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Miscellaneous - 140 ACADEMY ROAD 4/30/2018 (2)
/ 140 Academy Road 1 1 � I v I i i i E f I i I } of HORT � 6802 10- -+ 9 Town of North Andover ', HEALTH DEPARTMENT �sswCMus°` CHECK#: DATE: '51 lcth LOCATION: H/O NAME: S 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: S,s�: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5Inspector $ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts t T1 In � Title 5 Official 1 I c a spectlo , orris_, le Sewage Disposal System Form-Not for Voluntary Assessments MAY- Subsurface -1 9 9 P Y rY ZO14 TOWNF NORTH ANDOVER 140 AcademyRoad ,t _ Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 s City/Town 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 ❑ NpedS Further Evaluation by the Local Approving Authority ' on 5/13/2014 Inspectors Si nature 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 will perform in the future under the same or different conditions of use. I t5ins•3113 Title 5 Official Inspection Forth:Subsurface sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 every page. Cityfrown 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 3113 Title 5 official Inspection Forth.Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts 5 Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water i ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owners Name information is required for North Andover MA 01845 5/13/2014 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. ❑ 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 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 i El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system.Page 4 of 17 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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•3/13 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 every page. Cityrrown 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. ® ElDetermined 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): N/A Number of bedrooms(actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes 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? El 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road ,p Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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 three years ago, owner Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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 j ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I t5ins•3113 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 140 Academy Road Property Address Robert Stevens Owner Owner's Name I information is required for North Andover MA 01845 5/13/2014 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: 25 years old, 11/15/1989, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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"Cast iron through wall, 4"Cast iron in house no leaks visible Septic Tank(locate on site plan): Depth below grade: 2 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: 12'x6'x4' Sludge depth: 4" t5ins•3/13 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 Ai ,. 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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 29" Scum thickness 0" 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 15" 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.): Inlet tee ok. Outlet tee ok. Depth at outlet invert. No evidence of leakage. Inlet cover has riser to grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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.): I, *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i I I ' Commonwealth of Massachusetts : u"` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owners Name information is required for North Andover MA 01845 5/13/2014 every page. City/Town 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 level&distribution equal. No evidence of leakage. Evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 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 rY 140 Academy Road Property Address Robert Stevens Owner Owners Name information is required