTUAL): 5 TOTAL DESIGN FLOW: 550 NUMBER OF CURRENT RESIDENTS:4 GARBAGE GRINDER(YES OR NO): YES LAUNDRY(SEPARATE SYSTEM)(YES OR NO):NO;IF YES, SEPARATE INSPECTION REQUIRED LAUNDRY SYSTEM INSPECTED(YES OR NO):N/A SEASONAL USE(YES OR NO):NO WATER METER READINGS,IF AVAILABLE(LAST TWO YEAR'S USAGE(GPD): 354.552 FOR TWO YRS USAGE SUMP PUMP(YES OR NO):NO LAST DATE OF OCCUPANCY: CURRENT UO MERCIALANDUSTRIAL: TYPE OF LISHMENT: DESIGN FLOW: D(BASED ON 15.203) BASIS OF DESIGN FLOW: GREASE TRAP PRESENT(YES OR N INDUSTRIAL WASTE HOLDING TANK PRESE S OR NO): NON-SANITARY WASTE DISCHARGED TO THE TITLE (YES OR NO): WATER METER READINGS,IF AVAILABLE: LAST DATE OF OCCUPANCY: OTHER(DESCRIBE LAST DA CCUPANCY: GENERAL INFORMATION PUMPING RECORDS AND SOURCE OF INFORMATION: SYSTEM PUMPED AS PART OF INSPECTION(YES OR NO):YES IF YES,VOLUME PUMPED: 1500 GALLONS REASON FOR PUMPING: INSPECTION OF TANK TYPE OF SYSTEM YES SEPTIC TANK/DISTRIBUTION BOX/SOIL ABSORPTION SYSTEM N SINGLE CESSPOOL N OVERFLOW CESSPOOL N PRIVY N SHARED SYSTEM(YES OR NO)(IF YES,ATTACH PREVIOUS INSPECTION RECORDS,IF ANY) N UA TECHNOLOGY ETC. ATTACH COPY OF UP TO DATE OPERATION AND MAINTENANCE CONTRACT TIGHT TANK COPY OF DEP APPROVAL OTHER:N/A APPROXIMATE AGE OF ALL COMPONENTS,DATE INSTALLED(IF KNOWN)AND SOURCE OF INFORMATION: INSTALLED 4/8/98,ASBUILT AND OWNER SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE(YES OR NO):NO REVISED 9/2/98 PAGE 6 OF 11 t ` SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 BUILDING SEWER: (LOCATE ON THE SITE PLAN) DEPTH BELOW GRADE: 5'3" MATERIAL OF CONSTRUCTION: CAST IRON YES 40 PVC OTHER(EXPLAIN) DISTANCE FROM PRIVATE WATER SUPPLY WELL OR SUCTION LINE:N/A DIAMETER:4" COMMENTS: (CONDITION OF JOINTS,VENTING,EVIDENCE OF LEAKAGE,ETC.) NO SIGNS OF LEAKAGE IN OR OUT SOILS ARE CLEAN AND DRY. SEPTIC TANK: YES (LOCATE ON SITE PLAN) DEPTH BELOW GRADE:4'6" MATERIAL OF CONSTRUCTIOMYESCONCRETE METAL FIBERGLASS POLYETHYLENE OTHER (EXPLAIN): IF TANK IS METAL,LIST AGE IS AGE CONFIRMED BY CERTIFICATE OF COMPLIANCE(YES/NO) DIMENSIONS: 101 X 5'W X 5'H OUTLET INVERT na 4'4"= 1500 GAL SLUDGE DEPTH: 18" DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET TEE OR BAFFLE: 20" SCUM THICKNESS:<4" DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE: 5" DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE: 11" HOW DIMENSIONS WERE DETERMINED: SLUDGE JUDGE,ROD,RULER COMMENTS: (RECOMMENDATION FOR PUMPING,CONDITION OF INLET AND OUTLET TEES OR BAFFLES,DEPTH OF LIQUID LEVEL IN RELATION TO OUTLET INVERT,STRUCTURAL INTEGRITY,EVIDENCE OF LEAKAGE,ETC.)THE TANK WAS PUMPED.THE INLET AND OUTLET TEE ARE INTACT NO SIGNS OF LEAKAGE IN OR OUT THE LIQUID LEVEL IS @ NORMAL HIGHT.THERE'S NO SIGNS OF FAILURE IN OR AROUND AREA SOILS ARE CLEAN AND DRY THERE'S A MIDDLE EXTENSION,METEL MANHOLE COVER @ 23"UNDER GRADE GREASE TRAP: NO ZL'6 TE ON SITE PLAN) DEPTH BELO E: MATERIAL OF CONST ON:-CONCRETE-METAL-FIBERGLASS POLYET E OTHER (EXPLAIN) DIMENSIONS: SCUM THICKNESS: DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET T E: DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF ET OR BAFFLE: DATE OF LAST PUMPING: COMMENTS: (RECOMMENDATIO PUMPING,CONDITION OF INLET AND OUTLET TEES OR BAFFLES, OF LIQUID LEVEL IN ON TO OUTLET INVERT,STRUCTURAL INTEGRITY,EVIDENCE OF LEAKAGE,ETC.) REVISED 9/2/98 PAGE 7 OF 11 L • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 GHT OR HOLDING TANK: (TANK MUST BE PUMPED PRIOR TO,OR AT TIME OF,IN TION) (LO ON SITE