for North Andover MA 01845 5/13/2014 every page. CltyfTownState Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ eaching chambers number: ❑ eaching galleries number: ❑ eaching trenches number, length: ❑ 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.): Soil ok. Vegetation ok. No sign of ponding to surface.Camera inside of pits Pit#3 in failure.All pipes to pits has dip in lines holding water in pipes 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 140 Academy Road Property Address Robert Stevens Owner Owners Name information is required for North Andover MA 01845 5/13/2014 every page. Cityfrown 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•31 3 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 - i ° Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 every page. Cityrrown 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 i ❑ drawing attached separately ` O C - — —SCO I I I L/ 1 - aU g73 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form my Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 140 Academy Road Property Address Robert Stevens Owner Owner's Name information is required for North Andover MA 01845 5/13/2014 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 t5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 4/30/2014 1:33:41 PM by Karen Hanlon page 1 ' Town of North Andover Tax Map # 210-096.0-0033-0000.0 " Parcel Id 14077 140 ACADEMY ROAD STEVENS, ROBERT PO BOX 116 NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 2.85 Acres FY 2014 UB Mailinsa Index Name/Address Type Loan Number Active/Inact. From Until STEVENS,ROBERT Payor PO BOX 116 NORTH ANDOVER,MA 01845 UB Account Maint, Account No Cycle Occupant Name Active/Inactive Bldg Id. 18554.0-140 ACADEMY ROAD Last Billing Date 4/2/2014 31.80728 03 Cycle 03 Active UB Services Maint. Account No. 3180728 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 126.88 /1 UB Meter Maintenance Account No. 3180728 Serial No Status Location Brand Type Size YTD Cons 13242714 a Active 00 METE METE w Water 0.63 0.63 1040 Date Reading Code Consumption Posted Date Variance 3/31/2014 1867 m Manual estimate 30 4/11/2014 168% 12/18/2013 1837 aActual 10 1/17/2014 -88% 9/17/2013 1827 a Actual 81 10/15/2013 231% 6/17/2013 1746 a Actual 25 7/24/2013 -7% 3/15/2013 1721 a Actual 26 4/22/2013 -9% 12/14/2012 1695 aActual 27 1/9/2013 -72% 9/19/2012 1668 a Actual 106 10/15/2012 220% 6/15/2012 1562 a Actual 30 7/16/2012 9% 3/20/2012 1532 a Actual 29 4/14/2012 -29% 12/19/2011 1503 aActual 40 1/17/2012 -56% 9/20/2011 1463 a Actual 100 10/13/2011 142% 6/13/2011 1363 a Actual 38 7/20/2011 11% 3/14/2011 1325 a Actual 34 4/13/2011 -6% 12/14/2010 1291 aActual 36 1/12/2011 -64% 9/15/2010 1255 a Actual 106 10/15/2010 188% 6/11/2010 1149 aActual 33 7/15/2010 -8% 3/17/2010 1116 a Actual 38 4/14/2010 -4% 12/16/2009 1078 aActual 40 1/12/2010 0% 9/15/2009 1038 a Actual 40 10/15/2009 -7% 6/15/2009 998 a Actual 41 7/20/2009 23% 3/19/2009 957 a Actual 37 4/29/2009 3% 12/11/2008 920 aActual 32 1/20/2009 40% 9/15/2008 888 a Actual 25 10/10/2008 -34% 6/12/2008 863 a Actual 36 7/16/2008 15% 3/14/2008 827 a Actual 30 4111/2008 -23% 12/19/2007 797 aActual 42 1/22/2008 -70% 9/17/2007 755 a Actual 133 10/12/2007 340% 6/22/2007 622 a Actual 33 7/20/2007 28% 3/1912007 589 a Actual 26 4/16/2007 -16% I _ r & 413D �1PP�� CAti � (�AtEf� Sc�Pt'l7 �1 rbw,J D wEU- ,�PN�ouCD 1YJ FC-_---- 5tPTl G G I STF" pest 6 iPIT�0vP-J6 iuT,ol-�,Ty �►5,4PPr�v� DU 6 R�AsoNs = tia �vM� D �� SCPT'(C SYSTENt I�S�Al1,QT���1 eX4VAT(O,�1 )NSP6:6-roti 94 a 15s ❑ ►� 1V5PF�Tlon) Pi PE � t tvc 1�U TJ+J K Ll PA S5 `Q F74)L APPROVED AP)-ROWV\JG AUTHOI? y 4WITIOMAL. (AJ5Fbc.j j0"5 Clr A►-�Y) - - -- DISAppkovFID D,4T-C FIti,QL /JPPRQVAL DA�� �j 7�!� APP► (Nt�6 /v -��n = i lqo JOBG nk 1 Vo GILBERT REA �. 44 Rea St. SHEET NO. OF NO. ANDOVER, MA 01845 Phone 682-9864 CALCULATED BY DATE CHECKED BY DATE_ SCALE . ;.... ..... _..._ ...... .. .. .. ... ...... .... .... ..... ... x i .. ._..- - -._........ .. .............. _.......... . .. 1 ..... ' o , _, . ........ _ 77..k . yao 5;4 � - ..... k-/-f .... .. 3 - _ r x� C3 f a _1 .0 1 _ v { PF9AY.T 2C41 inti'%:�:%��a.f-r- .,.� r,..� ., � �::..••. , I 1 r 1 I 1^ � c� MERIDIAN ASSOCIATES JUL 19 2007 LETTER OF TRANSMITTAL T0N ALLTH N OF OE AR MDENTER TO: North Andover Board of Health DATE• July 17, 2007 1600 Osgood Street JOB NO: 4936 North Andover, Massachusetts 01845 RE: Academy Road North Andover, Massachusetts VIA: U.S. MAIL We are sending you the following items: Copies Date Description 1 Set 6/26/07 Form I 1 —Soil Suitability Assessment for On-site Sewage Disposal (TP-1 & TP-2) 1 6/26/07 Form 12—Percolation Test(TP-1 & TP-2 1 Set 6/26/07 Form 11 —Soil Suitability Assessment for On-site Sewage Disposal (TP-3 & TP-4) 1 6/26,107 Form 12—Percolation Test (TP-4 1 7/13/07 Sketch Plan Remarks: Copy To: Robert D. Stevens (1 Set) Signed: 'FZristOpFier.A. l�,yan (eezy) If enclosures are not as noted, kindly notify us at once. , 152 Conant Street Beverly,Massachusetts 01915 P:(978)299-0447 F:(978)299-0567 69 Milk Street,Suite 302 Westborough,Massachusetts 01581 P:(508)871-7030 F:(508)871-7039 200 Lake Drive East,Suite 204 Cherry Hill,New Jersey 08002 P:(856)414-1500 F:(856)414-1506 www.meridianassoc.com FENCE 30N PIN AT�� POSTS RECEIVED OF STONE O (TYP.) L 1.8' A.G. JUL 19 2007 )SE/LEANING) TOWN OF NORTH ANDOVER HEALTH DEPARTMENT to 0) N VACANT PARCEL NOW OR FORMERLY Q TRUSTEES OF THE RESER VA TIONS DEED BOOK 4778, PAGE o 260* j WF#A 7n cW 213.50'± MAEm N) AIL p2 TP4 � Q11� Q 100' O TP3Pi � g IL o. Q TP2 LOCUS 5 NASSESSOR'S MAP 96,I PiQ o D LOT 26 FENCE ` o I I Q POST TP1 (TYP.) WF#A 1 218.25'f NOW OR FORMERL Y ROBERT DALE STEVENS 135 ACADEMY ROAD NOW OR FORMERLY DA VID C. & KIMBERL Y W. PICKUL CERTIFICATE No. 13229 REGISTRATION BOOK 103, PAGE127* TP1"jj = APPROXIMATE TEST PIT LOCATION SKETCH PLAN P2 Q = APPROXIMATE PERC TEST LOCATION L OCA TED IN NORTH ANDOVER. MA NOTE. SCALE: 1"= 60' DA TE: JUL Y 13, 2007 THE SOLE PURPOSE OF THIS PLAN 30 0 30 60 120 IS TO DEPICT THE APPROXIMATE LOCATIONS OF SOIL TESTS PERFORMED JUNE 26, 2007 BY MERIDIAN ASSOCIATES, INC. E R I D I A N ASSOCIATES, INC. DWG No. 4936PP Copyrigbt 0 by Meridian Associates,Inc.All rigbts reserved. Commonwealth of Massachusetts Town of North Andover m Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal a DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Robert D. Stevens Owner Name Academy Road Map/Lot Map 96, Lot 26 Street Address North Andover MA 01845 Cityrrown State Zip Code B. Site Information 1. (Check one) New Construction ® Upgrade ❑ Repair ❑ 2. Published Soil Survey available? Yes ® No ❑ If yes: 1978 1:15,840 PaB, PbD Year Published Publication Scale Soil Map Unit Paxton Fine Sandy Loam Slope, slow permeability in substratum Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name eew\F:\-\4936\WORD\soils\t5form1 1-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G7 M I 6. Current Water Resource Conditions (USGS) May 2007 Range: Above Normal ® Normal ❑ Below Normal ❑ Month/Year 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TP-3 6/26/07 9:00 a.m. sunny 80% Date Time Weather 1. Location Ground Elevation at Surface of Hole Unknown Location (Identify on Plan ) See attached plan 2.Land Use: Vacant Lot 5-10 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded, Underbrush Ground Moraine See attached plan Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area 135± feet feet feet Property Line 22± Drinking Water Well Other feet feet 4. Parent Material: Fine Sandy Loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[] Fill Material❑ Impervious Layers)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit 122" Depth Standing Water in Hole 110" Estimated Depth to High Groundwater: 73" I inches elevation eew\F:\-\4936\WORDlsoils\t5form11-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 2 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal G^M Deep Observation Hole Number: TP-3 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-8 A 10 YR 4/3 Sandy Loam 8-33 B 10 YR 5/6 Sandy Loam 33-122 C 2.5 Y 6/3 . 