PLAN) DEPTH BELOW E: MATERIAL OF CONST R N: CONCRETE METAL FIBE ASS POLYETHYLENE OTHER (EXPLAIN) DIMENSIONS: CAPACITY: GALLONS DESIGN FLOW: GALLONS/DAY ALARM PRESENT: ALARM LEVEL: AL WORKING ORDER: YES DATE OF PREVIOUS P ING: COMMENTS: (CONDITIO INLET TEE, CONDITION OF ALARM AND FLOAT SWITCHES, ETC.) DISTRIBUTION BOX: YES (LOCATE ON SITE PLAN) DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: 0" DEPTH BELOW GRADE: 5' COMMENTS: (NOTE IF LEVEL AND DISTRIBUTION IS EQUAL,EVIDENCE OF SOLIDS CARRYOVER,EVIDENCE OF LEAKAGE INTO OR OUT OF BOX,ETC.) THERE'S EQUAL DISTRIBUTION AND THE BOX IS LEVEL NO SIGNS OF LEAKAGE IN OR AROUND AREA THERE IS ONE INLET AND TWO OUTLETS SCH 40 PVC CONSTRUCTION THE STONE AND SOILS ARE CLEAN AND DRY. PUMP CHAMBER: YES (LOCATE ON SITE PLAN) PUMPS IN WORKING ORDER(YES OR NO): YES ALARMS IN WORKING ORDER(YES OR NO): N/A COMMENTS: (NOTE CONDITIONS OF PUMP CHAMBER, CONDITION OF PUMPS AND APPURTENANCES,ETC.) THE PUMP CHAMBER IS SMALL WITH PUMP AND IT'S IN GOOD CONDITION.NO SIGNS OF LEAKS AND THE 11/2"PVC PIPE ALSO A CHECK VALVE ARE IN GOOD CONDITION AND WORKING.THE USE IS FOR LAUNDRY AND ONE SINK IN BASEMENT REVISED 9/2/98 PAGE 8 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 SOIL ABSORPTION SYSTEM(SAS): YES (LOCATE ON SITE PLAN,IF POSSIBLE;EXCAVATION NOT REQUIRED,LOCATION MAY BE APPROXIMATED BY NON-INTRUSIVE METHODS) IF NOT LOCATED,EXPLAIN: TYPE: LEACHING PITS,NUMBER: LEACHING CHAMBERS,NUMBER: LEACHING GALLERIES,NUMBER: LEACHING TRENCHES,NUMBER,LENGTH:TWO TREANCHES 24"W X 62'L LEACHING FIELDS,NUMBER,DIMENSIONS: OVERFLOW CESSPOOL,NUMBER: ALTERNATIVE SYSTEM: NAME OF TECHNOLOGY: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,DAMP SOIL,CONDITION OF VEGETATION,ETC.) NO SIGNS OF POOLING OR HIGH STATIC LEVEL IN OR AROUND LEACH LINES. SOILS AND STONE ARE CLEAN AND DRY.THERE'S A VENT IN S.A.S.THAT'S 24"ABOVE GRADE.THERE'S NO SIGNS OF WETLANDS VEGETATION IN OR NEAR SAS. SPOOL: NO (LOC ON SITE PLAN) NUMBER AND C GURATION: DEPTH-TOP OF LIQUID LET INVERT: DEPTH OF SOLID LAYER: DEPTH OF SCUM LAYER: DIMENSIONS OF CESSPOOL: MATERIALS OF CONSTRUCTION: INDICATION OF GROUNDWATER: INFLOW(CESSPOOL MUST BE PUMPED AS 0 PECTION) COMMENTS: (NOTE CONDITION OF SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,CONDITION OF ETATION,ETC.) • NO (LOCATE 0". N) MATERIALS OF CONSTRUCTION: ONS: DEPTH SOLIDS: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRA LURE,LEVEL OF PONDING,COND VEGETATION,ETC.) REVISED 9/2/98 PAGE 9 OF 1 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCE LANDMARKS OR BENCHMARKS LOCATE ALL WELLS WITHIN 100' (LOCATE WHERE PUBLIC WATER SUPPLY COMES INTO HOUSE) Zoning Vistrl c r: K-1 Residence 1 District AR 6 cy (Planned Residential Development) y Note: Property line data taken from a Definitive / W W Subdivision Plan Of "Jerod P/ace — Phase /V" By Thomas E. Neve Associates, Inc., doted September 1, 1995 and revised to March 12, 1996. °o �� N N Schedule of Inverts Invert ® Foundation = 128.88' o i i Septic Tonk /n = 128.09', Out = 127.87' z o D—Box In = 127.63', Out = 127.46' S O o� hyo i 'bTrench 1. In = 127.46', Out = 127.16' N a Trench 2 /n = 127.42', Out = 12714' y� q)� Ugn Schedule of Tie Distances AC = 18.4' AF = 72.3' W 3 BC = 75.3' BF = 16.9' o DC G 13 -j61-- �` AD = 31.8' AG = 43.1' \ 1 / BD = 76.3' BG = 78.3' � � �^ AE = 31.3' AH = 78.1' BE = 75.6' BH = 26.0' hereby certify that l have inspected the construction of this disposal system and that the