73" Fine Sandy 10% Loam Additional Notes Standing Water at 110" Estimated Seasonal High Groundwater at 73" eew1F:\-\4936\woRD\soiis\t5formi 1-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M C. On-Site Review (Cont.) Deep Observation Hole Number: TP-4 6/26/07 9:00 a.m. Sunny 80° Date Time Weather 1. Location Ground Elevation at Surface of Hole Unknown Location (Identify on Plan ) See attached plan 2. Land Use: Vacant Lot 5-10% (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded, Underbrush Ground Moraine See attached Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area 135± feet feet feet Property Line 25'± Drinking Water Well Other feet feet 4. Parent Material: Fine Sandy Loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes Z No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole 62" Estimated Depth to High Groundwater: 38" inches elevation eew\F:\-\4936\WORD\soils\t5form1 1-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: TP-4 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other (In) Layer (Munsell) (USDA) (Moist) Depth Color Percent Gravel Cobbles &Stones 0-6 A 10 YR 3/3 Sandy Loam 6-28 B 10 YR 5/6 Sandy Loam 28- 108 C 2.5 Y 6/3 38" Fine Sandy 10% j Loam I i Additional Notes Standing Water at 62" Estimated Seasonal High Groundwater at 38" eew1F:X-\4936\WORD\soils\t5form11-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 5 of 7 a Commonwealth of Massachusetts Town of North Andover T Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal a �M D. Determination of High Groundwater Elevation TP-3 TP-4 1. Method used: ® Depth observed standing water in observation hole A. 110 B. 62 inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 73 B. 38 inches inches ElGroundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes® No❑ b. If yes, at what depth was it observed? Upper boundary: 33 Lower boundary: 122 inches inches F. Certification I certify that I havthe soil evaluator examination'approved by the Department of Environmental Protection and that the above an s a e7�rmedby a consistent with the required training, expertise and experience described in 310 CMR 15.017. Sign ture of Soil Eva u r Date Michael J. Julian Typed or Printed NabXSoil Evaluator 'Date of Soil Evaluator Exam Randy Burley North Andover Board of Health Name of Board of Health Witness Board of Health eew\F:\-\4936\WORD\soils\t5form11-TP3-4.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 6 of 7 ' Commonwealth of Massachusetts RECEIVEDTown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Di pose 19 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Robert D. Stevens Owner Name Academy Road Map/Lot Map 96, Lot 26 Street Address North Andover MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ® Upgrade ❑ Repair ❑ 2. Published Soil Survey available? Yes ® No ❑ If yes: 1978 1:15,840 PaB Year Published Publication Scale Soil Map Unit Paxton Fine Sandy Loam Slope, slow permeability in substratum Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name eew\F:\-\4936\WORD\soils\t5form11-TP14doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 7 Commonwealth of Massachusetts Town of North Andover } Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) May 2007 Range: Above Normal ® Normal ❑ Below Normal ❑ MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: TP-1 6/26/07 9:00 a.m. Sunny so° Date Time Weather 1. Location Ground Elevation at Surface of Hole Unknown Location (Identify on Plan ) See plan attached 2.Land Use: Vacant Lot 5-10 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded, Underbrush Ground Moraine See attached plan Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area 135± feet feet feet Property Line 26± Drinking Water Well Other feet feet 4. Parent Material: - Fine Sandy Loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil[—] Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole 126" Estimated Depth to High Groundwater: 69" inches elevation eew\F.\-\4936\WORD\soils\t5form11-TP1-2.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 2 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal �M Deep Observation Hole Number: TP-1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In.) Depth Color Percent Gravel Cobbles &Stones 0-6 A 10 YR 3/2 Sandy Loam 6-33 B 10 YR 5/6 Sandy Loam 33-132 C 2.5 Y 6/4 69" Fine Sandy <5% Roots to 69" Loam Additional Notes Standing Water at 126" Estimated Seasonal High Groundwater at 69" eew\F:\-\4936\WORD\soils\t5form11JP1-2.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal iG^M C. On-Site Review (Cont.) Deep Observation Hole Number: TP-2 6/26107 9:00 a.m. Sunny 80% Date Time Weather 1. Location Ground Elevation at Surface of Hole Unknown Location (Identify on Plan ) See attached plan 2. Land Use: Vacant Lot 5-10 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Wooded, Underbrush Ground Moraine See attached plan Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body Drainage Way Possible Wet Area 145± feet feet feet Property Line 15± Drinking Water Well Other feet feet 4. Parent Material: Fine Sandy Loam Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ® No ❑ If Yes: Depth Weeping from Pit Depth Standing Water in Hole 130" Estimated Depth to High Groundwater: 80" inches elevation eew\F:\-\4936\WORD\soils\t5form11-TP1-2.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 7 Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal c Deep Observation Hole Number: TP-2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 0-72 Fill -- Coarse 72—84 C, 2.5 Y 6/8 80" Loamy Sand 84- 132 C2 2.5 Y 7/6 Fine Sandy <10% Loam Additional Notes Standing Water at 130" Estimated Seasonal High Groundwater at 80" eew\F:\—\4936\WORD\soils\t5formll-TP1-2.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 5 of 7 • Commonwealth of Massachusetts Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation TP-1 TP-2 1. Method used: ® Depth observed standing water in observation hole A. 126 B. 130 inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 69 B. 80 inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes® No❑ b. If yes, at what depth was it observed? Upper boundary: 33 Lower boundary: 132 inches inches F. Certification I certify that I assed the soil evaluator examination"approved by the Department of Environmental Protection and that the above analysi w s perfor d by a consistent with the required training, expertise and experience described in 310 CMR 15.017. Signalure of Soil E aluat —'�' Date / /f if Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam Name of Board of Hea0th Witness Board of Health eew\F:\–\4936\WORD\soils\t5form11-TPI-2.doc DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 7 Commonwealth of Massachusetts RECEIVED Town of North Andover JUL 19 2007 Percolation Test Form 1)2 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT �M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. 'mP°'�"t` When filling out A. Site Information forms on the computer, use Robert D. Stevens only the tab key Owner Name to move your Academy Road cursor-do not use the return Street Address or Lot# key. North Andover MA 01845 City/Town State Zip Code Michael J. Juliano, Meridian Associates, Inc. 978-299-0447 Contact Person(if different from Owner) Telephone Number B. Test Results 6/26/07 11:40 a.m. 6/26/07 10:15 a.m. Date Time Date Time. Observation Hole# TP-1 TP-2 Depth of Perc 50"+ 18"=68" 84" + 18"= 102" Start Pre-Soak 11:43 a.m. End Pre-Soak 11:59 a.m. Time at 12" 11:59 a.m. Time at 9" 12:28 p.m. Time at 6" 1:00 P.M. Time (9"-6") 32 min. Rate (Min./Inch) 10.7 *See below Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Michael J. Juliano Test Performed By: Randy Burley for North Andover Board of Health Witnessed By: Comments: *Stopped-Abandoned due to large rock in hole. Stop test new perc at TP-1 F:\—\4936\WORD\soils\t5forml2-TPl-2.doc t5form12.doc•06/03 Perc Test•Page 1 of 1 Commonwealth of Massachusetts Town .of North Andover w Percolation Test Form 12 �G 1 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with, the local Board of Health to determine the form they use. Important: When filling out A. Site Information forms on the computer, use Robert D. Stevens only the tab key Owner Name to move your Academy Road cursor-do not use the return Street Address or Lot# key. North Andover MA 01845 City/Town State Zip Code Michael J. Juliano, Meridian Associates, Inc. 978-299-0447 Contact Person(if different from Owner) Telephone Number B. Test Results 6/26/07 10:50 a.m. Date Time Date Time Observation Hole# TP-4 Depth of Perc 36" + 16"= 52" Start Pre-Soak 10:52 a.m. End Pre-Soak 11:07 a.m. Time at 12" 11:07 a.m. Time at 9" 11:19 P.M. Time at 6" 11:33 p.m. Time (9"-6") 14 min. Rate (Min./Inch) 4.7 Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Michael J. Juliano Test Performed By: Randy Burley for North Andover Board of Health Witnessed By: Comments: F:\—\4936\WORD\soils\t5form 12-TP4.doc t5form12.docc 06/03 Perc Test•Page 1 of 1 Ndrth Andover Health Department °f NOH DTqti 1600 Osgood Street ° Letter of Transmittal 3� g ° ° Building 20, Suite 2-36 North Andover, MA 01845 ey 978.688.9540 - Phone I cocA '-.