construction has been r in accordance with the designer's intent and that the kp' materials used conform to the plan specifications 3 , and 310 CMR 15.0. r e,� p0CQ r 60' lThis 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 in substantial conformance with the design plans as prepared. All work was done within the construction limitations expected for o job of this type. 4� � e•' 4/8/98 esr n7a(J,inser Date 1'q.39839 A REVISED 9/2/98 PAGE]0 OF I I Y � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 125 SHERWOOD DRIVE OWNER:MURPHY DATE OF INSPECTION: 10 AUG 2000 NRCS REPORT NAME NO SOIL TYPE NO TYPICAL DEPTH TO GROUNDWATER NO USGS DATE WEBSITE VISITED OBSERVATION WELLS CHECKED GROUNDWATER DEPTH: SHALLOW MODERATE DEEP SITE EXAM SLOPE SURFACE WATER CHECK CELLAR SHALLOW WELLS ESTIMATED DEPTH TO GROUNDWATER 10'+APPROX FEET PLEASE INDICATE ALL THE METHODS USED TO DETERMINE HIGH GROUNDWATER ELEVATION: Y OBTAINED FROM DESIGN PLANS ON RECORD Y OBSERVED SITE(ABUTTING PROPERTY, OBSERVATION HOLE,BASEMENT SUMP, ETC.) Y DETERMINED FROM LOCAL CONDITIONS N CHECKED WITH LOCAL BOARD OF HEALTH N CHECKED FEMA MAPS Y CHECKED PUMPING RECORDS N CHECKED LOCAL EXCAVATORS,INSTALLERS Y USED USGS DATA DESCRIBE HOW YOU ESTABLISHED THE HIGH GROUNDWATER ELEVATION. (MUST BE COMPLETED) THERE'S NO SUMP PUMP AND BASEMENT IS DRY.WHILE DIGGING IN YARD THERE WAS NO SIGNS OF WETLAND VEGETATION IN OR AROUND SYSTEM.THERE'S NO ABBUTTING PROPERTY'S WELLS WITHIN 100'.NO SIGNS OF WATER ON PLANS REVISED 9/2/98 PAGE 11 OF I 1 �� s Vie.:' ,,,•• r+' r , ..,r r� T. T. +gip;: '�-'�' tr`•- _ -' x ,+r jaPA ' y •x't.'.^ TheBelmont Lot NtrvnGer 10 A i T_ With nearly 4,100 square feet of living space,The Belmont gives the feel of an elegant Eur(j)ean m19SE SCHOLZ DESIGN � 'D ALL RIGHTS RESERVED. 2 BEDROOM Z MASTER SUEfE vo.Ir-r ABG estate.Ideal for BEDROOM 4 Low. * � entertaining,The ro+al oa» IBEORDOMG BEDROOM 5 12-0•12.0 Belmont offers a LIASTER MTH,1 '�.1�. 4 L _J SECOND FLOOR VLA" front porch Senrice entrance«pith direct access to the kitchen,and a J unique dual staircase to the second-floor family room from both the kitchen and foyer.For quiet LIBRARYmnNwm MEAKfAST KROENm - W"'"e� times,The Belmont also offers a secluded PfARGAR PGE 9 first-floor library with a walk-through bar and AR. R LAM L LM four decidedly remarkable bedrooms.You'll 019.0 SCHOLZ DESIGN ALL RIGHTS RESERVED. FIRST FLOOR PLAN I I enjoy every square-foot of this elegantly 1 appointed home. t Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH HORTM 1 Oft+� ° •^•tiO e p I ! r� —\ / 1951— L DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE • Applicant � ! Sz�� ,.5'—� � .2 NAME ADDRESS TELEPHONE Site Location �� !-�er`-c�y� Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 2 r3 6. CHAIRMAN, BOARD OF HEALTH D.W.C. No. g • tee • } APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERI' J O DATE: --18— CURRENT INSTALLER'S LICENSE# LOCATION: �0 2" LICENSED INSTALLER: sLS' Sa r SIGNATURE: TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: k_ ` IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes ✓ No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date. j.2 t Town of North Andover NORTH OFFICE OF ��oy",to 1�O COMMUNITY DEVELOPMENT AND SERVICES to 30 School Street North Andover,Massachusetts 01845 �9Ssgc►+us�s�� WILLIAM J. SCOTT Director June 2, 1997 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot#10 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: _ If new plans satisfactorily addressing all the following issues are submitted to the Health Department by June 16, 1997, then approval for the plans should be given by June 23, 1997. 