• 'kArea 60 978.688.8476 — Fax Page l of �9Ssgc►+u5���� healthdept(dtownofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: DANIEL OTTENHEIMER DATE: COMPANY:MILL RIVER CONSULTING FROM: Pamela DelleC iaiiee,,Health Department Assistant Re: Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We are sending you. Test Application O Plans for Review O Other These are transmitted as checked below: ❑As Required 0A Requested REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY T0: t� Z��:' FaxOr # G Mailed COPY TO: Fax# Or Mailed i TOWN OF NORTH ANDOVER roRrH. Gf ,�i° e 1a0 Office of COMMUNITY DEVELOPMENT AND SERVICES a�'`: '• �� HEALTH DEPARTMENT ; 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ,_; ,,•'g# NORTH ANDOVER,MASSACHUSETTS 01845 Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health.Director 978.688.8476—FAX Ih calth d ent@town ofn orth an d over.c om www.town ofnorthan lover.com APPLICATION FOR SOIL TESTS DATE: May 25, 2007 MAP&PARCEL: Map 96, Lot 26 LOCATION OF SOIL TESTS: Within 60' of road OWNER: Robert D. Stevens Contact#: 978-683-7377 APPLICANT: Same Contact#: ADDRESS: 140 Academy Road, North Andover, MA 01845 v , %Cc ENGINEER: Meridian Associates. Inc. tact#: 978-299-0447��V':/ CERTIFIED SOIL EVALUATOR: Michael J. Juliano, P.E. all'eJX Intended Use of Land: Residential SubdivisionCommercial Sin le Famil Home g y �/a�yhfQ� Is This: Repair Testing: Undeveloped Lot Testing: X Upgrade for Addition: In the Lake Cochichewick Watershed?. Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.511x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of3S 60.00 per lot for repairs or uasrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all.tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted: Please Do Not Write Below This Line N.A. Conservation Commission Approval Date:—A)m 12M7 .Signature of Conservation Agent: Date back to Health Department: (stamp in): X11 / 61��ja' 111A PIN A T-1FENCE POSTS STONE ' (TYP.) A.G. _EANING) b N VACANT PARCEL o z NOW OR FORMERLY ►-� Q TRUSTEES OF THE RESERVATIONS eL DEED BOOK 4778, PAGE o 260* j c ao WF#A 7213.50'-+ Q t m Tp MAN 2 Q I pTR m W x m' q a n TP N3 'kill LOCUS o z ASSESSOR'S MAP 96, ►� FENCE of LOT 26 O POST (TYP.) 1 I WF#A 1 218.25'f d OW OR FORMERLY ?ERT DALE STEVENS 135 ACADEMY ROAD NOW OR FORMERLY DA WD C. & KIMBERL Y W. PICKUL CERTIFICATE No. 13229 REGISTRA RON BOOK 103, PAGE127* TP = APPROXIMATE TEST LOCATION SKETCH PLAN LOCATED IN NOTE NORTH ANDOVER, MA THE SOLE PURPOSE OF THIS PLAN SCALE.•- 1"= 60' DATE.• MA Y 24, 2007 IS TO ACCOMPANY AN APPLICATION 30 0 30 60 120 FOR SOIL TES 77NG WITH THE NORTH ANDOVER BOARD OF HEALTH M E R I D I A N ASSOCIATES, INC. DWG No. 4936PP Coovrieht©by Meridien Associates,Inc.All rights reserved i y ' May 25, 2007 North Andover Board of Health 1600 Osgood Street, Building 20 Suite 2-36 North Andover, MA 01845 Re: Assessor's Map 96, Lot 26—Academy Road Dear Sir/Madam: As owner of the parcel of land on Academy Road depicted as Lot 26 on North Andover Assessor's Map 96, I hereby give permission to Meridian Associates, Inc. to schedule and perform exploratory soil tests on the property, to be witnessed by the North Andover Health Agent. Sincerely, Robert D. Stevens 140 Academy Road North Andover, MA 01845 NORT1t v ' o�...a; �tie • Town of North Andover HEALTH DEPARTMENT �ss�cHus°s CHECK#: /! DATE: 5�/d l`y LOCATION: pxi ,X H/O NAME: 'o�t/�,r,� -s ' '1S 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: _ ® S�tic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ 2441 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer R . TRANSMISSION VERIFICATION REPORT TIME 05/2912007 15:47 NAME HEALTH FAX 9796688476 TEL 9786888476 SER. # 000B4J120960 DATE,TIME 05129 15: 46 FAX NO./NAMF 819782820012 DURATION! 