1. Insufficient leaching for 5 bedrooms. (3 10 CMR 15.002 & 15.203) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp C;id5c2t` r01'1()N 6M8-953u fIEAL M 688-954% PLANNINU 688-9535... " - NORT ` F Town of - 4 _ over 0 m No-,Sas * _ z dover, Mass. 19 q C OC HIGH EWICK �S pAq E D" `G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic Syste�� THIS CERTIFIES THAT. !! .�{K. �,,,/. � �� , BUILDING INSPECTOR .5...................... ........ ................... Foundation has permission to erect........ !� .. .. buildingsApi .s..�.�. .. .................... ough to be occupied as...........00 .... !'�...... ...... oo ...... .... ........... imney provided that the person accepting This permit shall in every rform to the t the application on file in Final this office, and to the provisions of the Codes and By-taws relating to tInspection, ratio and,Copstru ion of Buildings in the Town of North Andover. JAWO - P�jPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES S UNLESS CONS ON ELECTRICAL C C ............ .... ................ .................................... Service DING INSPECTOR Final Occupancy Permit Required to GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �, ' SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan _( DATE: �' l tr DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary SEPTIC PLAN SUBMITTALS LOCATION: ,�jf /0 NEW PLANS: YES $60.00/Plan (/ REVISED PLANS: YES $25.00/Plan DATE: �/ DESIGN ENGINEER: l 4W i. �r2 When the submission is all in place, route to the Health Secretary Form No. 4 Town of North Andover, Massachusetis BOARD OF HEALTH 19 `/ CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired ( ) by William Sa er INSTALLER at Lot 10 Sherwood Drive N Andover MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 938 August 6 97 dated 9 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH ENGINEER .vSic;i.;ir::Q!r'3-'- :,•,., .:..r.!, . „:;r�'k+^r!r:;< .•..: ,, . 'art ,.. ... ... �,<Y�z it;``'R,'}i�<Zt7M^ ..., ';�.., xsa. _.:.i i,} , ,.. ..r,1�7`f :.> �p.R. `M A' Form No. 4 Town of north Andover, i\'lassachusettS BOARD OF HEALTH CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired ( ) by William Sawyer INSTALLER at Lot 10 Sherwood Drive. N. Andover, MA 01845__ SITE LO AT16N has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 938 dated August 6 19 97 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. /AW V / � t�R F� E T11 ENGINEER tr t rya:r�' s di:2d _}-i.�'.:h:+r.'.1.. . ..?.r yy},r�.y�tCf{ ?{Kir�t7h'�S„a,:}S ,.., ,Y.i}.,i?,•.1S�aTr}, ,:1�i`,k�:}Qt?t4{CS,})K?:a .-+ ..h .,?..- .may,;', uj'{4}'}}73}? .>tCii.?..+. ?, .}.,..y ,2a,,h}. .. i t TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION --- The undersigned hereby certify that the Sewage Disposal System{ )constructed; { }repaired; by l ma looted at was installed in conformance with the North Andover Board of Health approval plan, System Design Permit# dated, 6 7 with an,approved design flow of 0 gallons per day. The materials used were in conformance with those specified on the approved ___-• Ply,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. Installer: Lic. #: Dater Design Engineer: �►�C a Date: to c)g Cy PLAN REVIEW CHECKLIST ADDRESS Z /'D �S/�C 'ux�Qb ENGINEER iU&VE GENERAL 3 COPIES ✓ STAMP LOCUS `f NORTH ARROW SCALE CONTOURS PROFILE ✓(Sc) SECTION v BENCHMARK &-' SOIL & PERCS ✓ ELEVATIONSIv WETS . DISCLAIMER Li WELLS & WETS WATERSHED?.Ya DRIVEWAY L/ WATER LINE &,--" FDN DRAIN 1✓ M&P �� SCH40 l""' TESTS CURRENT? dr- SOIL EVAL 5. D lop s0 SEPTIC TANK MIN 150OG . 