00: 01: 03 PAGE(S) 04 RESULT Olt MODE STANDARD EGM North Andover Health Department ,�4 aO RT. 1600 Osgood Street tetter of Transmittal Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone Pae of ' .� �R4r�e•�°`�.t 978.688.8476— Fax S��MCHU healthdept@townofnorth_aAdpver.com-E-mail w w of orthandover.com-Website TO: DANIEL OTTENHEIMER DATE: COMPANY:MILL RIVER CONSULTING FROM: Pamela DelleCfiiaie,Ilealth Department Assistant Re: Phone: 1.000.377.3044 or 978.282.0014 Fax: 478.282.0012 We are sending you. 'o%l Test App/icatian G Plans for Review 0 Other These are transmitted as checked below: CTAS Required 0A Requested REMARKS: COPYTO: Homeowner Fox# Or 4 . r North Andover Health Department NORTFM o0�t,eo -6gti 1600 Osgood Street Letter of Transmittal O? �e:1- Y 1^ 'a o� L Building 20, Suite 2-36 ' North Andover, MA 01845 ;� a 978.688.9540 - Phone Page l of ,T.o q cocwc.uwu. '�• PP 5 978.688.8476 — Fax SSArmUS� healthdept(cDtownofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: DANIEL OTTENHEIMER DATE: I O� COMPANY:MILL RIVER CONSULTING FROM: Pamela DelleCfiiaie,Health Department Assistant Re: �y Phone: 1.800.377.3044 or 918.282.0014 �%'//J� / ,•C 07_��4 11 Fax: 978.282.0012 We are sending you: oil Test Application O Plans for Review O Other These are transmitted as checked below: 0 A Required DAs Requested REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY T0: q J Fax# C� `--- Or Mailed COPY TO: Fax# Or Mailed f TOWN OF NORTH ANDOVER N°eTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 '° �- NORTH ANDOVER,MASSACHUSETTS 01845 �ss '°•�`� ticHus Susan Y.Sawyer,REHS,RS 978.688.9540—Phone Public Health.Director 978.688.8476—FAX healthd eptQtownofnorthand over.com www.townofnoithaiidover.com APPLICATION FOR SOIL TESTS DATE: May 25, 2007 MAP&PARCEL: Map 96, Lot 26 LOCATION OF SOIL TESTS: Within 60' of road OWNER: Robert D. Stevens Contact#: 978-683-7377 APPLICANT: Same Contact#: ADDRESS: 140 Academy Road, North Andover, MA 01845 ENGINEER: Meridian Associates, Inc. Cgetact#: 978-299-0447,E O� CERTIFIED SOIL EVALUATOR: Michael J. Juliano, P.E. 57,7; �� Intended Use of Land: Residential Subdivision '��� Single Family Home Commercial .Biau�hf"�� Is This: Repair Testing: Undeveloped Lot Testing: X Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test pit sites on the plan ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: I Signature of Conservation Agent. Date back to Health Department: (stamp in): PIN A T-1I v FENCE POSTS STONE (TYP.) ' A.G. _EANING) N VACANT PARCEL Zd NOW OR FORMERLY ►"� Q TRUSTEES OF THE RESERVATIONS DEED BOOK 4778, PAGE o 260* .� a C � WF#A7 213.50'1TP u' l MAE m D Q W O x Om' o o � mI �' � o m T rn� LOCUS o Z' ASSESSOR'S MAP 96, FENCE o' LOT 26 O POST (TYP.) I I WF#A 1 218.25'1 OW OR FORMERLY ?ERT DALE STEVENS 135 ACADEMY ROAD NOW OR FORMERLY DA WD C. & KIMBERLY W. PICKUL CERTIFICATE No. 13229 REGISTRATION BOOK 103, PAGE127* 1p APPROXIMATE TEST LOCATION SKETCH PLAN L 0C TED IN NORTH ANDOVER, MA NOTE.- THE SOLE PURPOSE OF THIS PLAN SCALE.' 7"= 60' DATE.• MAY 24, 2007 IS TO ACCOMPANY AN APPLICATION 30 0 30 60 120 FOR SOIL TES TING WITH THE NORTH ANDOVER BOARD OF HEALTH M E R I D I A N ASSOCIATES, INC. DWG No. 4936PP Copyright©by Meridian Associates,Inc.All rights reseryed. May 25, 2007 North Andover Board of Health 1600 Osgood Street, Building 20 Suite 2-36 North Andover, MA 01845 Re: Assessor's Map 96, Lot 26—Academy Road Dear Sir/Madam: As owner of the parcel of land on Academy Road depicted as Lot 26 on North Andover Assessor's Map 96, I hereby give permission to Meridian Associates, Inc. to schedule and perform exploratory soil tests on the property, to be witnessed by the North Andover Health Agent. Sincerely, Robert D. Stevens 140 Academy Road North Andover, MA 01845 Addressp,0 Title of File Page of Date File Open: Date File closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes: action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department Gr