17 INVERT DROP GARB. GRINDERA(2 comps +200 ) 10 ' TO FDN MANHOLE L,, --" ELEV (/ GW l/ # COMPS . I GB D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET/97, S9 - OUTLET 1,A7- _ `aO (2" OR . 17 FT) TEE REQ'D? IVQ LEACHING MIN 440 GPD? RESERVE AREAL,--" 4 ' FROM PRIMARY? ✓ 20 SLOPE --' 100 ' TO WETLANDS ` 100 ' TO WELLS Z-� 4 ' TO S .H.GW 5 ' >2M/IN 20 ' TO FND & INTRCPTR DRAINS L-�400 ' TO SURFACE H2O SUPP �--� 4 ' PERM. SOIL BELOW FACILITY i-� MIN 12" COVER FILL? ( 15 ' ) BREAKOUT MET? ✓� TRENCHES �� MIN 440 gpd SLOPE (min . 005 or 6"/100 ' ) L-"�^SIDEWALL DIST . 3X EFF. W OR D (MIN 61 L-- RESERVE BETWEEN TRENCHES? 4/" IN FILL? MUST BE 10 ' MIN. ✓ 4" PEA STONE? ENT? (>3 ' COVER; LINES >501 ) BOT o 6 + SIDE 400 =CO0� X LDNG174 = TOT (L x W x #) (DxLx2x#) 7-44 (G/ft2) �4? X96 .LLQ �� Copyright (D1996 by S.L. Starr �'� Town of North Andover a HORTIy , OFFICE OF 3�o.�"" , do0 COMMUNITY DEVELOPMENT AND SERVICES 30 School Street ` t WILLIAM J. SCOTT North Andover,Massachusetts 01845 �9Ssgc►+us�t�� Director August 7, 1997 Neve Associates 447 Old Boston Road Topsfield, MA 01983 RE: Lot 10 Sherwood Drive Dear Tom: This letter is to inform you that the proposed septic plans for Lot 10 Sherwood Drive have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator 10 cc: Wm. Scott, Dir. CD&S Bob Janusz File CONSF.RVATTTON 688-9530 HEALTH 688-9540 P..ANNINr 688-9535 THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors * Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-85868 DATE 9OB N 7 !b JO. 14.45 _1 O FAX (508) 887-3480 ATTENTION S a►�,d� ��- f TO RE: `J'At�1DY STaRR Lo-t' 10 - Shec„=ood� �oo►c'd o� N¢� 1-41-, 1>c-••lt iJoc' �L, Ar,dlc its MR WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ;K Prints O Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION Re ,4 1449-to SAa 1 TA R y 1> I S PaS L S TF— t 1>6S t(x N 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 REMARKS "DfiAV� VJe, C' i n r t.o". o-F yj2g rdEi yap r oval ek0.4-tot JV Z 19 72 -Rc +I,* a50%rt re'ge r.n eA tat P« r 1 e{-fie c ., S' bcalt-o e.ru . COPY TO mob jent J$$ RECYCLED PAPER: W Contents:40%Pre-Consumer•10%Post-Consumer SIGNED:---C M If enclosures are not as noted,kindly notify us at once. a� - fag 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: RprzsE_ , Phone �53� LOCATION: Assessor' s Map Number Parcel Subdivision 7 A PF_�) 1V Lots) Street _125 �� ar�rp St. Number 1 Z� ************************Official Use Only************************ RECO TIONS OF TOWN AGENTS: �.� � '� Date Approved Conse ation Administrator Date Rejected Comments Ll Date Approved Z Town Planner/ Date Rejected Comments Date Approved Food Inspector- ealth Date Rejected Date Approved g� ✓ Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Z Fire Department Received by Building Inspector Date June 2, 1997 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #10 Sherwood Road Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: If new plans satisfactorily addressing all the following issues are submitted to the Health Department by then approval for the plans should be given by 1. Insufficient leaching for 5 bedrooms. (3 10 CMR 15.002 & 15.203) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE FEE : PERMIT # DATE RECEIVED APPLICANT �-BOP J4A)U5Z MAP PARCEL ADDRESS LOT # Iy STREET # ENG. /VE V Cr STREET v" h�rX lt)60 eit ENGINEER' S ADD. PLAN DATE 41c3e /qz REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: Rao IV,5 FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: 5/4/97 Commonwealth of Massachusetts North Andover, Massachusetts Soil Suitabilitv Assessment for On-site Sewage Dicno al I 1 Performed By: Steve D'Urso Date: 4/19/95 Witnessed By: Sandra Starr Location Address or Sherwood Drive Owner's Name Timberland BuildersInc. _ Lot# 10 Address and 15 Clement Court,Haverhill,MA 01832 Telephone# (508)373-7539 New Construction X❑ Repair Office Review Published Soil Survey Available: No F-1 Yes V=400' Year Published 1981 Publication Scale 1,000' Soil Map Unit Hinkley/Windsor-Outwash Drainage Class Well Drained Soil Limitations None Surficial Geologic Report Available: No 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 Yes Within 100 year flood boundary No Yes Wetlands near Ipswich River 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 soileval.sam FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 10 Sherwood.Drive,No. Andover,MA- Timberland Builders,Inc. File# 1449 On -Site Review Deep Hole Number OP#14-1 Date 4/19/95 Time Weather Location(identify on site plan) Land-Use Woods Slope(%) Surface Stones Vegetation Woods Landform Esker- Position skerPosition on landscape(sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* OP#14-1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency,% Gravel) 0'1-32" Loamy Fill 32"-108" Cl gcs I Oyr 4/4 M Fri, SGL, St. Sands 108"-120" C2_ gsl 2.5y 5/4 M Fri 108" Weep *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Outwash Depth to Bedrock: None Depth to Groundwater: Standing Water in the Hole: None Weeping from Pit Face: 108" Estimated Seasonal High Ground Water: None DEP APPROVED FORM-17!07/95 soileval.sam FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 10 Sherwood Drive,No. Andover, MA- Timberland Builders, Inc. File# 1449 On - Site Review Deep Hole Number OP#14-2 Date 4/19/95 Time Weather Location(identify on site plan) Land Use Woods Slope(%) Surface Stones Vegetation Woods Landform Esker Position on landscape(sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* OP#14-2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency,% Gravel) 0"-10" Loamy Fill A+Bw Rem. 10"-84" Cl CCS IOyr 4/4 M Fri, SGL 84"-132" C2 GSL 2.5y 5/4 M Fri 109" Weep 84" Design *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Outwash Depth to Bedrock: None Depth to Groundwater: Standing Water in the Hole: None Weeping from Pit Face: 109" Estimated Seasonal High Ground Water: 84" DEP APPROVED FORM-12/07/95 soilevatsam FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Lot 10 Sherwood Drive,No.Andover, MA Timberland Builders, Inc. File#1449 On-Site Review Deep Hole Number OP#95-14 Date 1/19/95 Time Weather Location(identify on site plan) Land Use Woods Slope(%) Surface Stones Vegetation Woods Landform Esker Position on landscape(sketch on the back) Distances from: Open Water Body Feet Drainage Way Feet Possible Wet Area Feet Property Line Feet Drinking Water Well Feet Other DEEP OBSERVATION HOLE LOG* OP #95-14 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, %Gravel) 2" Trace/Top 84" C1 S +GRVL Varies 84"-112" C2 Grvly S Loam Boulders 84" Mottling 96" Ground Water *MIMMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Outwash Depth to Bedrock: None Depth to Groundwater: Standing Water in the Hole: 96" Weeping from Pit Face: None Estimated Seasonal High Ground Water: None DEP APPROVED FORM-12/07/95 SOILEVISAM FORM 12 - PERCOLATION TEST Location Address or Lot No. Lot 10 Sherwood Drive,No. Andover, MA Timberland Builders, Inc. COMMONWEALTH OF MASSACHUSETTS North Andover, Massachusetts Percolation Test* Date: 8/8/95 Time: Observation Hole#: Perc#95-23 Perc#95-24 Depth of Perc 60" 60" Start Pre-soak 3:14 PM 3:23 PM End Pre-soak WNHS WNHS Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch <2 min/inch <2 min/inch *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed F7 Performed By: Steven D'Urso Witnessed By: Sandra Starr, Health Agent Comments: DEP APPROVED FORM-12/07/95 soileval.sam FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Lot 10 Sherwood Drive,North Andover Determination for Seasonal High Water Table See soil logs attached Method Used: Depth observed standing in observation hole inches X� Depth weeping from side of observation hole inches Xa Depth to soil mottles inches aGround water adjustment N/A 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 occuring pervious material? Certification I certify that on \\/o1y (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 .r L( DEP APPROVED FORM-12/07/95 soileval sam ,1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION /2 (example: left front of house) D:,TE OF PUMPING: QUANTITY PUMPEDZgO GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY 013SERV0NS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHEIZ (EXPLAIN) SYSTEM PUMPED BY: C_'O..N1:11ENTS: ��g km '1z,� Uyt e1,e A W4r' Af CONTENTS TRANSFERRED T0: Commonwealth of Mas achuset RECEIVED - City/Town ofd JUN 19 2006 S stem Pumping umping Recarda �► Form 4 TOWN OF NORTH ANDOVER hw j HEALTH DEPARTMENT 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. A. Facility Information Important: When filiin9 Qut 1- System Location: formsonthe computer, r,use ✓ J Jw'U/V) �, only the tab key Addr _ to move your cutaor-do not use the return Cityil own key. State Zip Code --- 2. System caner: e Nana _-- '� -� Address(f different from location) CitylTown _ State ip Code Telephone Number S. Pumping Record 1. Date of Pumping " oate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No !f Yes,wat it deaned? ❑ Yes ❑ No 5. Condition of System: 8. Syst u p g _ �,� Ni'n 0 i l Vehide Licen Number company 7- Locatio wh re cont were disposed: 7) Signa re of Hauler l Date t5form4-doe 06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town ofk--E F® System Pumping Record Form 4 AUG 2 7 2007 DEP has provided this form for use by local Boards of Health. Otha)r� �ls ,obutt e information must be substantially the same as that provided here. k with your local Board of Health to determine the form they use. The System Pumping eco—`dr bmitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System tlOn: forms on the computer,use only the tab key Address �` C Q A j to move your ., C- cursor-do not CitylTown Stat Zip Code use the return key. 2. System Owner: Name Address(if different from location) CitylTown Stat ZiCode Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: �,� / , � SCS\ 4� 6. Syste Pumped Name Vehicle License Number Company 7. Locatio re contents di ed: Signat 1 Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1